Search

The acute and long-lasting side effects of modern multimodal tumour therapy significantly impair quality of life and survival of patients afflicted with malignancies. The key components of this therapy include radiotherapy, conventional chemotherapy, immunotherapy and targeted therapies. In addition to established tumour therapy strategies, up to 30 new therapies are approved each year with only incompletely characterised side effects. This consensus paper discusses the risk factors that contribute to the development of a potentially adverse reaction to tumour therapy and, in addition, defines specific side effect profiles for different treatment groups. The focus is on novel therapeutics and recommendations for the surveillance and treatment of specific patient groups.

In this White Paper, we discuss the current state of microbial cancer therapy. This paper resulted from a meeting (‘Microbial Based Cancer Therapy’) at the US National Cancer Institute in the summer of 2017. Here, we define ‘Microbial Therapy’ to include both oncolytic viral therapy and bacterial anticancer therapy. Both of these fields exploit tumor-specific infectious microbes to treat cancer, have similar mechanisms of action, and are facing similar challenges to commercialization. We designed this paper to nucleate this growing field of microbial therapeutics and increase interactions between researchers in it and related fields. The authors of this paper include many primary researchers in this field. In this paper, we discuss the potential, status and opportunities for microbial therapy as well as strategies attempted to date and important questions that need to be addressed. The main areas that we think will have the greatest impact are immune stimulation, control of efficacy, control of delivery, and safety. There is much excitement about the potential of this field to treat currently intractable cancer. Much of the potential exists because these therapies utilize unique mechanisms of action, difficult to achieve with other biological or small molecule drugs. By better understanding and controlling these mechanisms, we will create new therapies that will become integral components of cancer care.

This Good Practice Paper was compiled according to the British Society for Haematology (BSH) process at http://www.b-s-h.org.uk/guidelines. The BSH produces Good Practice Papers to recommend good practice in areas where there is a limited evidence base but for which a degree of consensus or uniformity is likely to be beneficial to patient care. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org and is also detailed in Table 1.

PURPOSE OF REVIEW: The treatment landscape for older patients with acute myeloid leukemia (AML) is evolving. Many treatments have comparable efficacy making their impact on quality of life (QoL) an important differentiating factor. In this review, we discuss QoL in older adults with AML, focusing on therapeutic and observational trials that have incorporated QoL assessments. FINDINGS: Health-related quality of life (HRQoL) is a multi-dimensional concept incorporating physical, mental, emotional, and social functioning domains. HRQoL components overlap with components of geriatric assessment, a multidisciplinary diagnostic process that identifies underlying vulnerabilities of older adults and guides subsequent management strategies. HRQoL questionnaires may be general, cancer-specific, leukemia-specific, or symptom-focused. Therapeutic and observational cohort studies suggest HRQoL improves, or at least remains stable, during intensive and lower intensity therapies. Nonetheless, HRQoL is not routinely incorporated in AML therapeutic trials. SUMMARY: HRQoL assessments can inform both decision-making and management for older adults with AML.

Various epidemiological and biological evaluations and the recent publication of the DSM-V (diagnostic and statistical manual of mental disorders) has imposed on the scientific community a period of reflection on the diagnosis and treatment of what in the DSM-IV was defined as "addiction". To date, the term "addiction" has been replaced by the DSM-5, because there is no global scientific consensus that has unequivocally characterized its clinical characteristics. This, we will talk about substance/alcohol use disorders (SUDs/AUDs) and disorders related to behavioral alterations (DBA) that can generate organic diseases, mental disorders, and social problems. In the first psychotic episode 40-70% of subjects meet the criteria of a SUDs/AUDs, excluding tobacco dependence. Substances can not only be the cause of a psychotic onset, but they can also disrupt a psychotic picture or interfere with drug therapy. The pharmacodynamic profiles of many substances are able to provoke the phenomenology of the main psychotic symptoms in a way that can be superimposed onto those presented by psychotic subjects without a history of SUDs/AUDs. The Department of Addictions (DAs) must not be absorbed by or incorporated into the Departments of Mental Health (DMH), with which, however, precise operational cooperation protocols will have to be defined and maintained, but it will have to maintain its own autonomy and independent connotation. Addiction Medicine is a discipline that brings together elements of public health, prevention, internal medicine, clinical pharmacology, neurology, and even psychiatry. The inclusion of the DAs in those of DMH refers purely to a problem of pathology that has to do with lifestyle, choices, and behaviors. These, over time, show their dysfunctionality and only then do related problems emerge. Moreover, epidemiological, social, and clinical motivations impose the creation of alcohological teams dedicated to alcohol-related activities. The collaboration with self-help-groups (SHGs) is mandatory. The action of SHGs is accredited in numerous international recommendations both on the basis of consensus and evidence in the literature.

