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✅ CT Reveal – Teaching Case CT pulmonary angiography – Lung and soft-tissue windows In this 22-year-old male with acute hemoptysis and hemoglobin drop, CT shows: ✔ Focal pulmonary hemorrhage involving the right middle and lower lobes. ✔ Expansion of the bronchus intermedius filled with an endobronchial soft-tissue lesion....

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Dr Khaled Ahmed Abuzeid

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11,851 görüntüleme • 6 ay önce •via X (Twitter)

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Hey #medtwitter! Today #Scientissimum would like to show you an incredible case of #cardiothoracic #surgery of pulmonary embolism that was originated in the lower extremity. Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Diagnosis is based on signs and symptoms in combination with test results. If the risk is low, a blood test known as a D-dimer may rule out the condition. Otherwise, a CT pulmonary angiography, lung ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis. Did you know Pulmonary emboli affect about 430,000 people each year in Europe. In the United States, between 300,000 and 600,000 cases occur each year, which contribute to at least 40,000 deaths.🫀🫁 . #publichealth #saludpublica #cirurgia Video credit Dr.Erik Beyer text ref Wikipedia.
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Hey #medtwitter! Today #Scientissimum would like to show you an incredible case of #cardiothoracic #surgery of pulmonary embolism that was originated in the lower extremity. Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Diagnosis is based on signs and symptoms in combination with test results. If the risk is low, a blood test known as a D-dimer may rule out the condition. Otherwise, a CT pulmonary angiography, lung ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis. Did you know Pulmonary emboli affect about 430,000 people each year in Europe. In the United States, between 300,000 and 600,000 cases occur each year, which contribute to at least 40,000 deaths.🫀🫁 . #publichealth #saludpublica #cirurgia Video credit Dr.Erik Beyer text ref Wikipedia.

Scientissimum

44,297 görüntüleme • 3 yıl önce

🫀 Detecting Diffuse Non-Calcified Coronary Atherosclerosis with Photon Counting CT: Seeing What Conventional CT Often Misses In coronary CTA, the hardest disease to detect is not focal stenosis. It’s diffuse, non-calcified atherosclerosis. No obvious narrowing. No calcium. Just subtle, continuous vessel wall involvement. This is where Photon-Counting CT (PCCT) changes the rules. 🧠 Why it’s difficult Diffuse non-calcified disease presents as: ✔️ Mild, long-segment wall thickening ✔️ Subtle attenuation differences vs lumen ✔️ Positive remodeling without clear stenosis With conventional CT: ✔️ Limited spatial resolution blurs the wall ✔️ Low contrast resolution hides soft plaque ✔️ Motion and noise mask continuity 👉 Result: disease is underestimated or missed ⚡ What PCCT enables ✔️ Ultra-high spatial resolution Clear visualization of the vessel wall along its entire course Detection of subtle, diffuse thickening ✔️ High iodine concentration (400 mg I/mL) Strong intraluminal signal Higher contrast between lumen and vessel wall Diffuse disease becomes visible as a pattern, not noise ✔️ High temporal resolution Reduced motion blur Stable assessment of long coronary segments ✔️ Spectral capability Cleaner iodine–tissue separation Additional confidence in identifying non-calcified plaque 🎯 The shift We move from: Detecting focal stenosis To: Recognizing diffuse atherosclerotic burden From: “Is there a blockage?” To: “How diseased is the artery overall?” Diffuse coronary disease is real. It has always been there. Now we can see it. That’s the power of Photon-Counting CT in coronary atherosclerosis. ⚡🫀 #PhotonCountingCT #PCCT #CoronaryCTA #Atherosclerosis #NonCalcifiedPlaque #PreventiveCardiology #CardiacCT #RadiologyInnovation #yesCCT
0:24

🫀 Detecting Diffuse Non-Calcified Coronary Atherosclerosis with Photon Counting CT: Seeing What Conventional CT Often Misses In coronary CTA, the hardest disease to detect is not focal stenosis. It’s diffuse, non-calcified atherosclerosis. No obvious narrowing. No calcium. Just subtle, continuous vessel wall involvement. This is where Photon-Counting CT (PCCT) changes the rules. 🧠 Why it’s difficult Diffuse non-calcified disease presents as: ✔️ Mild, long-segment wall thickening ✔️ Subtle attenuation differences vs lumen ✔️ Positive remodeling without clear stenosis With conventional CT: ✔️ Limited spatial resolution blurs the wall ✔️ Low contrast resolution hides soft plaque ✔️ Motion and noise mask continuity 👉 Result: disease is underestimated or missed ⚡ What PCCT enables ✔️ Ultra-high spatial resolution Clear visualization of the vessel wall along its entire course Detection of subtle, diffuse thickening ✔️ High iodine concentration (400 mg I/mL) Strong intraluminal signal Higher contrast between lumen and vessel wall Diffuse disease becomes visible as a pattern, not noise ✔️ High temporal resolution Reduced motion blur Stable assessment of long coronary segments ✔️ Spectral capability Cleaner iodine–tissue separation Additional confidence in identifying non-calcified plaque 🎯 The shift We move from: Detecting focal stenosis To: Recognizing diffuse atherosclerotic burden From: “Is there a blockage?” To: “How diseased is the artery overall?” Diffuse coronary disease is real. It has always been there. Now we can see it. That’s the power of Photon-Counting CT in coronary atherosclerosis. ⚡🫀 #PhotonCountingCT #PCCT #CoronaryCTA #Atherosclerosis #NonCalcifiedPlaque #PreventiveCardiology #CardiacCT #RadiologyInnovation #yesCCT

Dr. Filippo Cademartiri

11,190 görüntüleme • 4 ay önce

There’s been a lot of buzz—and confusion—about the new Keto-CTA study, examining plaque progression in Lean Mass Hyper-Responders (LMHRs). Much of the social media debate has centered on whether high LDL on keto is safe or dangerous, driven largely by how to interpret the supplemental table comparing this study to others on LDL and plaque progression. In this episode of the Metabolic Mind Podcast, we sit down with Dr. Matthew Budoff, a world-renowned cardiologist, cardiac CT researcher, and the study's lead investigator, to discuss the the supplemental table, what the plaque markers mean, and how this fits into the discussion of high- vs -low-risk plaque progression. In this episode, we cover: ✅ What PAV (Percent Atheroma Volume) is, what it actually measures, and why it matters ✅ Why a 50% increase in plaque may sound scary, but can be deceiving ✅ The difference between “treatment-naive” and “treated” participants ✅ What the Miami Heart Study comparison reveals about keto, LDL, and plaque ✅ Why LDL alone may not tell the whole story about heart disease risk ✅ How some high-risk individuals may still benefit from statins and other therapies This study doesn’t answer whether keto causes heart disease or not. Instead, it shows that high LDL on a ketogenic diet is not a reliable predictor of plaque progression across all individuals. What is predictive? The presence of existing plaque. 💡 Key takeaway: Relying on surrogate markers of heart disease, like LDL and ApoB, is not the best way to assess heart disease risk in all populations. If you're concerned about how elevated LDL may be affecting your heart health, the best next step is to speak with your doctor about cardiac imaging to directly assess plaque and gain a clearer picture of your individual risk. Expert Featured: - Dr. Matthew Budoff - X: - Resources Mentioned: Plaque Begets Plaque, ApoB Does Not CMEs Mentioned: Managing Major Mental Illness with Dietary Change: The New Science of Hope Brain Energy: The Metabolic Theory of Mental Illness Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry. Learn more about metabolic psychiatry and find helpful resources at
32:51

There’s been a lot of buzz—and confusion—about the new Keto-CTA study, examining plaque progression in Lean Mass Hyper-Responders (LMHRs). Much of the social media debate has centered on whether high LDL on keto is safe or dangerous, driven largely by how to interpret the supplemental table comparing this study to others on LDL and plaque progression. In this episode of the Metabolic Mind Podcast, we sit down with Dr. Matthew Budoff, a world-renowned cardiologist, cardiac CT researcher, and the study's lead investigator, to discuss the the supplemental table, what the plaque markers mean, and how this fits into the discussion of high- vs -low-risk plaque progression. In this episode, we cover: ✅ What PAV (Percent Atheroma Volume) is, what it actually measures, and why it matters ✅ Why a 50% increase in plaque may sound scary, but can be deceiving ✅ The difference between “treatment-naive” and “treated” participants ✅ What the Miami Heart Study comparison reveals about keto, LDL, and plaque ✅ Why LDL alone may not tell the whole story about heart disease risk ✅ How some high-risk individuals may still benefit from statins and other therapies This study doesn’t answer whether keto causes heart disease or not. Instead, it shows that high LDL on a ketogenic diet is not a reliable predictor of plaque progression across all individuals. What is predictive? The presence of existing plaque. 💡 Key takeaway: Relying on surrogate markers of heart disease, like LDL and ApoB, is not the best way to assess heart disease risk in all populations. If you're concerned about how elevated LDL may be affecting your heart health, the best next step is to speak with your doctor about cardiac imaging to directly assess plaque and gain a clearer picture of your individual risk. Expert Featured: - Dr. Matthew Budoff - X: - Resources Mentioned: Plaque Begets Plaque, ApoB Does Not CMEs Mentioned: Managing Major Mental Illness with Dietary Change: The New Science of Hope Brain Energy: The Metabolic Theory of Mental Illness Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry. Learn more about metabolic psychiatry and find helpful resources at

Metabolic Mind

98,147 görüntüleme • 1 yıl önce

Humacyte is proud to announce that the FDA has granted full approval for Symvess™, a first-in-class, universally implantable, bioengineered human vessel for extremity vascular trauma replacement and repair. This approval is a significant milestone in regenerative medicine, offering a new treatment option for patients with severe arterial injuries. Congratulations to our incredible team and partners who made this possible! Learn more at See the Prescribing Information, including Boxed Warning: INDICATION SYMVESS is an acellular tissue engineered vessel indicated for use in adults as a vascular conduit for extremity arterial injury when urgent revascularization is needed to avoid imminent limb loss, and autologous vein graft is not feasible. IMPORTANT SAFETY INFORMATION BOXED WARNING: GRAFT FAILURE -Loss of SYMVESS integrity due to mid-graft rupture or anastomotic failure can result in life threatening hemorrhage. CONTRAINDICATIONS DO NOT use SYMVESS in patients who have a medical condition that would preclude long-term antiplatelet therapy (such as aspirin or clopidogrel) after resolution of acute injuries. WARNINGS & PRECAUTIONS -Graft Rupture: Vascular graft rupture has occurred in patients treated with SYMVESS. Advise patients that arterial bleeding can be life-threatening and to seek emergent medical evaluation for any signs or symptoms of graft rupture such as bleeding, pain and swelling in the extremity, or signs of extremity ischemia. Follow appropriate procedures for handling and administering SYMVESS. -Anastomotic Failure: Anastomotic failure has occurred in patients treated with SYMVESS. In clinical studies of SYMVESS, anastomotic failure occurred within the first 36 days post-implantation. Monitor patients for signs of anastomotic failure such as pain and swelling at the surgical site, decreasing hemoglobin or other signs and symptoms of bleeding. Advise patients to seek urgent medical evaluation if they have any signs or symptoms that may be indicative of anastomotic failure such as bleeding, swelling or worsening pain at the surgical site or changes in color of overlying skin. Follow appropriate procedures for handling and administering SYMVESS. -Thrombosis: Thrombosis has occurred in patients treated with SYMVESS. In clinical trials of SYMVESS, patients received antiplatelet therapy following implantation of SYMVESS to reduce the risk of thrombosis. The risk of thrombosis may increase in patients who discontinue antiplatelet therapy. Anti-platelet therapy is recommended following treatment with SYMVESS. -Transmission of Infectious Diseases: SYMVESS is manufactured using cells and reagents that may transmit infectious diseases or infectious agents. The cells used in the manufacture of SYMVESS are derived from a donor who met the donor eligibility requirements for transmissible infectious diseases. Animal-derived reagents are tested for animal viruses, bacteria, fungi, and mycoplasma before use, but this does not eliminate the risk of transmitting these or other transmissible infectious diseases and disease agents. No transmissible agent infections have been reported during clinical testing. ADVERSE REACTIONS The most common adverse reactions (≥3%) were thrombosis, fever, pain, anastomotic stenosis, rupture or anastomotic failure, and infection. USE IN SPECIFIC POPULATIONS Pediatric Use: The safety and effectiveness of SYMVESS in pediatric patients (0 to 17 years old) have not been established. Geriatric Use: Two patients out of the 54 Extremity Group implanted with SYMVESS as a conduit in Study 1 were aged ≥65 years. The number of patients aged ≥65 years was not sufficient to determine whether they responded differently than younger patients to SYMVESS. #Humacyte #FDAApproval #RegenerativeMedicine #Innovation #Biotech #Firstinclass $HUMA
0:35

Humacyte is proud to announce that the FDA has granted full approval for Symvess™, a first-in-class, universally implantable, bioengineered human vessel for extremity vascular trauma replacement and repair. This approval is a significant milestone in regenerative medicine, offering a new treatment option for patients with severe arterial injuries. Congratulations to our incredible team and partners who made this possible! Learn more at See the Prescribing Information, including Boxed Warning: INDICATION SYMVESS is an acellular tissue engineered vessel indicated for use in adults as a vascular conduit for extremity arterial injury when urgent revascularization is needed to avoid imminent limb loss, and autologous vein graft is not feasible. IMPORTANT SAFETY INFORMATION BOXED WARNING: GRAFT FAILURE -Loss of SYMVESS integrity due to mid-graft rupture or anastomotic failure can result in life threatening hemorrhage. CONTRAINDICATIONS DO NOT use SYMVESS in patients who have a medical condition that would preclude long-term antiplatelet therapy (such as aspirin or clopidogrel) after resolution of acute injuries. WARNINGS & PRECAUTIONS -Graft Rupture: Vascular graft rupture has occurred in patients treated with SYMVESS. Advise patients that arterial bleeding can be life-threatening and to seek emergent medical evaluation for any signs or symptoms of graft rupture such as bleeding, pain and swelling in the extremity, or signs of extremity ischemia. Follow appropriate procedures for handling and administering SYMVESS. -Anastomotic Failure: Anastomotic failure has occurred in patients treated with SYMVESS. In clinical studies of SYMVESS, anastomotic failure occurred within the first 36 days post-implantation. Monitor patients for signs of anastomotic failure such as pain and swelling at the surgical site, decreasing hemoglobin or other signs and symptoms of bleeding. Advise patients to seek urgent medical evaluation if they have any signs or symptoms that may be indicative of anastomotic failure such as bleeding, swelling or worsening pain at the surgical site or changes in color of overlying skin. Follow appropriate procedures for handling and administering SYMVESS. -Thrombosis: Thrombosis has occurred in patients treated with SYMVESS. In clinical trials of SYMVESS, patients received antiplatelet therapy following implantation of SYMVESS to reduce the risk of thrombosis. The risk of thrombosis may increase in patients who discontinue antiplatelet therapy. Anti-platelet therapy is recommended following treatment with SYMVESS. -Transmission of Infectious Diseases: SYMVESS is manufactured using cells and reagents that may transmit infectious diseases or infectious agents. The cells used in the manufacture of SYMVESS are derived from a donor who met the donor eligibility requirements for transmissible infectious diseases. Animal-derived reagents are tested for animal viruses, bacteria, fungi, and mycoplasma before use, but this does not eliminate the risk of transmitting these or other transmissible infectious diseases and disease agents. No transmissible agent infections have been reported during clinical testing. ADVERSE REACTIONS The most common adverse reactions (≥3%) were thrombosis, fever, pain, anastomotic stenosis, rupture or anastomotic failure, and infection. USE IN SPECIFIC POPULATIONS Pediatric Use: The safety and effectiveness of SYMVESS in pediatric patients (0 to 17 years old) have not been established. Geriatric Use: Two patients out of the 54 Extremity Group implanted with SYMVESS as a conduit in Study 1 were aged ≥65 years. The number of patients aged ≥65 years was not sufficient to determine whether they responded differently than younger patients to SYMVESS. #Humacyte #FDAApproval #RegenerativeMedicine #Innovation #Biotech #Firstinclass $HUMA

