The extensive history of pandemics has spanned many centuries, profoundly impacting societies, economies, and public health, and thereby shaping the course of history in various ways. Advances in medicine, science, and public health practices have played a pivotal role in mitigating the effects of pandemics over time. This review explores the scientific landscape of contemporary pandemics, examining their diverse and complex nature. It goes beyond the biological aspects of pandemics to consider socioeconomic, environmental, and technological factors. Through a scientific lens, this study aims to understand the complexities of pandemics and contribute to the expanding knowledge base that helps humanity strengthen its defenses against global health threats. By elucidating the enigmas of pandemics, the study hopes to foster a more resilient and prepared global health environment. Highlighting the importance of a multidisciplinary, cross-disciplinary, and transdisciplinary approach, this exploration emphasizes the critical need to integrate biological, socioeconomic, environmental, and technological domains to develop more robust defenses against these global health challenges. 

Pandemics: past, present, and future: multitasking challenges in need of cross-disciplinary, transdisciplinary, and multidisciplinary collaborative solutions

Exosomal circular RNA (circRNAs) are pivotal in cancer biology, and tumor pathophysiology. These stable, non-coding RNAs encapsulated in exosomes participated in cancer progression, tumor growth, metastasis, drug sensitivity and the tumor microenvironment (TME). Their presence in bodily fluids positions them as potential non-invasive biomarkers, revealing the molecular dynamics of cancers. Research in exosomal circRNAs is reshaping our understanding of neoplastic intercellular communication. Exploiting the natural properties of exosomes for targeted drug delivery and disrupting circRNA-mediated pro-tumorigenic signaling can develop new treatment modalities. Therefore, ongoing exploration of exosomal circRNAs in cancer research is poised to revolutionize clinical management of cancer. This emerging field offers hope for significant breakthroughs in cancer care. This review underscores the critical role of exosomal circRNAs in cancer biology and drug resistance, highlighting their potential as non-invasive biomarkers and therapeutic targets that could transform the clinical management of cancer.

Exosomal circRNAs: Deciphering the novel drug resistance roles in cancer therapy

During the COVID-19 pandemic, countries adopted mitigation strategies to reduce disruptions to cancer services. We reviewed their implementation across health system functions and their impact on cancer diagnosis and care during the pandemic. A systematic search was performed using terms related to cancer and COVID-19. Included studies reported on individuals with cancer or cancer care services, focusing on strategies/programs aimed to reduce delays and disruptions. Extracted data were grouped into four functions (governance, financing, service delivery, and resource generation) and sub-functions of the health system performance assessment framework. We included 30 studies from 16 countries involving 192,233 patients with cancer. Multiple mitigation approaches were implemented, predominantly affecting sub-functions of service delivery to control COVID-19 infection via the suspension of non-urgent cancer care, modified treatment guidelines, and increased telemedicine use in routine cancer care delivery. Resource generation was mainly ensured through adequate workforce supply. However, less emphasis on monitoring or assessing the effectiveness and financing of these strategies was observed. Seventeen studies suggested improved service uptake after mitigation implementation, yet the resulting impact on cancer diagnosis and care has not been established. This review emphasizes the importance of developing effective mitigation strategies across all health system (sub)functions to minimize cancer care service disruptions during crises. Deficiencies were observed in health service delivery (to ensure equity), governance (to monitor and evaluate the implementation of mitigation strategies), and financing. In the wake of future emergencies, implementation research studies that include pre-prepared protocols will be essential to assess mitigation impact across cancer care services. 

Global review of COVID-19 mitigation strategies and their impact on cancer service disruptions

The pandemic has inevitably led to disruptions in the provision of health services for all those patients not affected by COVID-19. At the same time, we have observed differences among health services in their ability to maintain their activities in the face of shocks: while some health services were largely able to ensure core functions, other suffered delays in prevention, acute care, and rehabilitation. In this paper, we explore the effect of regional health policies in terms of governance, workforce, and health service delivery on the ability to maintain oncological services during the COVID-19 pandemic to assess the resilience of the system. The study is based on secondary data collected on the 21 Italian regional health services during the first wave of the pandemic. We discuss the theoretical and practical implications of providing health services with specific characteristics pertaining to governance, workforce, and health service delivery to support the resilience of regional health policies during a crisis or shock. 