Inflammation, structural, and functional abnormalities within the airways are key features of asthma. Although these processes are well documented, their expression varies across the heterogeneous spectrum of asthma. Type 2 inflammatory responses are characterized by increased levels of eosinophils, FeNO, and type 2 cytokines in blood and/or airways. Presently, type 2 asthma is the best-defined endotype, typically found in patients with allergic asthma, but surprisingly also in nonallergic patients with (severe) asthma. The etiology of asthma with non-type 2 inflammation is less clear. During the past decade, targeted therapies, including biologicals and small molecules, have been increasingly integrated into treatment strategies of severe asthma. These treatments block specific inflammatory pathways or single mediators. Single or composite biomarkers help to identify patients who will benefit from these treatments. So far, only a few inflammatory biomarkers have been validated for clinical application. The European Academy of Allergy & Clinical Immunology Task Force on Biomarkers in Asthma was initiated to review different biomarker sampling methods and to investigate clinical applicability of new and existing inflammatory biomarkers (point-of-care) to support diagnosis, targeted treatment, and monitoring of severe asthma. Subsequently, we discuss existing and novel targeted therapies for asthma as well as applicable biomarkers.

The therapy of advanced (clear-cell) renal cell carcinoma (RCC) has recently experienced tremendous changes. Several new treatments have been developed, with PD-1 immune-checkpoint inhibition being the backbone of therapy. Diverse immunotherapy combinations change current first-line standards. These changes also require new approaches in subsequent lines of therapy. In an expert panel, we discussed the new treatment options and how they change clinical practice. While first-line immunotherapies introduce a new level of response rates, data on second-line therapies remains poor. This scenario poses a challenge for clinicians as guideline recommendations are based on historical patient cohorts and agents may lack the appropriate label for their in guidelines recommended use. Here, we summarize relevant clinical data and consider appropriate treatment strategies.

This position paper addresses the role of supra- and subgingival irrigation in the treatment of periodontal diseases. It was prepared by the Committee on Research, Science and Therapy of the American Academy of Periodontology. The document is divided into two portions, consisting of supragingival irrigation and subgingival irrigation. In their respective segments, these treatment techniques are assessed as monotherapies and as adjuncts to conventional treatment. The conclusions drawn in this paper represent the position of the American Academy of Periodontology regarding irrigation therapy in the treatment of periodontal diseases.

Prophylaxis against influenza is difficult, and current approaches against pandemics may be ineffective because of shortages of the two proven classes of antivirals in the face of a large-scale infection. Herbal/natural products may represent an effective alternative to conventional attempts to protect against infection by avian influenza virus. QR-435, an all-natural compound of green tea extract and other agents, has been developed to provide protection against a wide range of viral infections. The antiviral activities of several QR-435 preparations as well as QR-435 (1) green tea extract were tested against A/Sydney/5/97 and A/Panama-Resvir 17 strains of avian influenza virus H3N2 by means of an assay based on Madin-Darby canine kidney cells. Toxic effects of QR-435 formulations on these cells were also evaluated as were the virucidal properties of a commercially available mask impregnated with QR-435. The efficacy of a QR-435/mask combination was compared with that of the QR control/mask combination, an untreated mask, and no mask. QR-435 had significant in vitro activity against H3N2 at concentrations that were not associated with significant cellular toxic effects. The antiviral activity of QR-435 (1) was similar to that of QR-435. Masks impregnated with QR-435 were highly effective in blocking the passage of live H3N2 virus. These preclinical results warrant further evaluation of the prophylactic use of QR-435 against viral infection in humans.