Humacyte

27,584 görüntüleme • 1 yıl önce

This is Dr. Dimple Jangda. She makes us believe that she is an Ayurvedic practitioner. But the fact is that she is not a doctor. She is not even an Ayurvedic practitioner. She has no formal training in real medicine or pseudomedicine of Ayurveda. She was a television producer. Then an investment banker. Then a podcast host. And thereafter, a talk show host. She has a masters degree in business administration. She has a virtual online degree from National American University in (?)management which she claims is "honorary." She has a diploma in Yoga from Yoga Mumbai Institute. She has a virtual and unidentifiable degree in (?) business management from Thames International University, Paris. She has no formal training in any aspect of healthcare. She is a quack of quacks. A top of the line fearmongering "wellness fraud" - a bottom feeder in the ecosystem of healthcare business. She is a female version of Sadhguru. Lots of confidently sounding English words that takes shape of a word salad containing some of the biggest health-related misinformation and disinformation in Indian social media today. See this video for instance. She tells gullible people (who are already fearmongered about modern medicine and have distrust in doctors and medical science) not to opt for gall bladder removal surgery even if it gets complicated with stones disease or inflammation (called acute cholecystitis). A dangerous misinformation that can lead to loss of life. The physiology of gall bladder function and the change in function after gall bladder surgery that she provides is top-class garbage. Complicated gall stone disease require surgery for cure and to prevent further complications. If you remove the gall bladder, you do not develop more diseases like diabetes or obesity. The bile gets stored in the upper part of the small intestine in the absence of gall bladder and keeps helping in digestion. There is no food or diet shortcut that can dissolve gall stones. The story that this lady speaks about - from her own father's experience of using Ayurveda to remove gall stones is complete fabrication. It is an unverifiable, anecdotal bluff. There is no way, gall stones can just disappear in a month. There is only ONE method to diagnose and treat gall stones disease and it is the scientific method based consensus guidelines. See this from the European Association for Study of Liver - Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. It provides all information on 1. Prevention of gall stones 2. Diagnosis of gall bladder stones 3. Medical therapy of gall bladder stones 4. Surgical therapy of gall bladder stones 5. Diagnosis of bile duct stones 6. Endoscopic and surgical therapy of bile duct stones 7. Diagnosis and therapy of stones inside liver 8. Therapy of gall stones during pregnancy Peppermint tea, hibiscus tea, lemon water and such easy sounding kitchen-hacks are not the treatment for gall bladder disease or complicated gall stones. Gall bladder stones that are uncomplicated or incidentally detected do not require treatment. Do not worry about them unnecessarily. Gall stones that get stuck in the neck of the gall bladder or come down into the bile duct, causing bile duct obstruction, bile block and infection requires antibiotic therapy and after an interval, removal of gall bladder. Otherwise it could happen again and the second hit of infection could kill the person. It can also lead to gall stone pancreatitis that can lead to multiple organ failure. No amount of hibiscus tea and lemon water will save you when you are in septic shock due to cholangitis and a ruptured gall bladder, on the ventilator inside an ICU. High cholesterol, high blood pressure, obesity and fatty liver are not caused by removal of gall bladder, but are risk factors for development of the stones themselves - that is, metabolic diseases are associated with higher risk of developing gall stone disease and not the other way around. The lady had gotten it all topsy-turvy - why? Because she has no formal education in medicine and would probably have no clue on which side of the body the liver is. Increasing fruit and vegetable consumption in women aged 48-60 years prevented (a correlation) risk of complicated gall stone disease, and subsequent surgery, but is not in anyway same as not doing surgery for complicated gall stone disease. Once complicated, surgery is the best bet to prevent further complications. There is no evidence that drinking carrot and beetroot juice helps reduce complicated gall stone disease or dissolves gall stones. This is utter nonsense. You may be wondering why my post is so long and I had to keep going on and on to debunk small points made by Dimple Jangda. It is not so simple. Its because of this: The Bullshit Asymmetry Principle, also known as Brandolini’s Law, states that the amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it. PS: Please dont share any more of this quack's videos for me to debunk. I am getting too old for this.
1:28

This is Dr. Dimple Jangda. She makes us believe that she is an Ayurvedic practitioner. But the fact is that she is not a doctor. She is not even an Ayurvedic practitioner. She has no formal training in real medicine or pseudomedicine of Ayurveda. She was a television producer. Then an investment banker. Then a podcast host. And thereafter, a talk show host. She has a masters degree in business administration. She has a virtual online degree from National American University in (?)management which she claims is "honorary." She has a diploma in Yoga from Yoga Mumbai Institute. She has a virtual and unidentifiable degree in (?) business management from Thames International University, Paris. She has no formal training in any aspect of healthcare. She is a quack of quacks. A top of the line fearmongering "wellness fraud" - a bottom feeder in the ecosystem of healthcare business. She is a female version of Sadhguru. Lots of confidently sounding English words that takes shape of a word salad containing some of the biggest health-related misinformation and disinformation in Indian social media today. See this video for instance. She tells gullible people (who are already fearmongered about modern medicine and have distrust in doctors and medical science) not to opt for gall bladder removal surgery even if it gets complicated with stones disease or inflammation (called acute cholecystitis). A dangerous misinformation that can lead to loss of life. The physiology of gall bladder function and the change in function after gall bladder surgery that she provides is top-class garbage. Complicated gall stone disease require surgery for cure and to prevent further complications. If you remove the gall bladder, you do not develop more diseases like diabetes or obesity. The bile gets stored in the upper part of the small intestine in the absence of gall bladder and keeps helping in digestion. There is no food or diet shortcut that can dissolve gall stones. The story that this lady speaks about - from her own father's experience of using Ayurveda to remove gall stones is complete fabrication. It is an unverifiable, anecdotal bluff. There is no way, gall stones can just disappear in a month. There is only ONE method to diagnose and treat gall stones disease and it is the scientific method based consensus guidelines. See this from the European Association for Study of Liver - Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. It provides all information on 1. Prevention of gall stones 2. Diagnosis of gall bladder stones 3. Medical therapy of gall bladder stones 4. Surgical therapy of gall bladder stones 5. Diagnosis of bile duct stones 6. Endoscopic and surgical therapy of bile duct stones 7. Diagnosis and therapy of stones inside liver 8. Therapy of gall stones during pregnancy Peppermint tea, hibiscus tea, lemon water and such easy sounding kitchen-hacks are not the treatment for gall bladder disease or complicated gall stones. Gall bladder stones that are uncomplicated or incidentally detected do not require treatment. Do not worry about them unnecessarily. Gall stones that get stuck in the neck of the gall bladder or come down into the bile duct, causing bile duct obstruction, bile block and infection requires antibiotic therapy and after an interval, removal of gall bladder. Otherwise it could happen again and the second hit of infection could kill the person. It can also lead to gall stone pancreatitis that can lead to multiple organ failure. No amount of hibiscus tea and lemon water will save you when you are in septic shock due to cholangitis and a ruptured gall bladder, on the ventilator inside an ICU. High cholesterol, high blood pressure, obesity and fatty liver are not caused by removal of gall bladder, but are risk factors for development of the stones themselves - that is, metabolic diseases are associated with higher risk of developing gall stone disease and not the other way around. The lady had gotten it all topsy-turvy - why? Because she has no formal education in medicine and would probably have no clue on which side of the body the liver is. Increasing fruit and vegetable consumption in women aged 48-60 years prevented (a correlation) risk of complicated gall stone disease, and subsequent surgery, but is not in anyway same as not doing surgery for complicated gall stone disease. Once complicated, surgery is the best bet to prevent further complications. There is no evidence that drinking carrot and beetroot juice helps reduce complicated gall stone disease or dissolves gall stones. This is utter nonsense. You may be wondering why my post is so long and I had to keep going on and on to debunk small points made by Dimple Jangda. It is not so simple. Its because of this: The Bullshit Asymmetry Principle, also known as Brandolini’s Law, states that the amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it. PS: Please dont share any more of this quack's videos for me to debunk. I am getting too old for this.

TheLiverDoc™

314,397 görüntüleme • 3 yıl önce

Positioning of drugs in Crohn's disease ___ 1. Start effective therapy early This means at diagnosis in the vast majority of patients. Don’t make patients earn their way onto an effective drug. And use your best drug first. Please do not “save it in case you need it later”. ___ 2. Which of our effective therapies should you start? This matters less that just starting. Think holistically with a patient-centered approach. Age, co-morbidities, extra-intestinal manifestations, pregnancy, etc all important. Consider efficacy - speed of onset, mucosal healing, durability of remission - and safety. Mode of delivery - intravenous, subcutaneous, oral - is important. But comes after patient factors, efficacy and safety. Access issues will predominate for many. Use what you have. Use what you know. Just use an effective drug. ___ 3. Use a treat-to-target approach Without labouring the points around STRIDE-2, I’ll put it very simply: - monitor, monitor, monitor act on the results of the monitoring. Don’t keep going with a therapy that isn’t working. ___ 4. Know when to dose optimise versus switch Optimising anti-TNF is often a good ploy. But do it properly and don’t wait too long. Double the dose, shorten the frequency and wait 2-3 cycles. If it isn’t working then (objectively), switch out of class. With ustekinumab, I would no longer dose optimise, but rather switch a partial responder to risankizumab. ___ 5. Active disease is more dangerous than any drugs Two bits of data this year show this: i) In Profile, patients in the step-up group had twice as many adverse events as those in the top-down group. Most of this was because of flaring Crohn’s disease - including hospitalisations for severe disease - but there were also fewer serious infections in the top down group. And that was with combination infliximab and azathioprine. ii) Two meta-analyses of the harms from placebo in RCT’s show a very clear signal. Active Crohn’s disease and UC, when left untreated for even a number of week, is associated with increased toxicity. More on this later. ___ 6. Avoid steroids The majority of patients with Crohn’s disease can be managed effectively now without steroids. They will still have a role in sick patients, to bridge to some therapies, and a course of budesonide in mild to moderate ileal Crohn’s disease is often useful. However we have better strategies now, including using JAK inhibitors in place of steroids. We are increasingly using a short course to (re)capture response to a biologic or keeping the JAKi going in combination at a low dose. ___ 7. Other treatment modalities Surgery and nutritional therapy are particularly important. ___ 8. Changing the natural history of Crohn’s disease Disease modification is the end result when following these principles. We see it in the Edinburgh IBD clinic. A decade since we switched to a top-down strategy for Crohn’s disease and our patients have better disease control, less surgery and fewer hospitalisations. Clearly we still have work to do, but this is major progress.
4:55

Positioning of drugs in Crohn's disease ___ 1. Start effective therapy early This means at diagnosis in the vast majority of patients. Don’t make patients earn their way onto an effective drug. And use your best drug first. Please do not “save it in case you need it later”. ___ 2. Which of our effective therapies should you start? This matters less that just starting. Think holistically with a patient-centered approach. Age, co-morbidities, extra-intestinal manifestations, pregnancy, etc all important. Consider efficacy - speed of onset, mucosal healing, durability of remission - and safety. Mode of delivery - intravenous, subcutaneous, oral - is important. But comes after patient factors, efficacy and safety. Access issues will predominate for many. Use what you have. Use what you know. Just use an effective drug. ___ 3. Use a treat-to-target approach Without labouring the points around STRIDE-2, I’ll put it very simply: - monitor, monitor, monitor act on the results of the monitoring. Don’t keep going with a therapy that isn’t working. ___ 4. Know when to dose optimise versus switch Optimising anti-TNF is often a good ploy. But do it properly and don’t wait too long. Double the dose, shorten the frequency and wait 2-3 cycles. If it isn’t working then (objectively), switch out of class. With ustekinumab, I would no longer dose optimise, but rather switch a partial responder to risankizumab. ___ 5. Active disease is more dangerous than any drugs Two bits of data this year show this: i) In Profile, patients in the step-up group had twice as many adverse events as those in the top-down group. Most of this was because of flaring Crohn’s disease - including hospitalisations for severe disease - but there were also fewer serious infections in the top down group. And that was with combination infliximab and azathioprine. ii) Two meta-analyses of the harms from placebo in RCT’s show a very clear signal. Active Crohn’s disease and UC, when left untreated for even a number of week, is associated with increased toxicity. More on this later. ___ 6. Avoid steroids The majority of patients with Crohn’s disease can be managed effectively now without steroids. They will still have a role in sick patients, to bridge to some therapies, and a course of budesonide in mild to moderate ileal Crohn’s disease is often useful. However we have better strategies now, including using JAK inhibitors in place of steroids. We are increasingly using a short course to (re)capture response to a biologic or keeping the JAKi going in combination at a low dose. ___ 7. Other treatment modalities Surgery and nutritional therapy are particularly important. ___ 8. Changing the natural history of Crohn’s disease Disease modification is the end result when following these principles. We see it in the Edinburgh IBD clinic. A decade since we switched to a top-down strategy for Crohn’s disease and our patients have better disease control, less surgery and fewer hospitalisations. Clearly we still have work to do, but this is major progress.

Charlie Lees

15,650 görüntüleme • 1 yıl önce

PHOTON COUNTING CT is NOT a better CT It is a NEW imaging modality Photon Counting CT (PCCT) represents a transformative leap in medical imaging, not only as a molecular imaging modality but also as a technology offering ultra-high resolution and functional imaging capabilities. It is fundamentally more than just an enhanced version of traditional CT—PCCT introduces new ways of seeing and understanding the human body, providing critical insights at the molecular, structural, and functional levels. This positions PCCT as a unique imaging modality that requires a fresh approach to technical implementation, operational workflows, and financial planning. Despite the larger upfront investment, PCCT’s ability to drastically reduce downstream healthcare costs makes it a highly valuable investment in the long run. 1. Technical Innovations • Molecular Imaging and Energy Discrimination: Unlike traditional CT, which simply measures the total absorbed energy, PCCT counts individual X-ray photons and differentiates their energy levels. This allows for precise molecular imaging, revealing the composition of tissues and materials at a biochemical level. By distinguishing between different tissue types and contrast agents, PCCT opens up new diagnostic possibilities, such as identifying molecular biomarkers in tumors or distinguishing between stable and unstable plaque in coronary arteries. This capability shifts the focus of imaging from purely anatomical to both anatomical and molecular, offering more comprehensive diagnostic information. • Ultra-High Spatial Resolution: PCCT features significantly smaller detector elements compared to conventional CT scanners, allowing for ultra-high resolution imaging. This means clinicians can visualize fine structures such as microcalcifications in arteries, small lesions in soft tissues, or the intricate architecture of bones. This level of detail was previously unattainable with traditional CT. When combined with molecular imaging, this ultra-high resolution allows for the precise localization and characterization of disease at very early stages, which is essential for early diagnosis and intervention. • Functional Imaging Capabilities: PCCT also excels as a functional imaging modality. By capturing energy-resolved information, PCCT can provide insights into tissue functionality and dynamic physiological processes. For instance, it can detect changes in blood flow, tissue perfusion, and oxygenation without the need for additional contrast agents or scans. This functionality allows for real-time assessment of physiological processes, making it particularly valuable in cardiology, oncology, and neurology for evaluating organ function and monitoring disease progression. • Reduced Noise and Artifact Reduction: Photon-counting technology dramatically reduces electronic noise and imaging artifacts, such as beam hardening, resulting in clearer and more accurate images. The ability to deliver ultra-high resolution images with minimal artifacts improves diagnostic accuracy, reducing the need for repeat scans and ensuring that even subtle abnormalities are detected. 2. Operational Considerations • New Workflow for Molecular, High-Resolution, and Functional Imaging: The integration of molecular, ultra-high resolution, and functional imaging into routine clinical workflows introduces complexity that requires adaptation. Radiologists and technicians need specialized training to interpret and analyze multi-energy datasets that include molecular and functional information. PCCT produces a vast amount of detailed data, requiring clinicians to adopt new imaging protocols and refine their diagnostic approaches to fully leverage its capabilities. • Post-Processing and Data Management: PCCT generates richer, more complex datasets, which necessitates advanced post-processing tools and data management systems. Existing PACS and imaging software may not be equipped to handle such large volumes of data or to process functional and molecular information effectively. This means healthcare institutions must invest in robust IT infrastructure, including upgraded software and storage solutions, as well as provide additional training for staff on new imaging analysis techniques. • Revised Clinical Protocols: The molecular, functional, and ultra-high resolution imaging capabilities of PCCT will likely prompt changes in clinical protocols. For instance, the need for contrast agents may be reduced, simplifying patient preparation and decreasing the risk of adverse reactions. Additionally, the ability to monitor physiological functions in real-time through functional imaging could lead to more dynamic diagnostic procedures, such as assessing the effectiveness of interventions or treatments in real-time. 3. Financial Impact • Higher Initial Investment: PCCT systems are more expensive than traditional CT scanners due to their advanced technology, which includes photon-counting detectors and the computational power required for high-resolution, molecular, and functional imaging. While this upfront cost is significant, it is crucial to view it in the broader context of the downstream benefits and cost reductions that PCCT offers. • Downstream Cost Reductions: Although the initial capital investment is higher, PCCT’s ability to combine molecular, functional, and ultra-high resolution imaging leads to substantial reductions in downstream healthcare costs. Its superior diagnostic accuracy minimizes the need for follow-up tests, repeat scans, or invasive diagnostic procedures, such as diagnostic coronary angiographies. For example, in cardiology, PCCT can precisely differentiate between types of coronary plaque, reducing the need for invasive procedures to assess risk. • Lower Overall Healthcare Expenditures: By enabling earlier, more accurate diagnoses, PCCT can reduce the overall cost of patient care. Early detection of disease, particularly through its molecular and functional imaging capabilities, allows for more targeted treatments, potentially preventing the need for more aggressive and expensive interventions down the line. For instance, early-stage tumor detection via molecular imaging could lead to less invasive treatments, reducing hospital stays and improving patient outcomes, ultimately driving down healthcare costs. • Increased ROI Through Enhanced Patient Outcomes: Over time, the combination of molecular, functional, and ultra-high resolution imaging enhances diagnostic precision, which translates into better patient outcomes. Improved diagnostic accuracy reduces the incidence of unnecessary procedures, minimizes treatment delays, and results in more personalized and effective care. This leads to increased patient satisfaction, better healthcare outcomes, and greater patient throughput—all factors that improve the institution’s return on investment (ROI). • Competitive Advantage and New Revenue Streams: By adopting PCCT, healthcare institutions position themselves at the forefront of advanced imaging technologies. The ability to offer molecular, functional, and ultra-high resolution imaging creates a competitive advantage, attracting more complex and high-value cases. This can boost the institution’s reputation for excellence in diagnostics, leading to increased referrals, new patient populations, and expanded revenue opportunities. Summary Photon Counting CT (PCCT) is not just an evolution of existing CT technology—it is a molecular, ultra-high resolution, and functional imaging modality that fundamentally transforms the diagnostic landscape. Its ability to capture detailed molecular data, visualize minute anatomical structures with ultra-high resolution, and provide real-time functional imaging opens new possibilities for earlier and more precise diagnoses. While the financial investment in PCCT is larger, the reduction in downstream healthcare costs through improved diagnostic accuracy, fewer unnecessary interventions, and earlier disease detection far outweighs the initial expense. For institutions committed to advancing patient care and improving long-term financial outcomes, PCCT is an essential investment in the future of medical imaging. The video attached shows a patient accessing the Hospital for ACS. PCCT can provide ALL the imaging information of the concurrent imaging modalities (CXR, CAG, Echo, CMR) that you see around it... that's a lot! #PhotonCountingCT #MolecularImaging #UltraHighResolution #FunctionalImaging #FutureOfImaging #AdvancedMedicalImaging #EarlyDiseaseDetection #InnovativeCT #CuttingEdgeHealthcare #PrecisionDiagnostics #HealthcareInnovation #MedicalTechnology #CostEffectiveImaging #NextGenCT #PatientCareRevolution
1:10