Maintaining health service during COVID-19: A study on regional health services

Introduction The development of urban resilience, which is fundamentally a balance between the supply capacity of primary care resources and the demand from urban residents, includes an appropriate architecture of primary care facilities. Resilient city construction in highland areas is hampered by the physical environment and transportation constraints and frequently encounters issues like poor accessibility and unequal distribution of primary care facilities. Methods To optimize the supply and demand of primary care resources in highland cities and effectively improve the resilience of urban public health, this paper assesses the distribution of primary care facilities within the built-up area of Lhasa (China) through a spatial network analysis method based on GIS, combined with population distribution data, and employs a location-allocation model to optimize the distribution. Results Firstly, the overall supply of primary care exceeds the overall demand, but the facilities' service area can only accommodate 59% of the residences. Secondly, there is a clear spatial variation in the accessibility of primary care facilities, and the time cost of healthcare is too high in some residences. Thirdly, the supply-demand relationship of primary care facilities is unbalanced, with both over-saturated and over-deficient areas. Discussion After distribution optimization, the coverage and accessibility of primary care facilities have increased significantly, and the spatial imbalance of supply and demand has been alleviated. This paper proposes a research method to evaluate and optimize the spatial distribution of primary care facilities from multiple perspectives based on the resilience theory. The results of the study and visualization analysis methods can be used as an invaluable reference for planning the distribution of urban healthcare facilities and urban resilience construction in highland areas and other underdeveloped areas.

/pdf/supply-demand-balance-and-spatial-distribution-optimization-31arvjuw.pdf

Supply-demand balance and spatial distribution optimization of primary care facilities in highland cities from a resilience perspective: A study of Lhasa, China

<h3>Purpose/Objective(s)</h3> In order to maximize the therapeutic ratio, it is important to identify adverse prognostic features in men with prostate cancer, especially amongst those with intermediate risk disease, which represents a heterogeneous group. These men may benefit from treatment intensification. Prior studies have shown pretreatment mpMRI may predict biochemical failure in patients with intermediate and/or high-risk prostate cancer undergoing conventionally fractionated external beam radiotherapy and/or brachytherapy. This is the first study to evaluate pretreatment mpMRI findings as a marker for outcome in patients undergoing SBRT. <h3>Materials/Methods</h3> We identified all patients treated at our institution with linear accelerator-based SBRT to 3625 cGy in 5 fractions, with or without androgen deprivation therapy (ADT) from November 2015 to March 2021. All patients underwent SpaceOAR placement followed by pre-treatment MRI. Post-treatment PSA measurements were obtained 4 months after SBRT, followed by every 3-6 months thereafter. A two-sample t-test was used to compare preoperative mpMRI features with clinical outcomes. <h3>Results</h3> 123 men were included in the study. The table below summarizes the pretreatment patient characteristics. Patients with higher pretreatment diameter of the largest intraprostatic lesion, number of prostate lesions, and maximal PI-RADS score were associated with higher PSA nadir and longer time to PSA nadir (p<0.0001). When separated by ADT treatment, this association remained for patients who were not treated with ADT (p<0.001). In patients who received ADT, the pretreatment MRI variables were each significantly associated with time to PSA nadir (p<0.01) but not with PSA nadir (p>0.30). <h3>Conclusion</h3> Our experience shows a significant association between mpMRI features and PSA outcome in patients treated with SBRT with or without ADT. Since PSA nadir has been shown to correlate with biochemical failure, this information may help radiation oncologists better counsel their patients regarding outcome after SBRT and can help inform future studies regarding who may benefit from treatment intensification with, for example, ADT and / or boost to dominant intraprostatic lesion. 

Multiparametric MRI as a Predictor of PSA Response in Patients Undergoing Stereotactic Body Radiation (SBRT) Therapy for Prostate Cancer

PD-0154 Early prediction of therapeutic response by regular functional MRI during the treatment of NPC

666P Circulating CX3CR1+CD8 T and Th17 cells and immunotherapy response in recurrent or metastatic NPC

1081eP EGFR exon 19 duplications/insertions, rare but potential therapeutic targets for NSCLC: A real-world study and pooled analysis of case series

http://www.clinicaloncologyonline.net/article/S0936655523000067/pdf

Global Health System Resilience during Encounters with Stressors – Lessons Learnt from Cancer Services during the COVID-19 Pandemic

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