The International Society of Paediatric Oncology-Renal Tumour Study Group (SIOP-RTSG) has developed a new protocol for the diagnosis, treatment, and follow-up monitoring of childhood renal tumours - the UMBRELLA SIOP-RTSG 2016 protocol (the UMBRELLA protocol). This protocol has been designed to continue international collaboration in the treatment of childhood renal tumours and will be implemented in over 50 different countries. Clear cell sarcoma of the kidney, which is a rare paediatric renal tumour that most commonly occurs in children between 2 and 4 years of age, is specifically addressed in the UMBRELLA protocol.

The International Society of Paediatric Oncology-Renal Tumour Study Group (SIOP-RTSG) has developed a new protocol for the diagnosis, treatment, and follow-up monitoring of childhood renal tumours - the UMBRELLA SIOP-RTSG 2016 protocol (the UMBRELLA protocol). This protocol has been designed to continue international collaboration in the treatment of childhood renal tumours and will be implemented in over 50 different countries. Clear cell sarcoma of the kidney, which is a rare paediatric renal tumour that most commonly occurs in children between 2 and 4 years of age, is specifically addressed in the UMBRELLA protocol.

Despite many positive developments, postoperative pain and its treatment is still not always given the necessary attention. Severe pain after surgical procedures affects a significant proportion of patients. This very fact is not only detrimental to the immediate recovery process, but can also form the basis for the development of chronic pain conditions.An adequate and effective management of perioperative pain requires appropriate organizational structures. This multidisciplinary paper which was initiated by the Austrian Society for Anaesthesiology and Intensive Care and the Austrian Pain Society and developed together with numerous specialist and professional societies dealing with the subject aims at supporting the organization of perioperative pain management structures and to make best use of proven concepts. Additional recommendations describe specific interventions for selected types of intervention.

Sterilizing the pre-cancer skin of malignant melanoma (M.M.) with 70% Isopropyl alcohol intensified malignancy &the malignant response extended to surrounding normallooking skin, whilesterilizing with 80% (vodka) or 12% (plum wine) ethyl alcohol completely inhibited M.M. in the area (both effects lasted for about 90 minutes initially). Burnt food (bread, vegetables, meat, and fish), a variety of smoked & non-smokedfish-skin, many animal's skin, pepper, Vitamin C over 75 mg, mango, pineapple, coconut, almond, sugars, Saccharine & Aspartame, garlic, onion, etc& Electromagnetic field from cellular phones worsened M.M.& induced abnormal M.M. response of surrounding skin. We found the followingfactors inhibit early stage of M.M. significantly: 1) Increasing normal cell telomere, by taking 500mg Haritaki, often reached between 400-1150 ng& gradually diminished, but the M.M. response was completely inhibited until normal cell telomeres are reduced to 150 ng, which takes 6-8 hours. More than 70 mg Vitamin C, Orange Juice, &other high Vitamin C containing substances shouldn't be taken because they completely inhibit the effects of Haritaki. 2)We found Chrysotile asbestos &Tremolite asbestos (¼ of the Chrysotile amount) coexist. A special Cilantro tablet was used to remove asbestos & some toxic metals. 3) Vitamin D3 400 I.U. has a maximum inhibiting effect on M.M. but 800 I.U. or higher promotes malignancy. 4) Noricontaining Iodine, etc., was used. 5) EPA 180 mm with DHA 120 mg was most effectively used after metastasis to the surrounding skin was eliminated. When we combined 1 Cilantro tablet & Vitamin D3 400 I.U. withsmall Nori pieces& EPA with DHA, the effect of complete inhibition of M.M. lasted 9-11 hours. When these anti-M.M. substances (Haritaki, Vitamin D3, Cilantro, Nori, EPA with DHA) were taken together, the effect lasted 12-14 hoursand M.M. involvement in surrounding normal-looking skin disappeared rapidly&original dark brown or black areassatisfying "ABCD" of M.M. completely fell off. Both oral & frequent external application of mixed solution of plum wine & the same combination of anti-M.M. substances can be used as very effective treatment by taking 2-3 times daily. Additional application of special (+) Solar Energy Stored Paper reduced asbestos &accelerated reduction of M.M. positive area rapidly. This methodwith individualized optimal doses has also been successfully applied to treatseveral other types of malignancies.

