Pacific Tower

Social media may facilitate older adults' ability to engage socially and explore health information, but it can present difficulties for older adults. Therefore, it is important to explore older adults' experience of usability and user engagement. We conducted two rounds of pilot studies where we used Facebook to engage older adults. We performed a mixed-methods evaluation of user engagement and usability. A directed content analysis of qualitative data from the pilot studies was used to explore engagement and perceived usability, and the Mann-Whitney U test was used to examine differences in feature usage and engagement. We analyzed qualitative data from 13 participants. Qualitative data analysis yielded themes pertaining to three main domains: user engagement , usability , and usability related to aging-related changes . In terms of user engagement and usability, participants in both pilot studies reported positive feedback on felt involvement and endurability, and the second pilot group reported more positive comments regarding perceived usefulness compared with the first pilot group. There was no statistically significant difference in usage over the two studies. The findings of this study suggest opportunities to improve older adults' experience of online discussion platforms. Considering changes that improve perceived aesthetic appeal and focused attention will be helpful.

Neuroendocrine tumors rarely occur in the urinary bladder, relatively less than 1% of occurrence, as the tumor is very rare, pathogenesis is uncertain some authors showed that it is from urothelial origin. It can be carcinomatous, subdivided into small cell and large cell pathology. Small cell carcinoma of the bladder is a rarity that may present at an advanced pathologic stage. No treatment regimens have been standardized for local or metastatic disease. Many publications showed that the disease is treated with combined chemotherapy or with radical cystectomy, here we are presenting a case of a 78 years old male, who underwent transurethral resection of bladder 1 month ago and the biopsy report was suggestive of neuroendocrine tumor of bladder, after that patient underwent radical cystectomy with neobladder reconstruction surgery.

The Stupp protocol has become standard of care for the treatment of glioblastoma (GBM) (since its publication in 2005) and has led to some limited survival improvements. This protocol, consists of radiotherapy and concomitant chemotherapy with temozolomide, an alkylating agent. Temozolomide + radiation, compared to radiation alone had added in average 3 months additional life span, 16 percent improved survival at 2 years. That said since 2005, the standard of care has not changed in regards to the treatment of early diagnosed aggressive or multifocal GBM, and unfortunately the expected survival is still poor with 75 percent of patients dying in less than 2 years and average survival of 15 months. In patients with multifocal tumors (such as the case below) the average survival is even worse with less than 4 months at her age [1]. Here we present a case study of a patient with advanced multifocal, and rapidly progressing Glioblastoma Multiforme treated with STUPP protocol in combination with IV Quercetin. The patient experienced improved quality of life and response, compared to historical data. It is our recommendation to investigate such combinational approach in patients with Glioblastoma, as in our case it proved to be safe and effective with improved quality of life and performance as well as clinical response and survival.

Since the discovery of tyrosine kinase inhibitors in treatment of lung cancer harboring such actionable targets, many lives have been prolonged. To the same extent, same group of patients have failed to benefit from this category of drugs, in long run, either initially or during the course of treatments, simply due to either known or unknown mechanism of resistance which occurs very often in the first few months after initiation of therapy. The resistance is 100 percent expected, and no patient is reported to be a waiver of such pattern. With best practices of oncology, the average duration of response is expected to be below 12 months [1]. About half of the resistance is caused by mutation at T790M in EGFR target, which can be revealed by liquid biopsy [1] [2]. The most recent studies have revealed the significant role of epigenome in controlling this complicated resistance pattern. We have learned that Histone deacetylation, as opposed to promoter methylation, may contribute to the epigenetic silencing and to EGFR TKI resistance in NSCLC [3] [4]. Here we present a case study with a model of combinational therapy that targets the EGFR molecule, (by small molecule inhibitor, Afatanib) with simultaneous epigenetic modification of the target, (by application of multitargeted epigenetic therapy (MTET) with significantly improved clinical results. We propose further trials are needed to support such hypothesis, which if proved, could significantly shift the current practices in management of this set of cases in lung adenocarcinomas.

The patient’s personal and social development was stifled by his parent’s overprotection following two nearly fatal falls as a toddler. An unending list of medical precautions followed, including the warning that he needed to avoid occupied rooms where disease could be spread through the air. His identity became that of a medical cripple. The situation was exacerbated by the alleged development of epilepsy at age 12. In association, he claimed that he was too anxious to manage in school and was placed in special classes. No diagnosis apart from his allergic susceptibility was confirmed. The case narrative underscores the importance of personal psychotherapy and psychotropic medication trials in undoing his identity as a cripple and replacing this with a view of himself as normal. The narrative details the ways the patient and his parents attempted to defeat this effort and the techniques through which his self-image was normalized.

Fire in the operating theater is a rare but potentially fatal complication. We report igniting an intraperitoneal fire while preforming an exploratory laparotomy for perforated viscus. Fortunately, the patient suffered no injuries as a result.

Severe brachiocephalic artery stenoses are relatively rare obstructions of the extracranial arteries and can cause significant changes to hemodynamics and spectral Doppler waveform patterns, complicating diagnosis. This case study presents disease progression from stenosis to occlusion and resulting complex steal phenomena extending to the contralateral upper extremity, which has not been widely reported. The sonographic findings of disease progression and collateral pathways were confirmed by magnetic resonance angiography and contrast-enhanced computed tomography.

A 76-year-old Asian man with a 6-month history of intractable watery diarrhea proceeded to colonoscopic examination that revealed diffusely dull-appearing colonic mucosa with focal areas of superficial ulceration. Mucosal biopsies demonstrated a neoplastic population of monomorphous small-to-intermediate-sized CD8+/CD56+ cytotoxic T cells that densely infiltrated the surface epithelium and crypts in a near pan-colonic distribution without tumor formation. Clinical staging revealed no disease elsewhere. The patient was treated aggressively with chemotherapy but died from disease five and a half months after presentation. In all likelihood, the patient had primary colonic involvement by enteropathy-associated T cell lymphoma (EATL) type II, a rare and aggressive extranodal non-Hodgkin lymphoma that occurs more commonly in Asians in whom celiac disease is infrequent. Widespread colonic disease in the absence of a mass-forming infiltrate has not been characterized in EATL type II and highlights an expanded clinical and pathological spectrum of the disease.

Merkel cell carcinoma is a rare but often deadly cutaneous malignancy. It carries a 40 percent five-year mortality rate, in contrast to 15 percent for malignant melanoma, and the incidence is increasing among older and immunosuppressed patients. Dermatologists need to be aware of the particular diagnostic and treatment challenges as the incidence increases. New data is helping to identify patients most at risk, accurately stage the tumor and to optimize treatment regimens. With the recent discovery of a virus as part of the etiology of this tumor, approaches to use the body's immune system to attack the tumor have potential to significantly increase survival rates in the future. Merkel Cell carcinoma (MCC) is a rare but aggressive cutaneous malignancy. Its aggressive behavior, combined with its asymptomatic clinical presentation, means that tumors are often allowed to grow and spread before detection. As the tumor becomes better characterized and its etiology better understood, research is rapidly advancing in both pathogenesis and treatment. Since the discovery of a viral etiology for this tumor in 2008, progress is advancing rapidly.