PHOTON COUNTING CT is NOT a better CT It is a NEW imaging modality Photon Counting CT (PCCT) represents a transformative leap in medical imaging, not only as a molecular imaging modality but also as a technology offering ultra-high resolution and functional imaging capabilities. It is fundamentally more than just an enhanced version of traditional CT—PCCT introduces new ways of seeing and understanding the human body, providing critical insights at the molecular, structural, and functional levels. This positions PCCT as a unique imaging modality that requires a fresh approach to technical implementation, operational workflows, and financial planning. Despite the larger upfront investment, PCCT’s ability to drastically reduce downstream healthcare costs makes it a highly valuable investment in the long run. 1. Technical Innovations • Molecular Imaging and Energy Discrimination: Unlike traditional CT, which simply measures the total absorbed energy, PCCT counts individual X-ray photons and differentiates their energy levels. This allows for precise molecular imaging, revealing the composition of tissues and materials at a biochemical level. By distinguishing between different tissue types and contrast agents, PCCT opens up new diagnostic possibilities, such as identifying molecular biomarkers in tumors or distinguishing between stable and unstable plaque in coronary arteries. This capability shifts the focus of imaging from purely anatomical to both anatomical and molecular, offering more comprehensive diagnostic information. • Ultra-High Spatial Resolution: PCCT features significantly smaller detector elements compared to conventional CT scanners, allowing for ultra-high resolution imaging. This means clinicians can visualize fine structures such as microcalcifications in arteries, small lesions in soft tissues, or the intricate architecture of bones. This level of detail was previously unattainable with traditional CT. When combined with molecular imaging, this ultra-high resolution allows for the precise localization and characterization of disease at very early stages, which is essential for early diagnosis and intervention. • Functional Imaging Capabilities: PCCT also excels as a functional imaging modality. By capturing energy-resolved information, PCCT can provide insights into tissue functionality and dynamic physiological processes. For instance, it can detect changes in blood flow, tissue perfusion, and oxygenation without the need for additional contrast agents or scans. This functionality allows for real-time assessment of physiological processes, making it particularly valuable in cardiology, oncology, and neurology for evaluating organ function and monitoring disease progression. • Reduced Noise and Artifact Reduction: Photon-counting technology dramatically reduces electronic noise and imaging artifacts, such as beam hardening, resulting in clearer and more accurate images. The ability to deliver ultra-high resolution images with minimal artifacts improves diagnostic accuracy, reducing the need for repeat scans and ensuring that even subtle abnormalities are detected. 2. Operational Considerations • New Workflow for Molecular, High-Resolution, and Functional Imaging: The integration of molecular, ultra-high resolution, and functional imaging into routine clinical workflows introduces complexity that requires adaptation. Radiologists and technicians need specialized training to interpret and analyze multi-energy datasets that include molecular and functional information. PCCT produces a vast amount of detailed data, requiring clinicians to adopt new imaging protocols and refine their diagnostic approaches to fully leverage its capabilities. • Post-Processing and Data Management: PCCT generates richer, more complex datasets, which necessitates advanced post-processing tools and data management systems. Existing PACS and imaging software may not be equipped to handle such large volumes of data or to process functional and molecular information effectively. This means healthcare institutions must invest in robust IT infrastructure, including upgraded software and storage solutions, as well as provide additional training for staff on new imaging analysis techniques. • Revised Clinical Protocols: The molecular, functional, and ultra-high resolution imaging capabilities of PCCT will likely prompt changes in clinical protocols. For instance, the need for contrast agents may be reduced, simplifying patient preparation and decreasing the risk of adverse reactions. Additionally, the ability to monitor physiological functions in real-time through functional imaging could lead to more dynamic diagnostic procedures, such as assessing the effectiveness of interventions or treatments in real-time. 3. Financial Impact • Higher Initial Investment: PCCT systems are more expensive than traditional CT scanners due to their advanced technology, which includes photon-counting detectors and the computational power required for high-resolution, molecular, and functional imaging. While this upfront cost is significant, it is crucial to view it in the broader context of the downstream benefits and cost reductions that PCCT offers. • Downstream Cost Reductions: Although the initial capital investment is higher, PCCT’s ability to combine molecular, functional, and ultra-high resolution imaging leads to substantial reductions in downstream healthcare costs. Its superior diagnostic accuracy minimizes the need for follow-up tests, repeat scans, or invasive diagnostic procedures, such as diagnostic coronary angiographies. For example, in cardiology, PCCT can precisely differentiate between types of coronary plaque, reducing the need for invasive procedures to assess risk. • Lower Overall Healthcare Expenditures: By enabling earlier, more accurate diagnoses, PCCT can reduce the overall cost of patient care. Early detection of disease, particularly through its molecular and functional imaging capabilities, allows for more targeted treatments, potentially preventing the need for more aggressive and expensive interventions down the line. For instance, early-stage tumor detection via molecular imaging could lead to less invasive treatments, reducing hospital stays and improving patient outcomes, ultimately driving down healthcare costs. • Increased ROI Through Enhanced Patient Outcomes: Over time, the combination of molecular, functional, and ultra-high resolution imaging enhances diagnostic precision, which translates into better patient outcomes. Improved diagnostic accuracy reduces the incidence of unnecessary procedures, minimizes treatment delays, and results in more personalized and effective care. This leads to increased patient satisfaction, better healthcare outcomes, and greater patient throughput—all factors that improve the institution’s return on investment (ROI). • Competitive Advantage and New Revenue Streams: By adopting PCCT, healthcare institutions position themselves at the forefront of advanced imaging technologies. The ability to offer molecular, functional, and ultra-high resolution imaging creates a competitive advantage, attracting more complex and high-value cases. This can boost the institution’s reputation for excellence in diagnostics, leading to increased referrals, new patient populations, and expanded revenue opportunities. Summary Photon Counting CT (PCCT) is not just an evolution of existing CT technology—it is a molecular, ultra-high resolution, and functional imaging modality that fundamentally transforms the diagnostic landscape. Its ability to capture detailed molecular data, visualize minute anatomical structures with ultra-high resolution, and provide real-time functional imaging opens new possibilities for earlier and more precise diagnoses. While the financial investment in PCCT is larger, the reduction in downstream healthcare costs through improved diagnostic accuracy, fewer unnecessary interventions, and earlier disease detection far outweighs the initial expense. For institutions committed to advancing patient care and improving long-term financial outcomes, PCCT is an essential investment in the future of medical imaging. The video attached shows a patient accessing the Hospital for ACS. PCCT can provide ALL the imaging information of the concurrent imaging modalities (CXR, CAG, Echo, CMR) that you see around it... that's a lot! #PhotonCountingCT #MolecularImaging #UltraHighResolution #FunctionalImaging #FutureOfImaging #AdvancedMedicalImaging #EarlyDiseaseDetection #InnovativeCT #CuttingEdgeHealthcare #PrecisionDiagnostics #HealthcareInnovation #MedicalTechnology #CostEffectiveImaging #NextGenCT #PatientCareRevolution

Dr. Filippo Cademartiri

11,849 görüntüleme • 1 yıl önce

Remember when Dr. Fauci televised his COVID-19 vaccination? A short time later, part of his lung died. “He never told anybody,” Robert F. Kennedy Jr. reported to Laura Ingraham this week. “He got treated for it privately by the best doctors in America. At the same time he was telling everybody that was not an adverse event.” A pulmonary infarction is caused by a clot that travels to the lung. It is potentially life threatening. It is something a health authority should tell people about, especially when mRNA vaccines for COVID are considered to potentially be related to clotting pathology. It's just one of the secrets buried in Fauci's diary. Kelly Victory MD and I reviewed Fauci's private writings and key sections of more than 1100 pages released by Senator Rand Paul this week. December 22, 2020: Fauci rolls up his sleeve on camera at the NIH Clinical Center and tells the country he has "extreme confidence in the safety and the efficacy of this vaccine." June 19, 2021: Fauci's diary records a pulmonary infarction found on a CT scan, and his doctors start him on Eliquis, a blood thinner. You may recall that in June of 2021, my interviews with Steve Kirsch and Dr. Zev Zelenko were heavily censored on social media. I received multiple strikes on YouTube and was demonetized for almost a year. Alex Berenson was even banned by Twitter after warning about mRNA side effects. And after Elon Musk released the Twitter Files, it became crystal clear that all along, the government had been pressuring private companies to deplatform dissenting voices. This means at the same time Fauci was experiencing health issues after a COVID vaccination, the Biden administration was actively suppressing physicians who were warning about those same health issues.
17:38

Remember when Dr. Fauci televised his COVID-19 vaccination? A short time later, part of his lung died. “He never told anybody,” Robert F. Kennedy Jr. reported to Laura Ingraham this week. “He got treated for it privately by the best doctors in America. At the same time he was telling everybody that was not an adverse event.” A pulmonary infarction is caused by a clot that travels to the lung. It is potentially life threatening. It is something a health authority should tell people about, especially when mRNA vaccines for COVID are considered to potentially be related to clotting pathology. It's just one of the secrets buried in Fauci's diary. Kelly Victory MD and I reviewed Fauci's private writings and key sections of more than 1100 pages released by Senator Rand Paul this week. December 22, 2020: Fauci rolls up his sleeve on camera at the NIH Clinical Center and tells the country he has "extreme confidence in the safety and the efficacy of this vaccine." June 19, 2021: Fauci's diary records a pulmonary infarction found on a CT scan, and his doctors start him on Eliquis, a blood thinner. You may recall that in June of 2021, my interviews with Steve Kirsch and Dr. Zev Zelenko were heavily censored on social media. I received multiple strikes on YouTube and was demonetized for almost a year. Alex Berenson was even banned by Twitter after warning about mRNA side effects. And after Elon Musk released the Twitter Files, it became crystal clear that all along, the government had been pressuring private companies to deplatform dissenting voices. This means at the same time Fauci was experiencing health issues after a COVID vaccination, the Biden administration was actively suppressing physicians who were warning about those same health issues.

Dr. Drew

128,223 görüntüleme • 29 gün önce

Do you remember the case of the 'frozen addict' from recreational drug use (MPTP). Is there a 'new frozen addict syndrome' caused by methcathione (ephedrone). YES. This psychostimulant leads to release of brain catecholamines. Check out this case and video by Thayler and Gurevitch which responded to amantadine and check out the link to manganese. Key points: - Methcathione (ephedrone) can be used as a recreational drug and use has been documented in Eastern Europe and other world locations. - This chemical is synthesized by oxidation of ephedrine or pseudoephedrine w/potassium permanganate. - It is usually given IV and the 'parkinsonism' is thought to be caused by manganese. - It is unlike the MPTP frozen addict as in this case levodopa does not work to treat. - The authors point out that the syndrome tends to be more symmetrical than in idiopathic PD; the clinician should look for bradykinesia, dystonia, and gait impairment. - Check out this 41 year old case w/ a normal flurodopa PET and an abnormal MRI. - He was treated with a 5-day course of IV amantadine followed by oral amantadine. My take: It is humbling to think about the history of a recreational drug which provided one of our best overall animal models of PD (the MPTP model). Now we are observing another form of recreational drug induced parkinsonism, and this one seems to be related to manganese. It is interesting in this case to observe the response to IV and oral amantadine; which as a therapy has multiple mechanisms of action including on dopamine, acetlycholine and glutamate pathways. In the USA, we have not used IV amantadine so this will be a new trick for us. One important aspect of this case was that the clinicians resisted the urge to 'dismiss the person' as an addict or as functional case. Similar to Bill Langston's experience with the MPTP frozen addict, these authors persisted, made the diagnosis and designed and implemented a treatment. BRAVO. Remember, we will all (one day) come down with a disease or diseases and Fortuna est caeca; Fortune is blind. #Parkinsons #manganese #methcathione #ephedrone
1:07

Do you remember the case of the 'frozen addict' from recreational drug use (MPTP). Is there a 'new frozen addict syndrome' caused by methcathione (ephedrone). YES. This psychostimulant leads to release of brain catecholamines. Check out this case and video by Thayler and Gurevitch which responded to amantadine and check out the link to manganese. Key points: - Methcathione (ephedrone) can be used as a recreational drug and use has been documented in Eastern Europe and other world locations. - This chemical is synthesized by oxidation of ephedrine or pseudoephedrine w/potassium permanganate. - It is usually given IV and the 'parkinsonism' is thought to be caused by manganese. - It is unlike the MPTP frozen addict as in this case levodopa does not work to treat. - The authors point out that the syndrome tends to be more symmetrical than in idiopathic PD; the clinician should look for bradykinesia, dystonia, and gait impairment. - Check out this 41 year old case w/ a normal flurodopa PET and an abnormal MRI. - He was treated with a 5-day course of IV amantadine followed by oral amantadine. My take: It is humbling to think about the history of a recreational drug which provided one of our best overall animal models of PD (the MPTP model). Now we are observing another form of recreational drug induced parkinsonism, and this one seems to be related to manganese. It is interesting in this case to observe the response to IV and oral amantadine; which as a therapy has multiple mechanisms of action including on dopamine, acetlycholine and glutamate pathways. In the USA, we have not used IV amantadine so this will be a new trick for us. One important aspect of this case was that the clinicians resisted the urge to 'dismiss the person' as an addict or as functional case. Similar to Bill Langston's experience with the MPTP frozen addict, these authors persisted, made the diagnosis and designed and implemented a treatment. BRAVO. Remember, we will all (one day) come down with a disease or diseases and Fortuna est caeca; Fortune is blind. #Parkinsons #manganese #methcathione #ephedrone

Michael Okun

13,007 görüntüleme • 2 yıl önce

"Medical Facts, Not Political Agendas: The Reality of Parathyroid Disease Treatment in Pakistan" Every patient has the right to seek treatment in any country they choose in order to access the best possible care. However, they should not resort to blatant misinformation to justify their decision. It is misleading and inaccurate to claim by Maryam Nawaz Sharif that parathyroid diseases are only treated in the USA and Switzerland. Parathyroid conditions such as hyperparathyroidism and hypoparathyroidism have treatment options available in many countries around the world, including UK, Pakistan, France, Germany, Australia, India, the UAE, Qatar and many others. Hyperparathyroidism, often caused by a parathyroid adenoma, is primarily treated with surgical removal. The associated bone diseases due to high parathyroid hormone (PTH) levels are managed with medications like Cinacalcet (Mimcipar) , Bisphosphonates, and Denosumab—all of which are available in Pakistan. Many tertiary and private hospitals in Pakistan perform parathyroidectomy, including Aga Khan University Hospital, Shifa International, Doctors Hospital, and Shaukat Khanum Memorial Cancer Hospital & Research Centre. Endocrine surgery is a common procedure in almost every major city in Pakistan. In the case of hypoparathyroidism, treatment typically involves calcium and vitamin D supplements, and for severe chronic cases, Teriparatide (a PTH analogue) is available in Pakistan for replacement therapy with the name "Forteo". The prevalence of parathyroid disease is around 1%. I am writing this fact check to correct the medical inaccuracies, as such disinformation can have serious consequences: 1. It can create hopelessness and despair among tens of thousands of patients with hyperparathyroidism in Pakistan, who are currently being successfully treated through endocrine surgery and medical management within the country. 2. It is a disrespect to the Pakistani medical community, which includes many renowned specialists in endocrine surgery and disease management. One such name is Professor Dr. Khawaja Azim, who served as the head of surgery at Mayo Hospital in 2009 during our times, and is now working at Shalimar Hospital in Lahore as "consultant endocrine surgeon". I am surprised that none of the UK-based journalists present there have rebutted this false statement. Pakistani political figures must verify the facts and be aware of the impact such statements can have on the healthcare system. Not every Pakistani has the means to travel to the USA or Switzerland for parathyroid treatment—and, more importantly, they do not need to, as the same high-quality treatments are available in Pakistan. I am surprised they included UK in this list of countries without parathyroid treatment. I am tagging UK parathyroid foundation Parathyroid UK and UK medical license body GMC for the correction. I hope Maryam Nawaz Sharif will recognize this error and take the necessary steps to correct it because the parathyroid disease affecting thousands of Pakistani patients is equally important, and medical facts are not the political ballot boxes that could be manipulated for personal agendas. Thank you. ----------------------------------------------------------- Moeed Pirzada @drfaranahmad
0:28