Objectives In this paper, we present a review of critical concepts and research perspectives and produce recommendations on the optimal use of pixantrone in non-Hodgkin lymphoma (NHL) by group discussion from an expert panel appointed by the Italian Society of Hematology and the affiliate societies, Societa Italiana di Ematologia Sperimentale and Gruppo Italiano Trapianto di Midollo Osseo. Methods Recommendations were produced using the Delphi process. Scientific evidence on pixantrone efficacy was analyzed using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology in the areas where at least one randomized trial was published. The following key issues were addressed for practical recommendations: pixantrone monotherapy in aggressive relapsed or refractory non-Hodgkin B-cell lymphomas and toxicity risk management in patients candidates to pixantrone. Results and conclusions After a balanced and value-oriented discussion, the panel agreed that the benefit/risk profile was in favor of pixantrone in the treatment of adult patients with multiply relapsed or refractory aggressive NHL B-cell lymphomas. Pixantrone was deemed to be contraindicated in patients with uncontrolled cardiovascular disease. Despite a low rate of cardiotoxicity of pixantrone reported in clinical trials, the panel recommended that all patients receiving pixantrone should undergo periodical cardiac monitoring.

Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and AdultsSwallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.Schluckstörungen sind häufig. Sie können zu erhöhter Mortalität durch aspirationsbedingte Lungenkomplikationen und Mangelernährung einerseits sowie einer erheblichen Beeinträchtigung der Lebensqualität andererseits führen. Die demografische Entwicklung in Deutschland lässt einen kontinuierlichen Anstieg der Dysphagie in den kommenden Jahren erwarten. Schwerpunkte sind dabei neurodegenerative Erkrankungen, die Tumoren im Verlauf der Schluckstraße und die Folgen der Tumorbehandlung im oberen Aerodigestivtrakt.Vorrangig sind die Ärzte aus dem HNO-Bereich und der Phoniatrie als kompetente Fachgruppen zentrale Ansprechpartner für die Diagnostik und Therapieplanung der Dysphagie.Die meist komplexen Störungen verlangen eine differenzierte Anamnese, Diagnostik und eine symptomorientierte Behandlung.Das Einbeziehen auch von nicht-ärztlichen Fachgruppen wie Logopäden, Physiotherapeuten und Ergotherapeuten in die Planung einer effizienten Therapie erweitert und komplettiert die kompetente patientenzentrierte Betreuung. Die konservative Dysphagietherapie durch Logopäden und ähnliche Fachgruppen ist, auch längerfristig, ein wichtiges Standbein der Behandlung. Zudem können Anteile der spezifischen Diagnostik in enger Kooperation übernommen werden.Eine interdisziplinäre Zusammenarbeit insbesondere mit den intensivmedizinischen neurologischen und internistischen Fachgruppen ist erforderlich.Die in diesem Positionspapier beschriebenen Verfahren der speziellen Endoskopie gehören zu den originären ärztlichen Leistungen, vornehmlich der Fachärzte für Hals-, Nasen-, und Ohrenheilkunde bzw. für Sprach-, Stimm- und kindliche Hörstörungen (Phoniatrie und Pädaudiologie).Die Endoskopie ist eine ärztliche Leistung, die grundsätzlich nicht delegierbar ist „In keinem Fall delegierbar sind Leistungen der Endoskopie (außer Kapselendoskopien, die durch speziell ausgebildete nichtärztliche Mitarbeiter geführt werden können) und der Sonografie“ siehe 278. Entsprechend ist eine Substitution des Arztes ausgeschlossen.

