Emmanuel G. Villalpando

Patients with cancer often experience intertwined symptom burden and functional decline that contribute to falls, unsafe transfers, uncontrolled symptoms, caregiver strain, and crisis-driven care. Physical medicine and rehabilitation (PM&R), also known as physiatry, and specialty PC both address suffering and quality of life through complementary clinical approaches; however, collaborative care with and between these two specialties is inconsistent in routine oncology practice. This paper presents a clinical implementation framework informed by targeted literature synthesis for bidirectional referral and co-management between PM&R and PC in oncology. The framework was informed by the PC referral criteria literature, cancer rehabilitation triage literature, trigger-based serious illness identification models, and implementation science. Four clinic-usable tools are proposed, including a scope and overlap map, a clinical-needs gradient, a referral trigger table linking common clinical signals to the reason for referral and expected clinical actions, and a primary-service triage workflow. This framework is intended to clarify which service is best positioned to be the primary supportive service according to the patient’s current needs, when rehabilitation therapy alone may be sufficient, and when co-management should be the default. This concept-to-practice model is designed to facilitate early, needs-based referrals and coordinated supportive care in oncology settings.

Introduction: Endoscopic endonasal approaches (EEA) for resection of anterior skull base meningiomas are gaining widespread acceptance as the literature has shown comparable rates of complications and morbidity relative to open craniotomy approaches. However, insufficient data have been published thus far on patient-reported outcomes on quality-of-life (QOL) measures, specifically focusing on their well-being. Given that QOL measures are critically informative for patient-centered decision making in surgical care, we report our institutional series of prospectively collected QOL data from patients who have undergone EEA for anterior skull base meningiomas. Methods: We prospectively collected data using the Sino-Nasal Outcome Test (SNOT-22) Questionnaire and the 36-Item Short Form Survey (SF-36) version 2 in patients undergoing EEA for anterior skull base meningiomas both before and after their surgeries in our pre- and postoperative clinics from 2013 to 2020. We included only patients who have completed every question in both surveys both before and after the surgery. Paired Wilcoxon's ranked-sum tests were used to compare survey results for each question before and after surgery. Statistical significance was defined as p < 0.05. Results: We identified 12 patients in our study, which included 10 patients who had tuberculum sella meningioma, 1 patient with planum sphenoidale meningioma, and 1 patient with a sellar meningioma with extension into suprasellar space. These patients completed their post-op surveys between 3 and 72 days (median: 24 days) after surgery. Comparing the pre- and post-op SF36 results, we found no significant differences in 35 out of 36 questions regarding their daily physical activities as limited by their health or by any emotional problems, or regarding how they felt in general. We only found a significant decrease in “feeling full of pep” during post-op visit compared with pre-op visit (p = 0.03). Comparing the SNOT-22 pre-op and post-op results, we found an overall increase in the total SNOT-22 scores. Not surprisingly, the significant increases were in the sinonasal domains. However, we found that there were no significant differences in self-reported problems with cough, dizziness, ear pain, reduced productivity, reduced concentration, and feeling frustrated/restless/irritable. Conclusion: For patients undergoing EEA for resection of anterior skull base meningiomas, their overall physical and emotional health did not seem to be significantly affected as reflected by their SF36 results. However, there were expected short-term increases in sinonasal specific symptoms and related QOL changes, with few exceptions, as shown by their SNOT-22 results. Our data can be used to inform patients that their overall physical and emotional health is not expected to change dramatically. However, they can expect some QOL changes as a result of sinonasal-specific symptoms from the surgery, during the early postoperative period. Publication Date: 12 February 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Alcoholism is a chronic relapsing disorder with few therapeutic strategies that address the core pathophysiology. Brain tissue loss and oxidative damage are key components of alcoholism, such that reversal of these phenomena may help break the addictive cycle in alcohol use disorder (AUD). The current review focuses on platelet endothelial cell adhesion molecule 1 (PECAM-1), a key modulator of the cerebral endothelial integrity and neuroinflammation, and a targetable transmembrane protein whose interaction within AUD has not been well explored. The current review will elaborate on the function of PECAM-1 in physiology and pathology and infer its contribution in AUD neuropathology. Recent research reveals that oligodendrocytes, whose primary function is myelination of neurons in the brain, are a key component in new learning and adaptation to environmental challenges. The current review briefly introduces the role of oligodendrocytes in healthy physiology and neuropathology. Importantly, we will highlight the recent evidence of dysregulation of oligodendrocytes in the context of AUD and then discuss their potential interaction with PECAM-1 on the cerebral endothelium.