"Medical Facts, Not Political Agendas: The Reality of Parathyroid Disease Treatment in Pakistan" Every patient has the right to seek treatment in any country they choose in order to access the best possible care. However, they should not resort to blatant misinformation to justify their decision. It is misleading and inaccurate to claim by Maryam Nawaz Sharif that parathyroid diseases are only treated in the USA and Switzerland. Parathyroid conditions such as hyperparathyroidism and hypoparathyroidism have treatment options available in many countries around the world, including UK, Pakistan, France, Germany, Australia, India, the UAE, Qatar and many others. Hyperparathyroidism, often caused by a parathyroid adenoma, is primarily treated with surgical removal. The associated bone diseases due to high parathyroid hormone (PTH) levels are managed with medications like Cinacalcet (Mimcipar) , Bisphosphonates, and Denosumab—all of which are available in Pakistan. Many tertiary and private hospitals in Pakistan perform parathyroidectomy, including Aga Khan University Hospital, Shifa International, Doctors Hospital, and Shaukat Khanum Memorial Cancer Hospital & Research Centre. Endocrine surgery is a common procedure in almost every major city in Pakistan. In the case of hypoparathyroidism, treatment typically involves calcium and vitamin D supplements, and for severe chronic cases, Teriparatide (a PTH analogue) is available in Pakistan for replacement therapy with the name "Forteo". The prevalence of parathyroid disease is around 1%. I am writing this fact check to correct the medical inaccuracies, as such disinformation can have serious consequences: 1. It can create hopelessness and despair among tens of thousands of patients with hyperparathyroidism in Pakistan, who are currently being successfully treated through endocrine surgery and medical management within the country. 2. It is a disrespect to the Pakistani medical community, which includes many renowned specialists in endocrine surgery and disease management. One such name is Professor Dr. Khawaja Azim, who served as the head of surgery at Mayo Hospital in 2009 during our times, and is now working at Shalimar Hospital in Lahore as "consultant endocrine surgeon". I am surprised that none of the UK-based journalists present there have rebutted this false statement. Pakistani political figures must verify the facts and be aware of the impact such statements can have on the healthcare system. Not every Pakistani has the means to travel to the USA or Switzerland for parathyroid treatment—and, more importantly, they do not need to, as the same high-quality treatments are available in Pakistan. I am surprised they included UK in this list of countries without parathyroid treatment. I am tagging UK parathyroid foundation Parathyroid UK and UK medical license body GMC for the correction. I hope Maryam Nawaz Sharif will recognize this error and take the necessary steps to correct it because the parathyroid disease affecting thousands of Pakistani patients is equally important, and medical facts are not the political ballot boxes that could be manipulated for personal agendas. Thank you. ----------------------------------------------------------- Moeed Pirzada @drfaranahmad