This position paper summarises current developments in chronic thromboembolic pulmonary hypertension (CTEPH) including diagnostic approaches and treatment options. Based on the guidelines of the task force of CTEPH experts at the 5th World Symposium on Pulmonary Hypertension in Nice 2013. Open questions arising during the treatment of patients with CTEPH are addressed. Patients with suspected CTEPH should undergo echocardiography and cardiopulmonary exercise testing. A ventilation/perfusion scan is the recommended imaging test for screening in the diagnostic algorithm for the evaluation of CTEPH. CTEPH-patients should be discussed in an expert center with an interdisciplinary team and an experienced PEA surgeon to decide the further treatment. Pulmonary endarterectomy (PEA) is the treatment of choice for patients with CTEPH. Medical therapy with PH-targeted medications for inoperable CTEPH and residual disease after PEA should only be initiated if evaluation reveals that the patient is no candidate for a PEA. Current data suggest that CTEPH patients treated with PEA have a better long-term survival rate and quality of life than patients treated with medical therapy.

Background Use of Botulinum toxin-A (BoNT-A) for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A. Methods/Design A randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental) or bimanual occupational therapy group (control). Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale. Discussion The aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy) versus bimanual occupational therapy (a bimanual therapy) on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following upper limb injection of BoNT-A. The paper outlines the background to the study, the study hypotheses, outcome measures and trial methodology. It also provides a comprehensive description of the interventions provided. Trial Registration ACTRN12605000002684

Gene therapy seems to offer new hope in cancer treatment. The new molecular technology can be used to target tumour cells in many ways. These include techniques that correct genes directly—for example, by delivering a nucleic acid sequence that complements and therefore inactivates an oncogene (antisense technology) or by replacing copies of tumour suppressor genes that are often lost in malignant cells. However, the success of these direct approaches is limited because current technology cannot deliver therapeutic genes to all cancer cells. Alternative strategies have been developed using genes that encode proteins, such as cytokines, which can activate the patient's immune response against the tumour. Another application of gene therapy, which is already undergoing extensive clinical trials, is the transduction of tumour cells with so called suicide genes, which encode enzymes that can convert a prodrug to its toxic metabolite. Despite the diversity of gene therapies for cancer in both the laboratory and clinic, disappointment is emerging that gene therapy has not fulfilled its early promise.1 Since no dramatic clinical success has been reported to date, this criticism cannot be ignored, and an objective reconsideration of the potential of gene therapy is timely. Gene therapy has failed to live up to expectations so far because these have been unrealistic. A lack of realism can be destructive if it leads to disillusionment. Potential benefits of a new approach may be lost if research is abandoned prematurely because dramatic advances have not been made. In oncology, the excitement engendered by gene therapy has been heightened by the inadequacy of current treatments for many of the common adult cancers. There are good scientific explanations for the inability of gene therapy to produce impressive cures in cancer, but for an understanding of these, gene therapy must be considered within the context and aims …

In the current discussion on optimizing psychotherapeutic approaches, two important developments have to be considered: a tendency towards integrative and a tendency towards disorder specific approaches. For the years 2005 and 2006, an analysis of three German journals (covering the fields of psychosomatics, psychiatry and clinical psychology) was conducted on the question whether these two developments can be identified in current empirical and conceptual publications. Contrary to the expectations, there are only very few papers dealing with integrative approaches. As expected, there is a major emphasis on psychodynamic and cognitive behavioural approaches; other approaches are only marginally considered. A disorder specific approach can be identified not only for cognitive behavioural, but also for psychodynamic papers.

