Liver cancer-related deaths are projected to exceed one million annually by 2030. Existing therapies have significant limitations, including severe side effects and inconsistent efficacy. Innovative therapeutic approaches to address primary liver cancer (PLC) have led to the ongoing development of tumor-derived organoids. These are sophisticated three-dimensional structures capable of mimicking native tissue architecture and function in vitro, improving our ability to model in vivo homeostasis and disease. This systematic review consolidates known literature on human and mouse liver organoids across all PLC subtypes, emphasizing diagnostic precision, disease modeling, and drug screening capabilities. Across all 39 included studies, organoids were most frequently patient-derived, closely followed by cancer cell line-derived. The literature concentrated on hepatocellular carcinoma and intrahepatic cholangiocarcinoma, while exploration of other subtypes was limited. These studies demonstrate a valuable role for PLC organoid cultures in biomarker discovery, disease modeling, and therapeutic exploration. Encouraging advances such as organoid-on-a-chip and co-culturing systems hold promise for advancing treatment regimens for PLC. Standardizing in vitro protocols is crucial to integrate research breakthroughs into practical treatment strategies for PLC. This study provides an overview of the current understanding of tumor-derived organoids in primary liver cancers, emphasizing their potential in diagnostics, disease modeling, and drug screening. The scientific foundation rests on the organoids' ability to replicate the tumor microenvironment and genetic landscape, opening new avenues for personalized therapies. These insights are crucial for both researchers and clinicians, as patient-derived organoids can help identify biomarkers and therapeutic targets. Physicians and policymakers can harness these advances to drive progress in precision medicine, while recognizing the challenges involved in standardizing organoid models for clinical implementation.
Cholangiocarcinoma (CCA) is a rare and aggressive malignancy originating from the bile ducts, with poor prognosis and limited treatment options. Traditional therapies, such as surgery, chemotherapy, and radiation, have shown limited efficacy, especially in advanced cases. Recent advancements in immunotherapy, particularly T cell-based therapies like chimeric antigen receptor T (CAR T) cells, tumor-infiltrating lymphocytes (TILs), and T cell receptor (TCR)-based therapies, have opened new avenues for improving outcomes in CCA. This review provides a comprehensive overview of the current state of T cell therapies for CCA, focusing on CAR T cell therapy. It highlights key challenges, including the complex tumor microenvironment and immune evasion mechanisms, and the progress made in preclinical and clinical trials. The review also discusses ongoing clinical trials targeting specific CCA antigens, such as MUC1, EGFR, and CD133, and the evolving role of precision immunotherapy in enhancing treatment outcomes. Despite significant progress, further research is needed to optimize these therapies for solid tumors like CCA. By summarizing the most recent clinical results and future directions, this review underscores the promising potential of T cell therapies in revolutionizing CCA treatment.
1 December 2023 in Revista Española de Educación Médica
Background: Medical interns are frequently victims of a hierarchical system, suffering various forms of abuse, ranging from psychological harm to sexual threats and physical assault. Objective: Determine the prevalence of violence and identify the factors that contribute to it in medical interns. Methods: Cross-sectional survey study with 161 participants. The survey “Workplace Violence in The Health Sector Country Case Studies Research Instruments Survey Questionnaire 2003” was used. Results: 59% have suffered some type of violence, 87.3% psychological violence, 3.1% physical violence and 9.4% both types of violence. In psychological violence, verbal aggression was the most prevalent (76.6%). Health personnel are the main source of violence, in psychological violence it was nursing (32.2%) and in physical violence, senior doctors (41.6%). In both types of violence, the majority perceives it as an everyday event. The cause of violence lies in the behavior of the aggressor due to abuse of authority (31%) and stress in 27%. Only 18.1% know the policies to confront violence. Most do not report the incident mainly due to fear. Conclusion: Violence towards medical students manifests itself in different ways and emanates from hierarchical positions, this can have consequences on the professional and emotional development of future doctors. Antecedentes: Los internos de medicina frecuentemente son víctimas de un sistema jerárquico, sufriendo diversas formas de abuso, que van desde daño psicológico hasta amenazas sexuales y agresiones físicas. Objetivo: Determinar la prevalencia de la violencia e identificar los factores que contribuyen a la misma en los internos de medicina. Métodos: Estudio transversal de encuesta con 161 participantes. Se utilizó la encuesta “Workplace Violence in The Health Sector Country Case Studies Research Instruments Survey Questionnaire 2003”. Resultados: El 59% ha sufrido algún tipo de violencia, un 87.3% violencia psicológica, 3.1% violencia física y 9.4% ambos tipos de violencia. En la violencia psicológica, la agresión verbal fue la más prevalente (76.6%). El personal de salud es la principal fuente de violencia, en la psicológica fue enfermería (32.2%) y en la física, los médicos de mayor jerarquía (41.6%). En ambos tipos de violencia, la mayoría lo percibe como un evento cotidiano. La causa de violencia radica en el comportamiento del agresor debido al abuso de autoridad (31%) y estrés en un 27%. Apenas el 18.1% conoce las políticas para afrontar la violencia. La mayoría no reporta el incidente debido principalmente al miedo. Conclusión: La violencia hacia los estudiantes de medicina se manifiesta de diferentes formas y emana de posiciones jerárquicas, esto puede traer consecuencias en el desarrollo profesional y emocional del futuro médicos.