Dr Waqas Nawaz

280,908 görüntüleme • 1 yıl önce

$NWBO #𝗗𝗖𝗩𝗮𝘅-𝗟: 𝗧𝗵𝗲 𝗘𝘃𝗶𝗱𝗲𝗻𝗰𝗲 𝗶𝗻 𝗣𝗹𝗮𝗶𝗻 𝗧𝗲𝗿𝗺𝘀 A short, plain-language reading of the survival evidence for DCVax-L in #glioblastoma, and what it means under the MHRAgovuk guideline on external control arms. 📊 𝗣𝗔𝗥𝗧 𝗢𝗡𝗘: 𝗪𝗛𝗔𝗧 𝗧𝗛𝗘 𝗧𝗥𝗜𝗔𝗟 𝗙𝗢𝗨𝗡𝗗, 𝗔𝗡𝗗 𝗪𝗛𝗬 𝗜𝗧 𝗠𝗔𝗧𝗧𝗘𝗥𝗦 DCVax-L more than doubled five-year survival, and the benefit is durability: a subset gets lasting disease control and simply stays alive. 💉 𝗪𝗵𝗮𝘁 𝘁𝗵𝗲 𝗱𝗿𝘂𝗴 𝗶𝘀 DCVax-L is a personalized cancer vaccine for glioblastoma, the deadliest form of brain cancer and a designated orphan disease. It is a living drug: its active ingredient is the patient's own immune cells, primed with proteins from that patient's surgically removed tumor, so the immune system learns to attack the cancer. Unlike a chemical drug that is metabolized and cleared, it switches on a living immune response that keeps working long after the injection. Glioblastoma comes back in almost everyone: even with the full standard of surgery, radiation, and temozolomide chemotherapy, most patients live under two years, and only about one in twenty reaches five. DCVax-L is given on top of that standard care, not in place of it: every patient in the trial received surgery, radiation, and temozolomide, and the vaccine was added to it, so the comparison measures what the vaccine adds. For two decades, nearly every new drug tried in this disease has failed. That is the backdrop against which any positive result must be judged. 📈 𝗪𝗵𝗮𝘁 𝘁𝗵𝗲 𝘁𝗿𝗶𝗮𝗹 𝗳𝗼𝘂𝗻𝗱 In a Phase 3 trial of 331 patients, those who received DCVax-L lived longer. At the median the gain looks modest, about three months (19.3 versus 16.5). The number that matters sits at the far end of the survival curve: more than twice as many vaccine patients were alive at five years, 13.0% versus 5.7%, and a few reached ten years in a disease that usually kills within three. In patients whose tumor had already returned, the effect was larger still, cutting the risk of death by about 42%. 👥 𝗘𝘃𝗲𝗿𝘆 𝗴𝗿𝗼𝘂𝗽 𝗯𝗲𝗻𝗲𝗳𝗶𝘁𝗲𝗱, 𝗲𝘃𝗲𝗻 𝘁𝗵𝗲 𝗵𝗮𝗿𝗱𝗲𝘀𝘁 𝘁𝗼 𝘁𝗿𝗲𝗮𝘁 The benefit was not confined to the easy cases. Of the six prespecified subgroups the trial examined, every single one favored DCVax-L, and there was no group in which it did worse than standard care. The largest gains came in patients whose tumors carry MGMT methylation, who reached a median survival of 30.2 months from randomization against 21.3 for the controls. But even the hardest-to-treat patients, whose tumors lack that methylation, resist standard chemotherapy, and carry the worst prognosis in this disease, still came out ahead with the vaccine, at a hazard ratio of 0.93. A treatment that helps across the whole population, and helps most where the biology is most favorable, is acting like a real drug. 📉 𝗪𝗵𝘆 𝘁𝗵𝗲 𝗺𝗲𝗱𝗶𝗮𝗻 𝗵𝗶𝗱𝗲𝘀 𝘁𝗵𝗲 𝗿𝗲𝗮𝗹 𝘀𝘁𝗼𝗿𝘆 That five-year number is the whole story, and the median buries it. Almost every treatment that ever helped in glioblastoma did the same modest thing: it slid the survival curve a few months to the right, then let it fall back. Doubling five-year survival is different in kind. A three-month gain at the median cannot, by itself, double the fraction alive at five years. The only shape that produces both numbers is a split: most patients get the small delay the median measures, while a subset gets durable disease control that lasts for years, well past where glioblastoma should have ended them. That subset is the long tail of the curve, and it is where the benefit lives. A median ignores extremes, the way a town's median income tells you nothing about its millionaires. The real story is not a longer delay; it is that a meaningful share of patients simply stay alive. 🧬 𝗪𝗵𝘆 𝘁𝗵𝗲 𝗯𝗶𝗼𝗹𝗼𝗴𝘆 𝗽𝗿𝗲𝗱𝗶𝗰𝘁𝘀 𝘁𝗵𝗶𝘀 𝘀𝗵𝗮𝗽𝗲 The tail is not luck. It is what this biology is built to produce. The vaccine carries proteins from the patient's own tumor, so it aims the immune system at whatever that tumor is made of, not a fixed short list of targets. And it amplifies: one trained immune cell drives many others that multiply into cancer-killers. Andres Salazar, the neurologist who developed poly-ICLC into the clinical adjuvant given with the vaccine, puts it in a line: you start the fire, and you keep it burning. A response like that does not produce a one-time bump. It builds and widens over time. What matters is not just that a response forms, but what kind. Dendritic cells are the immune system's master switch for that, the cells that set what kind of attack the body mounts, and this vaccine is built from them. It drives what immunologists call a type 1 polarized response: an interferon-driven, cytotoxic program aimed squarely at the tumor. That direction comes from the vaccine itself; the poly-ICLC adjuvant given with it drives the same interferon program and sustains it. That is the active ingredient, and it has been measured. In UCLA studies of this approach, the patients whose immune systems mounted the strongest interferon response lived the longest. The response also spreads. In a different cancer, a vaccine carried on this same poly-ICLC adjuvant drove more than 70% of a patient's cancer-killing T cells to target proteins that were never in the vaccine: the immune system outgrew its original targets and went after the rest of the tumor on its own. This is called epitope spreading, and it is not particular to one tumor; it is what this kind of response does, and it is the kind of response DCVax-L builds. That breadth is the likeliest thing separating the long-term survivors from everyone else, a response that breaks past its targets and clears the disease rather than one that stays caged and stops. There is even a tell in who benefits most: the effect is largest in tumors whose biology builds up more mutations under chemotherapy, and more mutations mean more targets for a whole-tumor vaccine to find. The same logic explains what the vaccine is not, and what it does not need. Checkpoint inhibitors, the drugs that release the immune system's brakes, have failed on their own in glioblastoma because there was no active response to release; the vaccine supplies that response first. That makes the vaccine the natural foundation for combination therapy. Combining it with its poly-ICLC adjuvant, made by Oncovir, has already shown meaningful survival gains in a published analysis. In the pivotal trial, the vaccine's proven benefit came added on top of standard chemotherapy and radiation; the newer question is how much the immune response can carry on its own. A UCLA trial is now testing that in patients whose tumors have returned, adding #Keytruda (pembrolizumab), the checkpoint antibody from $MRK, in a regimen built entirely around the immune response with no chemotherapy or radiation in it at all. Its interim survival curve shows the shape the biology predicts. In the arm given the vaccine and Keytruda together after surgery, the curve does not fall away but flattens into a plateau, with roughly 65% of patients still alive well past the point where recurrent glioblastoma kills nearly everyone. That plateau is the signature of a response that took hold and lasted, the type 1 attack forming durable immune memory so that once the disease is controlled it stays controlled. That is where this points, and where it is already arriving, a treatment that works through the response itself, one that could in time lean less on the harsh radiation and chemotherapy that have defined glioblastoma care and barely moved its survival. These are interim results, from Prins, Cloughesy, and Liau at UCLA. 🔍 𝗣𝗔𝗥𝗧 𝗧𝗪𝗢: 𝗜𝗦 𝗜𝗧 𝗥𝗘𝗔𝗟? The trial was randomized, an independent experiment shows the outside comparison is trustworthy, and every separate check points the same way. 🤔 𝗧𝗵𝗲 𝗼𝗯𝗷𝗲𝗰𝘁𝗶𝗼𝗻, 𝗮𝗻𝗱 𝘄𝗵𝘆 𝗶𝘁 𝗺𝗶𝘀𝘀𝗲𝘀 𝘁𝗵𝗲 𝗺𝗮𝗿𝗸 So much for what happened; the harder question is whether to believe it. The trial has the feature critics attacked: it could not keep a normal placebo group, because patients assigned to placebo were allowed, by design and by medical ethics, to switch to the vaccine once their cancer returned, and almost all did. That erased the internal comparison, so survival was measured against closely matched patients from other completed trials, an approach called an external control, which critics argued could tilt toward the vaccine. What the objection misses is where the randomization went. This was a randomized, blinded trial. The patients who got the vaccine were assigned to it at random, not hand-picked, so the treated group is an ordinary slice of the trial population, not a favorable one. The crossover removed the placebo group but never touched how patients were assigned. That leaves exactly one place for bias to enter, the outside comparison group, which is precisely what the next checks test. ✅ 𝗧𝗵𝗲 𝗰𝗵𝗲𝗰𝗸 𝘁𝗵𝗮𝘁 𝗺𝗮𝗸𝗲𝘀 𝗶𝘁 𝘁𝗿𝘂𝘀𝘁𝘄𝗼𝗿𝘁𝗵𝘆 Before trusting a scale to weigh something unknown, you confirm it reads zero with nothing on it. That is what the calibration does, and it is the strongest part of the case. A separate, independent randomized trial called INSIGhT was run through the very same external-control method, and it gave two answers. First, three experimental drugs that had already failed were run through it, and it correctly found nothing (hazard ratios of 1.00, 0.93, and 0.88): the method does not manufacture a benefit where none exists. Second, INSIGhT's external controls were set head to head against its own randomized internal controls, and they were statistically indistinguishable. In this disease, an external control reproduces the answer a real randomized control would have given, and because that trial belonged to a different group, no one can say a sponsor graded its own work. The one place bias could enter, the control side, is the one place an independent randomized experiment certified as clean. There is a deeper fit worth naming, and it is what makes the two halves of this case one. The same instrument that reported those three failures as failures reads the vaccine as a success, and the biology says why: those drugs could not hold a tumor this varied, and the vaccine builds the broad, lasting response that finally does. One method, opposite readings, and one mechanism behind both. The statistics and the biology are not two arguments. They are the same argument seen twice. 🃏 𝗪𝗮𝘀 𝘁𝗵𝗲 𝗰𝗼𝗺𝗽𝗮𝗿𝗶𝘀𝗼𝗻 𝘀𝘁𝗮𝗰𝗸𝗲𝗱 𝗶𝗻 𝘁𝗵𝗲 𝘃𝗮𝗰𝗰𝗶𝗻𝗲'𝘀 𝗳𝗮𝘃𝗼𝗿? A natural worry is that the outside comparison was arranged after the fact to flatter the vaccine. The trial was built to prevent that. The patients to compare against, and the rules for matching them, were fixed in writing before anyone saw results, and an independent firm, not the company, chose the comparison trials against those rules. The trial also switched its main measure partway through, from delaying tumor growth to overall survival, but that was not a maneuver: immune treatments cause a harmless swelling that mimics tumor growth on scans and made the growth measure unreliable, and the switch was made while everyone was still blinded. Three further checks point the same way. Survival in this disease has not improved over the years the comparison spans, so same-era controls are sound. When the borrowed controls were tested directly, the comparison came out conservative rather than flattering. And the controls were counted from the same point in the disease as the vaccine patients, so neither side got a head start. Where the comparison can err, it errs against the drug. 🔬 𝗧𝗵𝗲 𝗺𝗼𝗿𝗲 𝗰𝗮𝗿𝗲𝗳𝘂𝗹 𝗮𝗻𝗮𝗹𝘆𝘀𝗶𝘀 𝗺𝗮𝗱𝗲 𝘁𝗵𝗲 𝗯𝗲𝗻𝗲𝗳𝗶𝘁 𝗯𝗶𝗴𝗴𝗲𝗿, 𝗻𝗼𝘁 𝘀𝗺𝗮𝗹𝗹𝗲𝗿 The first comparison used whole groups. A sharper one became possible once patient-level records from three other trials could be obtained, pairing each vaccine patient with controls matched on the traits that drive survival in glioblastoma, above all MGMT methylation status, matched exactly, plus age, sex, extent of surgery, residual disease, and performance status. When the comparison got sharper, the benefit grew in every one of these analyses. The original cohort-level estimate was 2.8 months. Patient-level matching across the three trials put the gain between 3.4 and 6.3 months, and a method that weights patients rather than pairing them put it between 3.4 and 4.3, with several of the matched comparisons roughly doubling the original figure. The hazard ratio moved the same way, from 0.80 to between 0.69 and 0.77. The direction matters. A real effect blurred by crude matching gets clearer when the matching improves, while a biased one tends to shrink. It got stronger. 🕵️ 𝗛𝗼𝘄 𝗺𝘂𝗰𝗵 𝗵𝗶𝗱𝗱𝗲𝗻 𝗯𝗶𝗮𝘀 𝘄𝗼𝘂𝗹𝗱 𝗶𝘁 𝘁𝗮𝗸𝗲 𝘁𝗼 𝗲𝘅𝗽𝗹𝗮𝗶𝗻 𝘁𝗵𝗶𝘀 𝗮𝘄𝗮𝘆 A fair question is how much hidden bias it would take to erase the result. Statisticians measure that with the E-value, and here a hidden factor would have to be about as strong as age is on survival, would also have to drive who received the vaccine, and would have to have escaped the decades of research that mapped every known risk factor in this disease. A second, independent check, Rosenbaum's Gamma, comes at it from the other side, asking how large an unseen imbalance between matched patients it would take to break the result, and it reaches the same verdict. Every factor strong enough to matter was already matched. A hidden one that clears that bar is not plausible. 🔒 𝗪𝗵𝘆 𝘁𝗵𝗲 𝗿𝗲𝘀𝘂𝗹𝘁 𝗶𝘀 𝗵𝗮𝗿𝗱 𝘁𝗼 𝗳𝗮𝗸𝗲 The strongest point is not any single result. It is that a hidden bias big enough to explain the effect away would have to produce the same answer in every independent test at once: • The independent randomized calibration trial. • Three separate comparison trials, drawn from different studies. • Two different statistical methods that handle the data in different ways. • A separate pooled analysis of other dendritic-cell vaccine trials. • The internal math of the survival curve, which points to the same result (about 0.71 at five years) that the patient matching found. And it would have to fall in the exact direction the biology predicted before any data existed: a slow, widening benefit concentrated in long-term survivors. A single hidden factor that could forge all of that at once is not a hidden factor. It is a coincidence that does not happen. 🩺 𝗣𝗔𝗥𝗧 𝗧𝗛𝗥𝗘𝗘: 𝗪𝗛𝗔𝗧 𝗜𝗧 𝗠𝗘𝗔𝗡𝗦 The drug is nearly free of harm, the evidence fits an established and approved regulatory path, and what remains unrun changes nothing about the case. 🛡️ 𝗧𝗵𝗲 𝘀𝗮𝗳𝗲𝘁𝘆 Two things decide whether a real effect reaches patients: whether the drug is safe enough to use, and whether regulators will accept the evidence. The first is settled. Across 2,151 doses, only five serious side effects were even possibly related to the vaccine, with no autoimmunity and no cytokine storm. It is made once, in about eight days, then stored and given as a simple injection. When a treatment barely harms, the benefit needed to justify it falls, and the benefit here clears that lower bar easily. ⏳ 𝗪𝗵𝘆 𝘁𝗵𝗲 𝘀𝘁𝗿𝗼𝗻𝗴𝗲𝗿 𝗱𝗮𝘁𝗮 𝗮𝗽𝗽𝗲𝗮𝗿𝗲𝗱 𝗼𝗻𝗹𝘆 𝗻𝗼𝘄 A reasonable person asks why the sharper analysis appeared in 2026 and not in 2023. The answer is access, not choice. The patient-level analysis was written into the trial's plan from the start, to run if and when the data could be obtained. The company tried and could not get it in 2023, because the trials that held it had not released it; it became available later through a data-sharing repository, on the data owners' timeline, not the company's. The stronger analysis was always the plan. It was waiting on data that other parties control. 🔄 𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗵𝗼𝘀𝗲 𝗰𝗮𝗻𝗰𝗲𝗿 𝗿𝗲𝘁𝘂𝗿𝗻𝗲𝗱 𝗮𝗹𝘀𝗼 𝗯𝗲𝗻𝗲𝗳𝗶𝘁𝗲𝗱 The vaccine helped not only newly diagnosed patients but also those whose tumor had already come back, and there the effect was the largest seen anywhere in the trial. In that group, median survival ran 13.2 months from recurrence against 7.8 for the controls. The separation opened immediately, with 90.6% of vaccine patients alive at six months against 64.0% of controls, and the lead held to the later marks, where survival more than doubled: 20.7% against 9.6% at two years, 11.1% against 5.1% at two and a half. These are the original cohort-level results, already published. The high-resolution patient-level matching that was applied to the newly diagnosed group has not yet been done here, for a practical reason: it needs patient records from other recurrent-cancer trials, held by a European research organization that shares them through its own formal request. Obtaining them is a routine next step, not an obstacle, and the newly diagnosed experience suggests the sharper analysis would only make the recurrent result stronger. The approval case rests on the newly diagnosed evidence, so nothing important depends on this step; it would simply sharpen a result that is already the strongest in the trial. 🏛️ 𝗪𝗵𝗮𝘁 𝘁𝗵𝗶𝘀 𝗺𝗲𝗮𝗻𝘀 𝗳𝗼𝗿 𝗮𝗽𝗽𝗿𝗼𝘃𝗮𝗹 Regulators do not treat an external control as a first choice, but the MHRA's guideline allows it in exactly this situation: a severe disease where a placebo trial is not ethical or feasible, and an effect large enough to interpret despite the design. The guideline even gives its own worked example of an acceptable external control, and it reads almost like a description of this trial: a rare disease, no ethical placebo, same-era standard-of-care controls, an objective survival endpoint, and an effect too large to blame on bias. DCVax-L fits on every count, and it was the first medicine ever to receive the MHRA's Promising Innovative Medicine designation, which asks essentially the same questions. The newly diagnosed case carries the decision on its own evidence, and regulators weigh that evidence against the disease it treats: in a cancer this lethal, with nothing better on offer, the question is whether the benefit is large, clear, and consistent enough to act on, and a benefit of this size, pointing the same way from every direction, is. 📜 𝗧𝗵𝗶𝘀 𝗵𝗮𝘀 𝗯𝗲𝗲𝗻 𝗱𝗼𝗻𝗲 𝗯𝗲𝗳𝗼𝗿𝗲, 𝗮𝗻𝗱 𝗮𝗽𝗽𝗿𝗼𝘃𝗲𝗱 External controls are not a novelty invented for this drug. Over the past two decades they have factored into roughly forty-five drug approvals by the United States regulator, each granted under the conditions that apply here: a serious or rare disease, a placebo that would be unethical, and high unmet need. Regulators do not grant this lightly. They grant it when the disease is serious, its course is predictable and objectively measured, and the effect is large. Glioblastoma meets all three. The named cases cover every part of this disease's profile. Defibrotide, for a life-threatening transplant complication, was approved on a propensity-score comparison to a historical control, the same kind of method used here. Blinatumomab, for an aggressive relapsed leukemia, is the precedent for a fast-killing cancer, cleared by both the United States and European regulators. Cerliponase alfa is the precedent for a fatal brain disease, cleared by both agencies on treated patients versus a matched natural-history group. Glioblastoma is both at once, a fast-killing cancer of the brain, read by the same method, so no part of its profile lacks a close approved precedent. And on the one axis that governs how far an external-control result can be trusted, DCVax-L goes beyond all three. Each of those drugs was tested in a single-arm trial, with no randomization at all. DCVax-L began as a randomized trial and became an external-control comparison only when ethics consumed its placebo group. It sits in that tradition, and at the top of it. 🎯 𝗧𝗵𝗲 𝗯𝗼𝘁𝘁𝗼𝗺 𝗹𝗶𝗻𝗲 This began as a randomized trial. Medical ethics forced it into an external-control comparison. Every independent way of checking it, on different data and different math, points the same direction, and the biology predicted that direction in advance. The first analysis did not overstate the vaccine's effect. Read with the right tools, it understated it.
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$NWBO #𝗗𝗖𝗩𝗮𝘅-𝗟: 𝗧𝗵𝗲 𝗘𝘃𝗶𝗱𝗲𝗻𝗰𝗲 𝗶𝗻 𝗣𝗹𝗮𝗶𝗻 𝗧𝗲𝗿𝗺𝘀 A short, plain-language reading of the survival evidence for DCVax-L in #glioblastoma, and what it means under the MHRAgovuk guideline on external control arms. 📊 𝗣𝗔𝗥𝗧 𝗢𝗡𝗘: 𝗪𝗛𝗔𝗧 𝗧𝗛𝗘 𝗧𝗥𝗜𝗔𝗟 𝗙𝗢𝗨𝗡𝗗, 𝗔𝗡𝗗 𝗪𝗛𝗬 𝗜𝗧 𝗠𝗔𝗧𝗧𝗘𝗥𝗦 DCVax-L more than doubled five-year survival, and the benefit is durability: a subset gets lasting disease control and simply stays alive. 💉 𝗪𝗵𝗮𝘁 𝘁𝗵𝗲 𝗱𝗿𝘂𝗴 𝗶𝘀 DCVax-L is a personalized cancer vaccine for glioblastoma, the deadliest form of brain cancer and a designated orphan disease. It is a living drug: its active ingredient is the patient's own immune cells, primed with proteins from that patient's surgically removed tumor, so the immune system learns to attack the cancer. Unlike a chemical drug that is metabolized and cleared, it switches on a living immune response that keeps working long after the injection. Glioblastoma comes back in almost everyone: even with the full standard of surgery, radiation, and temozolomide chemotherapy, most patients live under two years, and only about one in twenty reaches five. DCVax-L is given on top of that standard care, not in place of it: every patient in the trial received surgery, radiation, and temozolomide, and the vaccine was added to it, so the comparison measures what the vaccine adds. For two decades, nearly every new drug tried in this disease has failed. That is the backdrop against which any positive result must be judged. 📈 𝗪𝗵𝗮𝘁 𝘁𝗵𝗲 𝘁𝗿𝗶𝗮𝗹 𝗳𝗼𝘂𝗻𝗱 In a Phase 3 trial of 331 patients, those who received DCVax-L lived longer. At the median the gain looks modest, about three months (19.3 versus 16.5). The number that matters sits at the far end of the survival curve: more than twice as many vaccine patients were alive at five years, 13.0% versus 5.7%, and a few reached ten years in a disease that usually kills within three. In patients whose tumor had already returned, the effect was larger still, cutting the risk of death by about 42%. 👥 𝗘𝘃𝗲𝗿𝘆 𝗴𝗿𝗼𝘂𝗽 𝗯𝗲𝗻𝗲𝗳𝗶𝘁𝗲𝗱, 𝗲𝘃𝗲𝗻 𝘁𝗵𝗲 𝗵𝗮𝗿𝗱𝗲𝘀𝘁 𝘁𝗼 𝘁𝗿𝗲𝗮𝘁 The benefit was not confined to the easy cases. Of the six prespecified subgroups the trial examined, every single one favored DCVax-L, and there was no group in which it did worse than standard care. The largest gains came in patients whose tumors carry MGMT methylation, who reached a median survival of 30.2 months from randomization against 21.3 for the controls. But even the hardest-to-treat patients, whose tumors lack that methylation, resist standard chemotherapy, and carry the worst prognosis in this disease, still came out ahead with the vaccine, at a hazard ratio of 0.93. A treatment that helps across the whole population, and helps most where the biology is most favorable, is acting like a real drug. 📉 𝗪𝗵𝘆 𝘁𝗵𝗲 𝗺𝗲𝗱𝗶𝗮𝗻 𝗵𝗶𝗱𝗲𝘀 𝘁𝗵𝗲 𝗿𝗲𝗮𝗹 𝘀𝘁𝗼𝗿𝘆 That five-year number is the whole story, and the median buries it. Almost every treatment that ever helped in glioblastoma did the same modest thing: it slid the survival curve a few months to the right, then let it fall back. Doubling five-year survival is different in kind. A three-month gain at the median cannot, by itself, double the fraction alive at five years. The only shape that produces both numbers is a split: most patients get the small delay the median measures, while a subset gets durable disease control that lasts for years, well past where glioblastoma should have ended them. That subset is the long tail of the curve, and it is where the benefit lives. A median ignores extremes, the way a town's median income tells you nothing about its millionaires. The real story is not a longer delay; it is that a meaningful share of patients simply stay alive. 🧬 𝗪𝗵𝘆 𝘁𝗵𝗲 𝗯𝗶𝗼𝗹𝗼𝗴𝘆 𝗽𝗿𝗲𝗱𝗶𝗰𝘁𝘀 𝘁𝗵𝗶𝘀 𝘀𝗵𝗮𝗽𝗲 The tail is not luck. It is what this biology is built to produce. The vaccine carries proteins from the patient's own tumor, so it aims the immune system at whatever that tumor is made of, not a fixed short list of targets. And it amplifies: one trained immune cell drives many others that multiply into cancer-killers. Andres Salazar, the neurologist who developed poly-ICLC into the clinical adjuvant given with the vaccine, puts it in a line: you start the fire, and you keep it burning. A response like that does not produce a one-time bump. It builds and widens over time. What matters is not just that a response forms, but what kind. Dendritic cells are the immune system's master switch for that, the cells that set what kind of attack the body mounts, and this vaccine is built from them. It drives what immunologists call a type 1 polarized response: an interferon-driven, cytotoxic program aimed squarely at the tumor. That direction comes from the vaccine itself; the poly-ICLC adjuvant given with it drives the same interferon program and sustains it. That is the active ingredient, and it has been measured. In UCLA studies of this approach, the patients whose immune systems mounted the strongest interferon response lived the longest. The response also spreads. In a different cancer, a vaccine carried on this same poly-ICLC adjuvant drove more than 70% of a patient's cancer-killing T cells to target proteins that were never in the vaccine: the immune system outgrew its original targets and went after the rest of the tumor on its own. This is called epitope spreading, and it is not particular to one tumor; it is what this kind of response does, and it is the kind of response DCVax-L builds. That breadth is the likeliest thing separating the long-term survivors from everyone else, a response that breaks past its targets and clears the disease rather than one that stays caged and stops. There is even a tell in who benefits most: the effect is largest in tumors whose biology builds up more mutations under chemotherapy, and more mutations mean more targets for a whole-tumor vaccine to find. The same logic explains what the vaccine is not, and what it does not need. Checkpoint inhibitors, the drugs that release the immune system's brakes, have failed on their own in glioblastoma because there was no active response to release; the vaccine supplies that response first. That makes the vaccine the natural foundation for combination therapy. Combining it with its poly-ICLC adjuvant, made by Oncovir, has already shown meaningful survival gains in a published analysis. In the pivotal trial, the vaccine's proven benefit came added on top of standard chemotherapy and radiation; the newer question is how much the immune response can carry on its own. A UCLA trial is now testing that in patients whose tumors have returned, adding #Keytruda (pembrolizumab), the checkpoint antibody from $MRK, in a regimen built entirely around the immune response with no chemotherapy or radiation in it at all. Its interim survival curve shows the shape the biology predicts. In the arm given the vaccine and Keytruda together after surgery, the curve does not fall away but flattens into a plateau, with roughly 65% of patients still alive well past the point where recurrent glioblastoma kills nearly everyone. That plateau is the signature of a response that took hold and lasted, the type 1 attack forming durable immune memory so that once the disease is controlled it stays controlled. That is where this points, and where it is already arriving, a treatment that works through the response itself, one that could in time lean less on the harsh radiation and chemotherapy that have defined glioblastoma care and barely moved its survival. These are interim results, from Prins, Cloughesy, and Liau at UCLA. 🔍 𝗣𝗔𝗥𝗧 𝗧𝗪𝗢: 𝗜𝗦 𝗜𝗧 𝗥𝗘𝗔𝗟? The trial was randomized, an independent experiment shows the outside comparison is trustworthy, and every separate check points the same way. 🤔 𝗧𝗵𝗲 𝗼𝗯𝗷𝗲𝗰𝘁𝗶𝗼𝗻, 𝗮𝗻𝗱 𝘄𝗵𝘆 𝗶𝘁 𝗺𝗶𝘀𝘀𝗲𝘀 𝘁𝗵𝗲 𝗺𝗮𝗿𝗸 So much for what happened; the harder question is whether to believe it. The trial has the feature critics attacked: it could not keep a normal placebo group, because patients assigned to placebo were allowed, by design and by medical ethics, to switch to the vaccine once their cancer returned, and almost all did. That erased the internal comparison, so survival was measured against closely matched patients from other completed trials, an approach called an external control, which critics argued could tilt toward the vaccine. What the objection misses is where the randomization went. This was a randomized, blinded trial. The patients who got the vaccine were assigned to it at random, not hand-picked, so the treated group is an ordinary slice of the trial population, not a favorable one. The crossover removed the placebo group but never touched how patients were assigned. That leaves exactly one place for bias to enter, the outside comparison group, which is precisely what the next checks test. ✅ 𝗧𝗵𝗲 𝗰𝗵𝗲𝗰𝗸 𝘁𝗵𝗮𝘁 𝗺𝗮𝗸𝗲𝘀 𝗶𝘁 𝘁𝗿𝘂𝘀𝘁𝘄𝗼𝗿𝘁𝗵𝘆 Before trusting a scale to weigh something unknown, you confirm it reads zero with nothing on it. That is what the calibration does, and it is the strongest part of the case. A separate, independent randomized trial called INSIGhT was run through the very same external-control method, and it gave two answers. First, three experimental drugs that had already failed were run through it, and it correctly found nothing (hazard ratios of 1.00, 0.93, and 0.88): the method does not manufacture a benefit where none exists. Second, INSIGhT's external controls were set head to head against its own randomized internal controls, and they were statistically indistinguishable. In this disease, an external control reproduces the answer a real randomized control would have given, and because that trial belonged to a different group, no one can say a sponsor graded its own work. The one place bias could enter, the control side, is the one place an independent randomized experiment certified as clean. There is a deeper fit worth naming, and it is what makes the two halves of this case one. The same instrument that reported those three failures as failures reads the vaccine as a success, and the biology says why: those drugs could not hold a tumor this varied, and the vaccine builds the broad, lasting response that finally does. One method, opposite readings, and one mechanism behind both. The statistics and the biology are not two arguments. They are the same argument seen twice. 🃏 𝗪𝗮𝘀 𝘁𝗵𝗲 𝗰𝗼𝗺𝗽𝗮𝗿𝗶𝘀𝗼𝗻 𝘀𝘁𝗮𝗰𝗸𝗲𝗱 𝗶𝗻 𝘁𝗵𝗲 𝘃𝗮𝗰𝗰𝗶𝗻𝗲'𝘀 𝗳𝗮𝘃𝗼𝗿? A natural worry is that the outside comparison was arranged after the fact to flatter the vaccine. The trial was built to prevent that. The patients to compare against, and the rules for matching them, were fixed in writing before anyone saw results, and an independent firm, not the company, chose the comparison trials against those rules. The trial also switched its main measure partway through, from delaying tumor growth to overall survival, but that was not a maneuver: immune treatments cause a harmless swelling that mimics tumor growth on scans and made the growth measure unreliable, and the switch was made while everyone was still blinded. Three further checks point the same way. Survival in this disease has not improved over the years the comparison spans, so same-era controls are sound. When the borrowed controls were tested directly, the comparison came out conservative rather than flattering. And the controls were counted from the same point in the disease as the vaccine patients, so neither side got a head start. Where the comparison can err, it errs against the drug. 🔬 𝗧𝗵𝗲 𝗺𝗼𝗿𝗲 𝗰𝗮𝗿𝗲𝗳𝘂𝗹 𝗮𝗻𝗮𝗹𝘆𝘀𝗶𝘀 𝗺𝗮𝗱𝗲 𝘁𝗵𝗲 𝗯𝗲𝗻𝗲𝗳𝗶𝘁 𝗯𝗶𝗴𝗴𝗲𝗿, 𝗻𝗼𝘁 𝘀𝗺𝗮𝗹𝗹𝗲𝗿 The first comparison used whole groups. A sharper one became possible once patient-level records from three other trials could be obtained, pairing each vaccine patient with controls matched on the traits that drive survival in glioblastoma, above all MGMT methylation status, matched exactly, plus age, sex, extent of surgery, residual disease, and performance status. When the comparison got sharper, the benefit grew in every one of these analyses. The original cohort-level estimate was 2.8 months. Patient-level matching across the three trials put the gain between 3.4 and 6.3 months, and a method that weights patients rather than pairing them put it between 3.4 and 4.3, with several of the matched comparisons roughly doubling the original figure. The hazard ratio moved the same way, from 0.80 to between 0.69 and 0.77. The direction matters. A real effect blurred by crude matching gets clearer when the matching improves, while a biased one tends to shrink. It got stronger. 🕵️ 𝗛𝗼𝘄 𝗺𝘂𝗰𝗵 𝗵𝗶𝗱𝗱𝗲𝗻 𝗯𝗶𝗮𝘀 𝘄𝗼𝘂𝗹𝗱 𝗶𝘁 𝘁𝗮𝗸𝗲 𝘁𝗼 𝗲𝘅𝗽𝗹𝗮𝗶𝗻 𝘁𝗵𝗶𝘀 𝗮𝘄𝗮𝘆 A fair question is how much hidden bias it would take to erase the result. Statisticians measure that with the E-value, and here a hidden factor would have to be about as strong as age is on survival, would also have to drive who received the vaccine, and would have to have escaped the decades of research that mapped every known risk factor in this disease. A second, independent check, Rosenbaum's Gamma, comes at it from the other side, asking how large an unseen imbalance between matched patients it would take to break the result, and it reaches the same verdict. Every factor strong enough to matter was already matched. A hidden one that clears that bar is not plausible. 🔒 𝗪𝗵𝘆 𝘁𝗵𝗲 𝗿𝗲𝘀𝘂𝗹𝘁 𝗶𝘀 𝗵𝗮𝗿𝗱 𝘁𝗼 𝗳𝗮𝗸𝗲 The strongest point is not any single result. It is that a hidden bias big enough to explain the effect away would have to produce the same answer in every independent test at once: • The independent randomized calibration trial. • Three separate comparison trials, drawn from different studies. • Two different statistical methods that handle the data in different ways. • A separate pooled analysis of other dendritic-cell vaccine trials. • The internal math of the survival curve, which points to the same result (about 0.71 at five years) that the patient matching found. And it would have to fall in the exact direction the biology predicted before any data existed: a slow, widening benefit concentrated in long-term survivors. A single hidden factor that could forge all of that at once is not a hidden factor. It is a coincidence that does not happen. 🩺 𝗣𝗔𝗥𝗧 𝗧𝗛𝗥𝗘𝗘: 𝗪𝗛𝗔𝗧 𝗜𝗧 𝗠𝗘𝗔𝗡𝗦 The drug is nearly free of harm, the evidence fits an established and approved regulatory path, and what remains unrun changes nothing about the case. 🛡️ 𝗧𝗵𝗲 𝘀𝗮𝗳𝗲𝘁𝘆 Two things decide whether a real effect reaches patients: whether the drug is safe enough to use, and whether regulators will accept the evidence. The first is settled. Across 2,151 doses, only five serious side effects were even possibly related to the vaccine, with no autoimmunity and no cytokine storm. It is made once, in about eight days, then stored and given as a simple injection. When a treatment barely harms, the benefit needed to justify it falls, and the benefit here clears that lower bar easily. ⏳ 𝗪𝗵𝘆 𝘁𝗵𝗲 𝘀𝘁𝗿𝗼𝗻𝗴𝗲𝗿 𝗱𝗮𝘁𝗮 𝗮𝗽𝗽𝗲𝗮𝗿𝗲𝗱 𝗼𝗻𝗹𝘆 𝗻𝗼𝘄 A reasonable person asks why the sharper analysis appeared in 2026 and not in 2023. The answer is access, not choice. The patient-level analysis was written into the trial's plan from the start, to run if and when the data could be obtained. The company tried and could not get it in 2023, because the trials that held it had not released it; it became available later through a data-sharing repository, on the data owners' timeline, not the company's. The stronger analysis was always the plan. It was waiting on data that other parties control. 🔄 𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗵𝗼𝘀𝗲 𝗰𝗮𝗻𝗰𝗲𝗿 𝗿𝗲𝘁𝘂𝗿𝗻𝗲𝗱 𝗮𝗹𝘀𝗼 𝗯𝗲𝗻𝗲𝗳𝗶𝘁𝗲𝗱 The vaccine helped not only newly diagnosed patients but also those whose tumor had already come back, and there the effect was the largest seen anywhere in the trial. In that group, median survival ran 13.2 months from recurrence against 7.8 for the controls. The separation opened immediately, with 90.6% of vaccine patients alive at six months against 64.0% of controls, and the lead held to the later marks, where survival more than doubled: 20.7% against 9.6% at two years, 11.1% against 5.1% at two and a half. These are the original cohort-level results, already published. The high-resolution patient-level matching that was applied to the newly diagnosed group has not yet been done here, for a practical reason: it needs patient records from other recurrent-cancer trials, held by a European research organization that shares them through its own formal request. Obtaining them is a routine next step, not an obstacle, and the newly diagnosed experience suggests the sharper analysis would only make the recurrent result stronger. The approval case rests on the newly diagnosed evidence, so nothing important depends on this step; it would simply sharpen a result that is already the strongest in the trial. 🏛️ 𝗪𝗵𝗮𝘁 𝘁𝗵𝗶𝘀 𝗺𝗲𝗮𝗻𝘀 𝗳𝗼𝗿 𝗮𝗽𝗽𝗿𝗼𝘃𝗮𝗹 Regulators do not treat an external control as a first choice, but the MHRA's guideline allows it in exactly this situation: a severe disease where a placebo trial is not ethical or feasible, and an effect large enough to interpret despite the design. The guideline even gives its own worked example of an acceptable external control, and it reads almost like a description of this trial: a rare disease, no ethical placebo, same-era standard-of-care controls, an objective survival endpoint, and an effect too large to blame on bias. DCVax-L fits on every count, and it was the first medicine ever to receive the MHRA's Promising Innovative Medicine designation, which asks essentially the same questions. The newly diagnosed case carries the decision on its own evidence, and regulators weigh that evidence against the disease it treats: in a cancer this lethal, with nothing better on offer, the question is whether the benefit is large, clear, and consistent enough to act on, and a benefit of this size, pointing the same way from every direction, is. 📜 𝗧𝗵𝗶𝘀 𝗵𝗮𝘀 𝗯𝗲𝗲𝗻 𝗱𝗼𝗻𝗲 𝗯𝗲𝗳𝗼𝗿𝗲, 𝗮𝗻𝗱 𝗮𝗽𝗽𝗿𝗼𝘃𝗲𝗱 External controls are not a novelty invented for this drug. Over the past two decades they have factored into roughly forty-five drug approvals by the United States regulator, each granted under the conditions that apply here: a serious or rare disease, a placebo that would be unethical, and high unmet need. Regulators do not grant this lightly. They grant it when the disease is serious, its course is predictable and objectively measured, and the effect is large. Glioblastoma meets all three. The named cases cover every part of this disease's profile. Defibrotide, for a life-threatening transplant complication, was approved on a propensity-score comparison to a historical control, the same kind of method used here. Blinatumomab, for an aggressive relapsed leukemia, is the precedent for a fast-killing cancer, cleared by both the United States and European regulators. Cerliponase alfa is the precedent for a fatal brain disease, cleared by both agencies on treated patients versus a matched natural-history group. Glioblastoma is both at once, a fast-killing cancer of the brain, read by the same method, so no part of its profile lacks a close approved precedent. And on the one axis that governs how far an external-control result can be trusted, DCVax-L goes beyond all three. Each of those drugs was tested in a single-arm trial, with no randomization at all. DCVax-L began as a randomized trial and became an external-control comparison only when ethics consumed its placebo group. It sits in that tradition, and at the top of it. 🎯 𝗧𝗵𝗲 𝗯𝗼𝘁𝘁𝗼𝗺 𝗹𝗶𝗻𝗲 This began as a randomized trial. Medical ethics forced it into an external-control comparison. Every independent way of checking it, on different data and different math, points the same direction, and the biology predicted that direction in advance. The first analysis did not overstate the vaccine's effect. Read with the right tools, it understated it.