Observational studies demonstrate that the proportion of treated hypertensive patients who attain the recommended blood pressure goals (140/90 mmHg) does not exceed 30-40%. Conversely, clinical trials have consistently shown that effective blood pressure control within the recommended targets can be achieved in 70-80% of treated hypertensive patients with different cardiovascular risk profile, especially when appropriate, effective and well tolerated combination therapies are used. In order to bridge the gap between current and optimal blood pressure control rates and to achieve a more effective cardiovascular prevention, the Italian Society of Hypertension has recently developed an interventional strategy that aims to approximate 70% of treated controlled patients by 2015. This ambitious goal can be realistically achieved by the appropriate use of modern aids and tools, also including the implementation of combination therapy, especially if this approach can be simplified into a single pill, now available in Italy. At present, 70-80% of hypertensive patients require combination therapies based on at least two classes of antihypertensive drugs to achieve the recommended blood pressure goals. It is therefore of paramount importance to implement this strategy in routine clinical practice. Among the different combination therapies, the use of combination strategies based on drugs inhibiting the renin-angiotensin system, such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, combined with diuretics and/or calcium-channel blockers, have demonstrated to significantly reduce the rates of major cardiovascular events and discontinuations from prescribed therapies, resulting in higher antihypertensive efficacy and better tolerability than monotherapy. The present document of the Italian Society of Hypertension aims to provide main indications for implementing combination therapy in the clinical management of hypertension in order to improve blood pressure control in Italy.

This is a condensed consensus report, summarizing the present status of various aspects of epidemiology, diagnosis, and treatment of venous ulcers. There are conflicting results regarding the prevalence of venous ulcers ranging from 0.18 to 1.3%, depending on the types of ulcers reported. With regard to macrovascular changes preceding venous leg ulceration, ambulatory venous hypertension is the common pathway, usually related to incompetent perforating veins and the deep venous system. Obstruction of the deep venous system seems to be less frequently related to venous ulcers. Microvascular changes have been recently studied in more detail; morphologic as well as functional changes are summarized and considered from the viewpoint of various hypotheses, including fibrin cuff, leukocyte adhesion, etc. Various investigational approaches are summarized and recommendations for the most cost-effective diagnostic tests are given. Finally, conservative medical as well as surgical treatment avenues are evaluated. Emphasis is given to the normalization of ambulatory venous pressure by sclerotherapy, ligation, or other surgical procedures, in addition to compression. The consensus report is concluded by detailed recommendations for future clinical trials.

Psoriasis is a common, chronic skin disorder that is conservatively estimated to affect between 1% and 2% of the population in the United States, not including mild cases. Despite the fact that psoriasis is one of the more common skin conditions requiring medical attention, it is poorly understood by the general public. This lack of information or misinformation on the part of health care administrators and insurers can affect the medical treatment of psoriasis and concomitant reimbursement in a manner that may be inappropriate and/or inadvertently deleterious to the patient's health care. The Committee on Psoriasis of the American Academy of Dermatology has sought to address this void. The Committee on Psoriasis is comprised of several dermatologists from the major academic medical centers in the United States. The combined expertise of this group reflects decades of experience in research, diagnosis, and treatment of psoriasis, as well as other skin diseases. This group has approved the "White Paper on Hospitalization for Psoriasis Care" as a straightforward, accurate, and well-documented source of information on psoriasis and psoriasis care. The purpose of this document is to explore the relevant medical aspects of the disease, its treatment modalities and their associated risks, and the outcomes of care.

The aim of the study was to determine the risk of distant metastases in patients with gynecologic cancers after surgery, including cervical, uterine and ovarian cancers. This is a retrospective study evaluating gynecologic cancer from 2009 to 2014 using population-based administrative datasets from the Health and Welfare Data Science Center (HWDC) and from The National Health Informatics Project (NHIP). A total of 1,464 gynecologic cancer patients, including 321 cervical cancer patients, 724 uterine cancer patients and 419 ovarian cancer patients, were analyzed retrospectively from 2009 to 2014. Among the cervical cancer patients, 173 (53.89%) received surgery only and 148 (46.11%) received surgery with radiotherapy /chemotherapy. Among the uterus cancer patients, 425(58.70%) received surgery only and 299 (41.3%) received surgery with radiotherapy /chemotherapy. Among the ovarian cancer patients, 81 (19.33%) received surgery only and 338 (80.67%) received surgery with radiotherapy/chemotherapy. Among patients with brain, liver or lung metastasis, cervical cancer patients have more cumulative metastasis-free survival than those ovarian cancer (p=0.0041). In analyzing liver metastasis based on primary cancer sites, cervical cancer patients and uterine cancer cases have more cumulative metastasis- free survival than those ovarian cancer (p