Andrew Caravello, DO

10,959 görüntüleme • 1 ay önce

TOPIC #19: CORRECTION OF MISCONCEPTIONS IN SOME PIONEERS Happy Sunday, Global Pioneers.🌹🌹🌹 I hope you are all doing well. I wanted to address some misconceptions that I've noticed among our community of Pi Network pioneers. ✅Firstly, Pi is a cryptocurrency that is intended to become a real currency, but it won't replace FIAT currency. Traditional cryptocurrencies have failed as currencies but have instead become assets. Therefore, Pi Network needs a consensus price to OM instead of relying on the exchange market. Please don't use traditional cryptocurrency concepts to limit Pi Network, as regulations will be different from current cryptocurrencies. The regulation for Pi Network as a currency has not yet been released because Pi has not yet been introduced to the world. All activities are currently happening within the community. ✅Secondly, many pioneers have requested the Core Team (CT) to give a price so that we can OM, but this is not possible. CT cannot give a price or guide or indicate a price because it would pose a risk to the project. CT can only work on infrastructure and technology. The government will not be involved in Pi Network, especially during the enclosed mainnet period. This period is for CT, ecosystem developers, and pioneers to work together for the ecosystem. They provide applications and utilities, and pioneers provide the consensus price to help the ecosystem prosper and become robust and mature so that the price won't be affected by the exchange market when OM. Therefore, the current emergency for pioneers is to achieve a safe and high enough consensus price. If we can reach this price and prove it on the blockchain record, the sooner pioneers can pass KYC and migrate to reach OM. ✅Thirdly, some pioneers think of themselves as customers and imagine that they don't have to do anything but require CT or big companies to stand in front and do everything so that they can get wealth. This is impossible. Pioneers have a responsibility to reach a consensus price that aligns with Pi Network's long-term goal, which is to become a world currency. 👉The sooner we can achieve this, the faster KYC and migration will be. Please don't complain to CT because they've completed their task. It's up to pioneers to do our work. 👉Fighting over the price has delayed the process. How can we help? Study the white paper yourself, educate your community, and generate good data. This will help your region's KYC and migration speed. 👉Please remember that Pi Network is contributing a lot and is eager to OM more than us because they spend a lot of money every day. If they didn't insist on their mission, they could have gone to the exchange market two years ago and made a profit. But they have a mission and can withstand high pressure to achieve their goal. 👉They called pioneers one year before to complete our task, which is to reach a price consensus. It's not just about completing your checklist. The checklist can be done in a few minutes. It's not because there aren't enough validators, but rather that many validators have no applications to validate because CT hasn't released them. 👉Why? Because too many pioneers are involved in the black market, and too many low prices are recorded. If they do, Pi's mission cannot be realized. 👉The point is not just to pass KYC and migration. The critical point is united price to GCV! And total leave blackmarket! 👉If CT lets everyone pass when the price is too low, Pi will fail as a currency, and there will be no chance to change it. I was involved in a German cryptocurrency that was in the same situation five years ago. Yes, it was OM on time, and everyone passed KYC. But what happened? Since the holders received the coin at a very low price, around 0.2 Euro by ICO, and some got it for 0.05 Euro, many holders sold it when OM, causing the price to drop to 0.004 USD in 2 months for four years, and now it's still 0.002 USD. Even though the boss invested a huge amount of money to create a need and develop many ecosystems, it still cannot change the reality. ✅So our goal is not just KYC, which cannot make you earn money or at least cannot make you financially free. Our goal is for Pi to successfully OM, satisfying its long-term mission and goal! When Pi Network successfully launches Mainnet, you will definitely achieve financial freedom. This is not just a matter of earning a few hundred or thousand dollars ( Actully I heard a lot pioneers have been scammed which means they lost Pi but no FIAT transfer to them) as you may have experienced before. Those funds will eventually be spent and you may find yourself in the same financial situation as before. In fact your wallet Pi will be confiscated before OM which means you are totally lose change your life opportunity. Do you think it's worth the risk? If you really need hundreds dollars, I suggest to find a labor work such as a waiter who can earn at leas $3000 -$4000 monthly. 👉Therefore, I strongly suggest that pioneers spread education on GCV and study the white paper in your community. Our behavior should align with Pi Network's long-term vision. Only in this way can we push OM quickly, and maybe you will be lucky, and your region can get more KYC slots and migrate more because of your hard work. DISCLAIMER: THE ABOVE opinions or statements shared are only my personal and not affiliated with Pi Network. For your reference only! Doris Yin 🪷🪷🪷
0:48

TOPIC #19: CORRECTION OF MISCONCEPTIONS IN SOME PIONEERS Happy Sunday, Global Pioneers.🌹🌹🌹 I hope you are all doing well. I wanted to address some misconceptions that I've noticed among our community of Pi Network pioneers. ✅Firstly, Pi is a cryptocurrency that is intended to become a real currency, but it won't replace FIAT currency. Traditional cryptocurrencies have failed as currencies but have instead become assets. Therefore, Pi Network needs a consensus price to OM instead of relying on the exchange market. Please don't use traditional cryptocurrency concepts to limit Pi Network, as regulations will be different from current cryptocurrencies. The regulation for Pi Network as a currency has not yet been released because Pi has not yet been introduced to the world. All activities are currently happening within the community. ✅Secondly, many pioneers have requested the Core Team (CT) to give a price so that we can OM, but this is not possible. CT cannot give a price or guide or indicate a price because it would pose a risk to the project. CT can only work on infrastructure and technology. The government will not be involved in Pi Network, especially during the enclosed mainnet period. This period is for CT, ecosystem developers, and pioneers to work together for the ecosystem. They provide applications and utilities, and pioneers provide the consensus price to help the ecosystem prosper and become robust and mature so that the price won't be affected by the exchange market when OM. Therefore, the current emergency for pioneers is to achieve a safe and high enough consensus price. If we can reach this price and prove it on the blockchain record, the sooner pioneers can pass KYC and migrate to reach OM. ✅Thirdly, some pioneers think of themselves as customers and imagine that they don't have to do anything but require CT or big companies to stand in front and do everything so that they can get wealth. This is impossible. Pioneers have a responsibility to reach a consensus price that aligns with Pi Network's long-term goal, which is to become a world currency. 👉The sooner we can achieve this, the faster KYC and migration will be. Please don't complain to CT because they've completed their task. It's up to pioneers to do our work. 👉Fighting over the price has delayed the process. How can we help? Study the white paper yourself, educate your community, and generate good data. This will help your region's KYC and migration speed. 👉Please remember that Pi Network is contributing a lot and is eager to OM more than us because they spend a lot of money every day. If they didn't insist on their mission, they could have gone to the exchange market two years ago and made a profit. But they have a mission and can withstand high pressure to achieve their goal. 👉They called pioneers one year before to complete our task, which is to reach a price consensus. It's not just about completing your checklist. The checklist can be done in a few minutes. It's not because there aren't enough validators, but rather that many validators have no applications to validate because CT hasn't released them. 👉Why? Because too many pioneers are involved in the black market, and too many low prices are recorded. If they do, Pi's mission cannot be realized. 👉The point is not just to pass KYC and migration. The critical point is united price to GCV! And total leave blackmarket! 👉If CT lets everyone pass when the price is too low, Pi will fail as a currency, and there will be no chance to change it. I was involved in a German cryptocurrency that was in the same situation five years ago. Yes, it was OM on time, and everyone passed KYC. But what happened? Since the holders received the coin at a very low price, around 0.2 Euro by ICO, and some got it for 0.05 Euro, many holders sold it when OM, causing the price to drop to 0.004 USD in 2 months for four years, and now it's still 0.002 USD. Even though the boss invested a huge amount of money to create a need and develop many ecosystems, it still cannot change the reality. ✅So our goal is not just KYC, which cannot make you earn money or at least cannot make you financially free. Our goal is for Pi to successfully OM, satisfying its long-term mission and goal! When Pi Network successfully launches Mainnet, you will definitely achieve financial freedom. This is not just a matter of earning a few hundred or thousand dollars ( Actully I heard a lot pioneers have been scammed which means they lost Pi but no FIAT transfer to them) as you may have experienced before. Those funds will eventually be spent and you may find yourself in the same financial situation as before. In fact your wallet Pi will be confiscated before OM which means you are totally lose change your life opportunity. Do you think it's worth the risk? If you really need hundreds dollars, I suggest to find a labor work such as a waiter who can earn at leas $3000 -$4000 monthly. 👉Therefore, I strongly suggest that pioneers spread education on GCV and study the white paper in your community. Our behavior should align with Pi Network's long-term vision. Only in this way can we push OM quickly, and maybe you will be lucky, and your region can get more KYC slots and migrate more because of your hard work. DISCLAIMER: THE ABOVE opinions or statements shared are only my personal and not affiliated with Pi Network. For your reference only! Doris Yin 🪷🪷🪷

Doris Yin 东方紫莲🪷

114,843 görüntüleme • 2 yıl önce

Awakening "inner fire" to completely make gall bladder polyps disappear is the new rubbish "medinfluencer" Ayurveda practitioners are bringing to town. Do not for a second believe this nonsense. "Before" and "After" reports based on anecdotal, single patient "stories" are a common tactic by alternative medicine practitioners to mislead people into believing that their voodoo treatments work. In fact, I know of a Homeopathy practitioner, who famously "cured" patients with chronic hepatitis B virus infection by simply changing the positive report to a negative one using Adobe Photoshop. The same can be true here too. Please do not believe or opt for pseudoscientific alternative treatments for diseases that require realistic care based on "before and after" social media stories. The reports may be manipulated or it could be another patient's report - which is possible in this video too. Removal of gall bladder is a best option and curative treatment for certain gall bladder diseases. Removing the gall bladder does not increase pressure on the liver (trust me, I am a Liver Doctor) and does not make the liver "work hard!" Removing the gall bladder will anatomically change the storage of bile produced by the liver to the upper part of small intestine and nothing more. This does not affect the functioning of the liver in any way. All gall bladder polyps do not require surgical management. Here is what the science has to say on it. To oversimplify: Polyps even in the absence of symptoms, smaller than 10 mm do have the capacity to become cancerous and surgery is recommended when patient has one of more risk factors such as: age more than 60 years, history of primary sclerosing cholangitis (PSC), Asian ethnicity, sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm). For polyps smaller than 10 mm without risk factors, a follow-up at 6 months, 1 year and 2 years with abdominal ultrasound seems to be appropriate. The indication for gall bladder removal should be discussed with the patient in the case of dynamic or unexpected polyp growth. Here is a very detailed and simple guideline on when to surgically manage gall bladder polyps (and no, it does not mention "inner fire or AGNI awakening.") Also please go and educate this Ayurvedic practitioner and reel poster on the real thing:
1:00

Awakening "inner fire" to completely make gall bladder polyps disappear is the new rubbish "medinfluencer" Ayurveda practitioners are bringing to town. Do not for a second believe this nonsense. "Before" and "After" reports based on anecdotal, single patient "stories" are a common tactic by alternative medicine practitioners to mislead people into believing that their voodoo treatments work. In fact, I know of a Homeopathy practitioner, who famously "cured" patients with chronic hepatitis B virus infection by simply changing the positive report to a negative one using Adobe Photoshop. The same can be true here too. Please do not believe or opt for pseudoscientific alternative treatments for diseases that require realistic care based on "before and after" social media stories. The reports may be manipulated or it could be another patient's report - which is possible in this video too. Removal of gall bladder is a best option and curative treatment for certain gall bladder diseases. Removing the gall bladder does not increase pressure on the liver (trust me, I am a Liver Doctor) and does not make the liver "work hard!" Removing the gall bladder will anatomically change the storage of bile produced by the liver to the upper part of small intestine and nothing more. This does not affect the functioning of the liver in any way. All gall bladder polyps do not require surgical management. Here is what the science has to say on it. To oversimplify: Polyps even in the absence of symptoms, smaller than 10 mm do have the capacity to become cancerous and surgery is recommended when patient has one of more risk factors such as: age more than 60 years, history of primary sclerosing cholangitis (PSC), Asian ethnicity, sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm). For polyps smaller than 10 mm without risk factors, a follow-up at 6 months, 1 year and 2 years with abdominal ultrasound seems to be appropriate. The indication for gall bladder removal should be discussed with the patient in the case of dynamic or unexpected polyp growth. Here is a very detailed and simple guideline on when to surgically manage gall bladder polyps (and no, it does not mention "inner fire or AGNI awakening.") Also please go and educate this Ayurvedic practitioner and reel poster on the real thing:

TheLiverDoc™

72,148 görüntüleme • 2 yıl önce

UgandaVsMollyKatanga Injuries Suffered by Mrs Molly Katanga Were Defense Injuries: Says One of East Africa’s Leading Orthopedic Surgeons Yesterday’s court session was marked by bitter exchanges between both sets of lawyers, accusations of witness intimidation and threats by a state attorney and an impromptu walkout by the presiding Judge who had visibly had enough of the bitter exchanges before her. But that was all after the defense’s second expert witness, an Orthopedic and Trauma Surgeon, Associate Professor and Researcher, told Justice Rosette Comfort Kania that before her was a woman who had likely suffered domestic violence and whose injuries were “pathognomonic of defense injuries”. That difficult “p word” being medical speak for “specifically characteristic or indicative of a particular disease or condition”. In this case, he explained that “when someone is facing you and trying to hit you, the natural reaction is to cover the sensitive parts like the eyes and face. The natural defense position that people take is to try to hide their face as much as possible.” He continued: “The reason we call them defense injuries is that these are injuries acquired when someone is trying to defend themselves.” While referencing Mrs Katanga’s injuries and deep tissue bleeding, he’d earlier described, he told Justice Kania, who was staring right at him that; “the reason I call them pathognomonic (very strongly suggestive) of defense injuries is that all the ecchymosis were on the ulnar side of the forearm and the hands which you usually put on the head as someone is trying to assault you.” The witness-who by the Judge’s witness protection order, we can only refer to as DW3XXX-stood in the witness stand at just after 10:20 am, spoke with the calm, confident authority of a man who has practiced at the top of his orthopedic surgery craft for 23 years! He told Judge Kania that on the morning of 2nd November 2023, he was called to attend to an emergency. This was at IHK. He saw a lady whose head was covered in heavy bandages. She was under the care of a neurosurgeon. He was “called to asses her upper limbs”. These he said are “the arms, the forearms and the hands”. Asked what he observed by Mrs Katanga’s defense attorney, Mr Elison Karuhanga (EK), DW3XXX said: “she had injuries on the palm, fingers, wrist area and on the forearm”. These injuries were on both sides; the left and right fore limbs. EK: Did you observe any other injuries? DW3XXX: I said she had a heavy bandage on the head. EK: So, Doctor, after you assessed her injuries, what did you do? DW3: We agreed with my colleagues that the patient should as urgently as possible be taken to theater for management of the injuries that she had. EK: was there an order in which you (different sets of specialists) would work on her? DW3: because of the urgency of the bleeding on the scalp that I came to understand, that bleeding was the most urgent. So, the first part was for him (the neurosurgeon) to arrest the bleeding on the scalp, stitch the wounds then I come in to perform a procedure on the upper limbs. EK: can you tell this court about the surgery you performed? DW3: you don’t want to know about the diagnosis I made before I go to the surgery? EK: please tell us the diagnosis DW3: in medicine, in order for us to come to the conclusion of what injuries the patient has got, we inspect, we palpate. Then after assessing, we do X-rays to see the status of the bones and joints. Mr Muwaganya: My Lord, is he giving us hypothetical scenarios or is he telling us what he did? DW3: I’m telling you what I did and how I make my decisions as a professional. He then said with the help of X-rays and theater assessment after the (blood) soiled dressings had been removed he assessed her injuries. In a report to Dr Moses Byaruhanga, he noted that Mrs Katanga presented with scalp bleeding and lacerations, painful wrists and hands following domestic violence. Injuries found were 👇🏾
1:51

UgandaVsMollyKatanga Injuries Suffered by Mrs Molly Katanga Were Defense Injuries: Says One of East Africa’s Leading Orthopedic Surgeons Yesterday’s court session was marked by bitter exchanges between both sets of lawyers, accusations of witness intimidation and threats by a state attorney and an impromptu walkout by the presiding Judge who had visibly had enough of the bitter exchanges before her. But that was all after the defense’s second expert witness, an Orthopedic and Trauma Surgeon, Associate Professor and Researcher, told Justice Rosette Comfort Kania that before her was a woman who had likely suffered domestic violence and whose injuries were “pathognomonic of defense injuries”. That difficult “p word” being medical speak for “specifically characteristic or indicative of a particular disease or condition”. In this case, he explained that “when someone is facing you and trying to hit you, the natural reaction is to cover the sensitive parts like the eyes and face. The natural defense position that people take is to try to hide their face as much as possible.” He continued: “The reason we call them defense injuries is that these are injuries acquired when someone is trying to defend themselves.” While referencing Mrs Katanga’s injuries and deep tissue bleeding, he’d earlier described, he told Justice Kania, who was staring right at him that; “the reason I call them pathognomonic (very strongly suggestive) of defense injuries is that all the ecchymosis were on the ulnar side of the forearm and the hands which you usually put on the head as someone is trying to assault you.” The witness-who by the Judge’s witness protection order, we can only refer to as DW3XXX-stood in the witness stand at just after 10:20 am, spoke with the calm, confident authority of a man who has practiced at the top of his orthopedic surgery craft for 23 years! He told Judge Kania that on the morning of 2nd November 2023, he was called to attend to an emergency. This was at IHK. He saw a lady whose head was covered in heavy bandages. She was under the care of a neurosurgeon. He was “called to asses her upper limbs”. These he said are “the arms, the forearms and the hands”. Asked what he observed by Mrs Katanga’s defense attorney, Mr Elison Karuhanga (EK), DW3XXX said: “she had injuries on the palm, fingers, wrist area and on the forearm”. These injuries were on both sides; the left and right fore limbs. EK: Did you observe any other injuries? DW3XXX: I said she had a heavy bandage on the head. EK: So, Doctor, after you assessed her injuries, what did you do? DW3: We agreed with my colleagues that the patient should as urgently as possible be taken to theater for management of the injuries that she had. EK: was there an order in which you (different sets of specialists) would work on her? DW3: because of the urgency of the bleeding on the scalp that I came to understand, that bleeding was the most urgent. So, the first part was for him (the neurosurgeon) to arrest the bleeding on the scalp, stitch the wounds then I come in to perform a procedure on the upper limbs. EK: can you tell this court about the surgery you performed? DW3: you don’t want to know about the diagnosis I made before I go to the surgery? EK: please tell us the diagnosis DW3: in medicine, in order for us to come to the conclusion of what injuries the patient has got, we inspect, we palpate. Then after assessing, we do X-rays to see the status of the bones and joints. Mr Muwaganya: My Lord, is he giving us hypothetical scenarios or is he telling us what he did? DW3: I’m telling you what I did and how I make my decisions as a professional. He then said with the help of X-rays and theater assessment after the (blood) soiled dressings had been removed he assessed her injuries. In a report to Dr Moses Byaruhanga, he noted that Mrs Katanga presented with scalp bleeding and lacerations, painful wrists and hands following domestic violence. Injuries found were 👇🏾

Anthony Natif

42,706 görüntüleme • 2 ay önce

** Call to Action for Global Pioneers: Uniting Efforts to Stabilize the GCV Price in the Exchange Market** Dear Global Pioneers, We are currently at a critical juncture that may determine our ability to swiftly realize the GCV in the exchange market. As of now, we are in the Open Network phase, which serves as a preparatory stage for a fully decentralized network where all code can be activated. It is important to note that the Pi Network has not registered as a security because it aims to function as a digital currency rather than a digital asset. However, given recent list on the exchange market, compliance with the United States Securities and Exchange Commission (SEC) is now necessary for Pi Network, which subsequently require CT not to guide Pi's price in the exchange market. To address this situation, we urge all pioneers to unite in a call auction to ensure the GCV is stabilized as soon as possible. We implore you not to sell below the GCV price. Conversely, you are encouraged to buy if you have the means, as the current prices are significantly low. It is essential to emphasize that we are now in the Open Network phase, permitting both buying and selling. We have observed that many pioneers may be hesitant to make purchases; however, it is imperative that you do not let this concern deter you. We have surpassed the enclosed mainnet phase, where buying and selling were prohibited. Increasing liquidity in the exchange market is crucial for attracting external investors. At this stage, the combined strength of all pioneers is required to enhance purchasing power and to capitalize on lower prices. Please clarify your understanding of our current pricing situation. The existing market prices do not reflect Pi's value of our source code, which is derived from our blockchain record. Our efforts have previously focused on establishing Pi as a digital currency, culminating in the creation of the GCV blockchain record, which has indeed achieved success. For instance, the GitHub record indicates a GCV of $314,159, and Mr. Kasasih's code fork has now been integrated into the CT’s main bran code of the signifying its official status. The rationale for the current low prices in the exchange market stems, in part, from a lack of awareness among many pioneers, some of whom may be in financially constrained positions and require immediate funds for necessities. Such individuals may be misled by those who do not support GCV's potential, thereby selling their holdings at depressed prices. This underscores the importance of CT's control over KYC processes and migration procedures. Allowing all pioneers pass KYC and migrating Pi could lead to detrimental outcomes for the project, as uninformed pioneers may sell at significantly low prices. Just we see right now there are a lot of pioneers sell at very low price. So, CT only allow 10 million wallets migrated. It is important to recognize that the current low pricing is not the fault of the PCT or GCV CT, it is a consequence of a collective lack of proactive engagement from the pioneers. By promoting education on the true value of Pi as GCV, we can mitigate the prevalence of low-price sellers. While complaints about pricing may arise, it is essential to understand that we cannot prevent pioneers from selling. What we can do is purchase the available low-priced offerings from the market and collectively urge all pioneers not to sell below the GCV price. This remains a top priority for all involved if we aim to achieve the OM status swiftly. Additionally, it is vital to understand that the CT cannot announce the price of Pi in the exchange market, nor can they buy all the Pi in the exchange market. The price must ultimately be determined by the actions of our pioneering community and outside investors. Therefore, it is everyone's responsibility to refrain from complaints and instead focus on advancing the project collectively. We recommend all pioneers take the following actions: - Do not sell below $314,159. Please list selling price at $314,159. You should have confidence on GCV when it has been in the code already. Once the OM completed; all ecosystems will implement GCV. And you don’t need to wait long time and I estimate in one month or less. - Consider purchasing if you have extra funds available but ensure that you are not borrowing money or using essential living funds for these investments. Any amount such as $10 or $20 or $100 you choose to invest can contribute to increasing the visibility of Pi in the exchange market, potentially attracting outside investors. Also, many pioneers have locked three years with 100%, it is a good chance. You can acquire 6 Pi for just $10 right now. Once our pioneers warm up the market, you'll see outside investors becoming active, so there's no need to worry about how long or how much funding it will take to reach GCV. As soon as the low-priced Pi are being purchased, the price is poised to surge from just a few dollars to GCV in no time. We won't follow the traditional cryptocurrency path for growth because we have a strong community backing GCV.` It is crucial for all global pioneers to recognize that we are all collectively striving towards the successful realization of the OM. The CT shares this goal as well. However, if the exchange market price remains as low as $1 or $2, the likelihood of merchants joining the Pi Network diminishes. It is imperative that the gap between the ecosystem's Pi value and its exchange market price remain minimal. If the exchange price is low, it inhibits the CT's ability to fulfill ecosystem objectives. You need not worry about protracted timelines. With collective action, the path to achieving GCV can be expedited. While it would indeed be beneficial for the CT to manage arrangements efficiently, it is vital that we do not adopt a passive stance, awaiting resolutions. Delays could adversely affect both the reputation of PCT and the GCV CT. Lastly, I would like to address recent rumors suggesting that pioneers are unable to transfer Pi to or from the exchange market; this information is misleading. Pi Network is indeed open already, and the CT has verified five exchange markets for transactions. I have personally encountered challenges while attempting to purchase 1,000 Pi on the exchange market, with multiple platforms rejecting my credit and debit card payments. Nonetheless, I firmly believe that this represents a valuable investment opportunity critical for advancing our collective mission toward GCV unification in the exchange market. Your understanding of this message and prompt actions will be appreciated as we move forward together. Best regards, Doris Yin🪷🪷🪷 Founder, Global GCV Movement Feb.23rd, 2025
11:55

** Call to Action for Global Pioneers: Uniting Efforts to Stabilize the GCV Price in the Exchange Market** Dear Global Pioneers, We are currently at a critical juncture that may determine our ability to swiftly realize the GCV in the exchange market. As of now, we are in the Open Network phase, which serves as a preparatory stage for a fully decentralized network where all code can be activated. It is important to note that the Pi Network has not registered as a security because it aims to function as a digital currency rather than a digital asset. However, given recent list on the exchange market, compliance with the United States Securities and Exchange Commission (SEC) is now necessary for Pi Network, which subsequently require CT not to guide Pi's price in the exchange market. To address this situation, we urge all pioneers to unite in a call auction to ensure the GCV is stabilized as soon as possible. We implore you not to sell below the GCV price. Conversely, you are encouraged to buy if you have the means, as the current prices are significantly low. It is essential to emphasize that we are now in the Open Network phase, permitting both buying and selling. We have observed that many pioneers may be hesitant to make purchases; however, it is imperative that you do not let this concern deter you. We have surpassed the enclosed mainnet phase, where buying and selling were prohibited. Increasing liquidity in the exchange market is crucial for attracting external investors. At this stage, the combined strength of all pioneers is required to enhance purchasing power and to capitalize on lower prices. Please clarify your understanding of our current pricing situation. The existing market prices do not reflect Pi's value of our source code, which is derived from our blockchain record. Our efforts have previously focused on establishing Pi as a digital currency, culminating in the creation of the GCV blockchain record, which has indeed achieved success. For instance, the GitHub record indicates a GCV of $314,159, and Mr. Kasasih's code fork has now been integrated into the CT’s main bran code of the signifying its official status. The rationale for the current low prices in the exchange market stems, in part, from a lack of awareness among many pioneers, some of whom may be in financially constrained positions and require immediate funds for necessities. Such individuals may be misled by those who do not support GCV's potential, thereby selling their holdings at depressed prices. This underscores the importance of CT's control over KYC processes and migration procedures. Allowing all pioneers pass KYC and migrating Pi could lead to detrimental outcomes for the project, as uninformed pioneers may sell at significantly low prices. Just we see right now there are a lot of pioneers sell at very low price. So, CT only allow 10 million wallets migrated. It is important to recognize that the current low pricing is not the fault of the PCT or GCV CT, it is a consequence of a collective lack of proactive engagement from the pioneers. By promoting education on the true value of Pi as GCV, we can mitigate the prevalence of low-price sellers. While complaints about pricing may arise, it is essential to understand that we cannot prevent pioneers from selling. What we can do is purchase the available low-priced offerings from the market and collectively urge all pioneers not to sell below the GCV price. This remains a top priority for all involved if we aim to achieve the OM status swiftly. Additionally, it is vital to understand that the CT cannot announce the price of Pi in the exchange market, nor can they buy all the Pi in the exchange market. The price must ultimately be determined by the actions of our pioneering community and outside investors. Therefore, it is everyone's responsibility to refrain from complaints and instead focus on advancing the project collectively. We recommend all pioneers take the following actions: - Do not sell below $314,159. Please list selling price at $314,159. You should have confidence on GCV when it has been in the code already. Once the OM completed; all ecosystems will implement GCV. And you don’t need to wait long time and I estimate in one month or less. - Consider purchasing if you have extra funds available but ensure that you are not borrowing money or using essential living funds for these investments. Any amount such as $10 or $20 or $100 you choose to invest can contribute to increasing the visibility of Pi in the exchange market, potentially attracting outside investors. Also, many pioneers have locked three years with 100%, it is a good chance. You can acquire 6 Pi for just $10 right now. Once our pioneers warm up the market, you'll see outside investors becoming active, so there's no need to worry about how long or how much funding it will take to reach GCV. As soon as the low-priced Pi are being purchased, the price is poised to surge from just a few dollars to GCV in no time. We won't follow the traditional cryptocurrency path for growth because we have a strong community backing GCV.` It is crucial for all global pioneers to recognize that we are all collectively striving towards the successful realization of the OM. The CT shares this goal as well. However, if the exchange market price remains as low as $1 or $2, the likelihood of merchants joining the Pi Network diminishes. It is imperative that the gap between the ecosystem's Pi value and its exchange market price remain minimal. If the exchange price is low, it inhibits the CT's ability to fulfill ecosystem objectives. You need not worry about protracted timelines. With collective action, the path to achieving GCV can be expedited. While it would indeed be beneficial for the CT to manage arrangements efficiently, it is vital that we do not adopt a passive stance, awaiting resolutions. Delays could adversely affect both the reputation of PCT and the GCV CT. Lastly, I would like to address recent rumors suggesting that pioneers are unable to transfer Pi to or from the exchange market; this information is misleading. Pi Network is indeed open already, and the CT has verified five exchange markets for transactions. I have personally encountered challenges while attempting to purchase 1,000 Pi on the exchange market, with multiple platforms rejecting my credit and debit card payments. Nonetheless, I firmly believe that this represents a valuable investment opportunity critical for advancing our collective mission toward GCV unification in the exchange market. Your understanding of this message and prompt actions will be appreciated as we move forward together. Best regards, Doris Yin🪷🪷🪷 Founder, Global GCV Movement Feb.23rd, 2025

Doris Yin 东方紫莲🪷

143,112 görüntüleme • 1 yıl önce

A scientific rebuttal to a dangerous pseudoscience. [1/2] The "leech therapy" promoted on social media and in alternative medicine clinics is a dangerous pseudoscience that bears no resemblance to the legitimate, highly specialized medical use of leeches in micro-surgery. One is a last-resort surgical tool, applied under the strictest safety protocols to manage its inherent dangers. The other is an unproven, unregulated ritual based on archaic beliefs, performed without any regard for patient safety. There is absolutely no scientific evidence to support the use of leech therapy for the treatment of cancer. The claims are based on a deliberate misrepresentation of preliminary lab research. Patients who are lured by these false promises risk abandoning effective, life-saving treatments, a decision that can have fatal consequences. The risks of severe, drug-resistant bacterial infections, uncontrolled bleeding, and the transmission of blood-borne diseases like HIV and hepatitis are not theoretical; they are real and life-threatening. Even in modern hospitals that use prophylactic antibiotics, infection rates following leech therapy are reported to be as high as 20%. Aeromonas species in leeches are naturally resistant to many first-line antibiotics making these infections incredibly difficult to treat. In an unregulated setting (like an Ayurveda clinic) where no antibiotics are given, the risk of a severe, potentially untreatable infection is unacceptably high. This is the strongest possible warning to the public: Never seek leech therapy for cancer or any other systemic disease. It is not an effective treatment and will cause you harm by delaying proper medical care. Avoid any practitioner promoting leech therapy for conditions beyond its narrow, FDA-approved surgical use. Such individuals are not offering a valid "alternative" therapy; they are marketing a dangerous and discredited practice. Trust evidence-based medicine. Decisions about your health, especially when facing a serious diagnosis like cancer, should be made in consultation with qualified medical doctors and based on rigorous scientific evidence, not on viral videos or promises of ancient cures. Choosing unregulated leech therapy is not an informed choice; it is a disastrous and potentially deadly mistake.
1:15

A scientific rebuttal to a dangerous pseudoscience. [1/2] The "leech therapy" promoted on social media and in alternative medicine clinics is a dangerous pseudoscience that bears no resemblance to the legitimate, highly specialized medical use of leeches in micro-surgery. One is a last-resort surgical tool, applied under the strictest safety protocols to manage its inherent dangers. The other is an unproven, unregulated ritual based on archaic beliefs, performed without any regard for patient safety. There is absolutely no scientific evidence to support the use of leech therapy for the treatment of cancer. The claims are based on a deliberate misrepresentation of preliminary lab research. Patients who are lured by these false promises risk abandoning effective, life-saving treatments, a decision that can have fatal consequences. The risks of severe, drug-resistant bacterial infections, uncontrolled bleeding, and the transmission of blood-borne diseases like HIV and hepatitis are not theoretical; they are real and life-threatening. Even in modern hospitals that use prophylactic antibiotics, infection rates following leech therapy are reported to be as high as 20%. Aeromonas species in leeches are naturally resistant to many first-line antibiotics making these infections incredibly difficult to treat. In an unregulated setting (like an Ayurveda clinic) where no antibiotics are given, the risk of a severe, potentially untreatable infection is unacceptably high. This is the strongest possible warning to the public: Never seek leech therapy for cancer or any other systemic disease. It is not an effective treatment and will cause you harm by delaying proper medical care. Avoid any practitioner promoting leech therapy for conditions beyond its narrow, FDA-approved surgical use. Such individuals are not offering a valid "alternative" therapy; they are marketing a dangerous and discredited practice. Trust evidence-based medicine. Decisions about your health, especially when facing a serious diagnosis like cancer, should be made in consultation with qualified medical doctors and based on rigorous scientific evidence, not on viral videos or promises of ancient cures. Choosing unregulated leech therapy is not an informed choice; it is a disastrous and potentially deadly mistake.

TheLiverDoc™

35,568 görüntüleme • 10 ay önce

TOPIC # 46 DEVELOP REAL ECOSYSTEM DURING 2ND STAGE Dear Global Pioneers, Happy Saturday! Today, I recorded a ten-minute video for you. However, I understand that many of the pioneers may not understand English. So, I am writing this article to help you understand my message. ✅Summary of the 1st Currency stage work from the pioneers' community: According to the white paper, Pi will be a global currency, designed not as an asset or a traditional investment, but as a currency. Therefore, we, as the pioneers' community, need to help Pi complete its mission. The core team can only take care of the infrastructure work; the rest depends on us. This is why it's important for pioneers to understand that we have our task. Our task is not just to complete KYC and migration; it's to develop Pi as a currency. The characteristics of currency include durability, portability, divisibility, uniformity, limited supply, and acceptability. Currency has five major functions: scale of value, means of circulation, means of storage, means of payment, a world settlement currency. Over the past two and a half years, our focus has been on establishing the first currency function as " scale of value" and generating at least one million GCV $314,159 data. We have received support from pioneers representing at least 120 countries. We believe there is no alternative to GCV in terms of pricing. CT’s announcement on Pi2Day indicates that we are on right track and at the forefront of OM. As a result, GCV $314,159 is aligned with Pi Network's mission and vision. I’ve noticed that many pioneers are questioning CT about the delay in KYC and migration procedures over the past two and a half years. My response is that they were awaiting GCV from pioneers. Without this support, our goal of establishing a currency would not be achievable. However, despite the recent Global GCV movement, we have not seen significant involvement from merchants in the exchange of GCV. Most of the data has been generated by pioneers. This is crucial during the initial stages for "value scale." from our pioneers. We have submitted petitions to CT three times for OM on Pi2Day. This is because most community leaders and pioneers are facing resource shortages, and the first function of "value scale" has been successful. If CT can announce the GCV price and OM on Pi2Day , the entire ecosystem will operates on the same pricing system for development. We believe this strategy can also work well. However, CT has announced that OM will be at the earliest by the end of this year. From my perspective, the goal is to reach 15 million KYC and 10 migration Pi wallets, and more importantly, to ensure that the ecosystem has developed to meet the maturity level outlined in the 2019 white paper, or at least has a prototype of the ecosystem. This approach may eliminate the need to announce the Pi price once the entire ecosystem has been accepted. This conservative approach aims to prevent pioneers from converting Pi to FIAT after OM. Instead, the ecosystem will offer utilities for pioneers to use. This will result in a more stable and secure Pi currency. ✅Since CT has decided to OM until the year end or later, there will be at least five months for ecosystem development. Hence, the question now is what pioneers can do during Currency 2nd Stage? Pioneers always have the task of completing their KYC and migration on time, and they are encouraged to become validators if they wish. In addition to the above, pioneers have another important task, which CT cannot directly ask us to do, but it's something we need to do for ourselves. This task is to join the ecosystem with GCV price. As we have discussed, since we want Pi as a currency, it must circulate in our community. Therefore, we need merchants and service providers to offer products or services. However, we cannot force them to do so. If we enforce full Pi payments, they will avoid participating. Currently, we are seeing some full Pi payments in our online ecosystem at different prices, but almost all are very low, less than $1 or less than $0.1. We believe this price is not suitable for Pi's long-term vision and mission. That's why we choose to only support GCV. ✅So the next question is: How can we motivate merchants and service providers to join our ecosystem so that we can OM with GCV $314,159? My suggestion is to allow partial Pi and partial FIAT. They can use 50%, 60%, 70%, 80%, or even 90% FIAT. As long as the FIAT value is lower than the market price, it will benefit pioneers. When more merchants join, they will compete with each other to lower the FIAT ratio. This concept aims to create a real business environment, not a charity environment. We should not depend on leaders, pioneers, or merchants to donate. Instead, we need to create a mechanism to let them compete, which will benefit them and motivate more merchants to join. What about pioneers? If given two options, which one would you choose? a. Only small items worth $1 available for full Pi payment, with no higher value products available and still needing to spend FIAT from the outside market. b. Buy products inside our community at a 50%, 60%, 70%, 80%, 90% FIAT ratio, lower than the outside market price, and including larger items like cell phones, TVs, appliances, jewelry, furniture, clothing, shoes, etc. without limitation. You will save at least 20%-30% on your daily or luxury purchases. I believe you would want option b, as you would save a significant amount of money during the five months. Most importantly, you would be very happy because you understand that what you do will make GCV $314,159 a reality without any doubt. Do you want to live with uncertainty or certainty? Joining this kind of barter system will bring you happiness with certainty. This is what I call the creation of Pi circulation, which is our second stage. After OM, we will enter the third, fourth, and fifth stages, which are the storage, payment, and international settlement currency stages. Since GCV $314,159 on the right track to OM, we need to make GCV more widely accepted and widely used to create circulation. In this way, we will make GCV OM foundation very strong and this will help the ecosystem after OM to reduce any risk that pioneers all go to exchange market to dump. Pi represents not only the future of our pioneers but also the future of the world. Let us come together as a strong, unified family and community. However, beyond this unity, it is imperative to establish a robust business ecosystem and a supportive development environment to encourage and incentivize the participation of more ecosystem members towards our long-term objectives. This will have a positive impact on our local economy and facilitate garnering support from various national governments for the Pi Network. It is crucial for the ecosystem to adhere to FIAT tax obligations to respective country governments, even during the mainnet enclosure. Therefore, partial FIAT payments are essential to enable compliance. Without such a practice, merchants would struggle to sustain themselves and would not have the necessary FIAT currency for tax payments. Doris Yin 🪷🪷🪷 Disclaimer: The above is only my personal analysis and does not represent CT or any business, and is only for community education. Any merchants or pioneers should use their own evaluation to see if it is suitable for them.
4:56

TOPIC # 46 DEVELOP REAL ECOSYSTEM DURING 2ND STAGE Dear Global Pioneers, Happy Saturday! Today, I recorded a ten-minute video for you. However, I understand that many of the pioneers may not understand English. So, I am writing this article to help you understand my message. ✅Summary of the 1st Currency stage work from the pioneers' community: According to the white paper, Pi will be a global currency, designed not as an asset or a traditional investment, but as a currency. Therefore, we, as the pioneers' community, need to help Pi complete its mission. The core team can only take care of the infrastructure work; the rest depends on us. This is why it's important for pioneers to understand that we have our task. Our task is not just to complete KYC and migration; it's to develop Pi as a currency. The characteristics of currency include durability, portability, divisibility, uniformity, limited supply, and acceptability. Currency has five major functions: scale of value, means of circulation, means of storage, means of payment, a world settlement currency. Over the past two and a half years, our focus has been on establishing the first currency function as " scale of value" and generating at least one million GCV $314,159 data. We have received support from pioneers representing at least 120 countries. We believe there is no alternative to GCV in terms of pricing. CT’s announcement on Pi2Day indicates that we are on right track and at the forefront of OM. As a result, GCV $314,159 is aligned with Pi Network's mission and vision. I’ve noticed that many pioneers are questioning CT about the delay in KYC and migration procedures over the past two and a half years. My response is that they were awaiting GCV from pioneers. Without this support, our goal of establishing a currency would not be achievable. However, despite the recent Global GCV movement, we have not seen significant involvement from merchants in the exchange of GCV. Most of the data has been generated by pioneers. This is crucial during the initial stages for "value scale." from our pioneers. We have submitted petitions to CT three times for OM on Pi2Day. This is because most community leaders and pioneers are facing resource shortages, and the first function of "value scale" has been successful. If CT can announce the GCV price and OM on Pi2Day , the entire ecosystem will operates on the same pricing system for development. We believe this strategy can also work well. However, CT has announced that OM will be at the earliest by the end of this year. From my perspective, the goal is to reach 15 million KYC and 10 migration Pi wallets, and more importantly, to ensure that the ecosystem has developed to meet the maturity level outlined in the 2019 white paper, or at least has a prototype of the ecosystem. This approach may eliminate the need to announce the Pi price once the entire ecosystem has been accepted. This conservative approach aims to prevent pioneers from converting Pi to FIAT after OM. Instead, the ecosystem will offer utilities for pioneers to use. This will result in a more stable and secure Pi currency. ✅Since CT has decided to OM until the year end or later, there will be at least five months for ecosystem development. Hence, the question now is what pioneers can do during Currency 2nd Stage? Pioneers always have the task of completing their KYC and migration on time, and they are encouraged to become validators if they wish. In addition to the above, pioneers have another important task, which CT cannot directly ask us to do, but it's something we need to do for ourselves. This task is to join the ecosystem with GCV price. As we have discussed, since we want Pi as a currency, it must circulate in our community. Therefore, we need merchants and service providers to offer products or services. However, we cannot force them to do so. If we enforce full Pi payments, they will avoid participating. Currently, we are seeing some full Pi payments in our online ecosystem at different prices, but almost all are very low, less than $1 or less than $0.1. We believe this price is not suitable for Pi's long-term vision and mission. That's why we choose to only support GCV. ✅So the next question is: How can we motivate merchants and service providers to join our ecosystem so that we can OM with GCV $314,159? My suggestion is to allow partial Pi and partial FIAT. They can use 50%, 60%, 70%, 80%, or even 90% FIAT. As long as the FIAT value is lower than the market price, it will benefit pioneers. When more merchants join, they will compete with each other to lower the FIAT ratio. This concept aims to create a real business environment, not a charity environment. We should not depend on leaders, pioneers, or merchants to donate. Instead, we need to create a mechanism to let them compete, which will benefit them and motivate more merchants to join. What about pioneers? If given two options, which one would you choose? a. Only small items worth $1 available for full Pi payment, with no higher value products available and still needing to spend FIAT from the outside market. b. Buy products inside our community at a 50%, 60%, 70%, 80%, 90% FIAT ratio, lower than the outside market price, and including larger items like cell phones, TVs, appliances, jewelry, furniture, clothing, shoes, etc. without limitation. You will save at least 20%-30% on your daily or luxury purchases. I believe you would want option b, as you would save a significant amount of money during the five months. Most importantly, you would be very happy because you understand that what you do will make GCV $314,159 a reality without any doubt. Do you want to live with uncertainty or certainty? Joining this kind of barter system will bring you happiness with certainty. This is what I call the creation of Pi circulation, which is our second stage. After OM, we will enter the third, fourth, and fifth stages, which are the storage, payment, and international settlement currency stages. Since GCV $314,159 on the right track to OM, we need to make GCV more widely accepted and widely used to create circulation. In this way, we will make GCV OM foundation very strong and this will help the ecosystem after OM to reduce any risk that pioneers all go to exchange market to dump. Pi represents not only the future of our pioneers but also the future of the world. Let us come together as a strong, unified family and community. However, beyond this unity, it is imperative to establish a robust business ecosystem and a supportive development environment to encourage and incentivize the participation of more ecosystem members towards our long-term objectives. This will have a positive impact on our local economy and facilitate garnering support from various national governments for the Pi Network. It is crucial for the ecosystem to adhere to FIAT tax obligations to respective country governments, even during the mainnet enclosure. Therefore, partial FIAT payments are essential to enable compliance. Without such a practice, merchants would struggle to sustain themselves and would not have the necessary FIAT currency for tax payments. Doris Yin 🪷🪷🪷 Disclaimer: The above is only my personal analysis and does not represent CT or any business, and is only for community education. Any merchants or pioneers should use their own evaluation to see if it is suitable for them.

Doris Yin 东方紫莲🪷

35,873 görüntüleme • 2 yıl önce

Yoga and improved skin health and hair growth? India’s pseudoscience poster boy, Ranveer, aka Beerbiceps gets it embarrassingly wrong. Let us break it down. I am sorry this is lengthy, because – as per Brandolini's Law (aka the Bullshit Asymmetry Principle): It takes a lot more energy to refute bullshit than to produce it. Check out this video. In it, Ranveer “pseudoscience peddler” Allahbadia with over 8 million followers on YouTube and Instagram bullshits everyone in just 35 seconds. He showcases some major female movie celebrities and tells the viewers that the secret to their skin and hair is that they perform Yoga every day, especially a Yoga pose called the “Sarvangasana” or shoulder-stand or candle pose. His “scientific” explanation? The stance increases blood flow the scalp and head, and improves skin health and hair growth. This is utter nonsense. What happens to the blood flow, heart, head, and brain region when someone takes an upside-down stance? For that, you must know the meaning of one word – Homeostasis. Homeostasis is a self-regulating process by which human body maintains internal stability in its organ functions while adjusting to changing external conditions. This is also consists of “autoregulation,” the method by which an organ or tissue maintains blood flow despite a change in perfusion due to external (eg: body position changes) or internal (block in blood vessels) conditions. For example, we are normally supposed to walk on two legs or rest by sitting down or lying down. The heart rate, blood flow to all organs including scalp and brain is all maintained depending on the importance and metabolic activity of that organ. For example, at rest, highest proportion of blood flow is received by the liver (nearly 25% of cardiac output) which is 100ml/min per 100g liver weight. The brain receives 50ml/min per 100g weight, while the skin receives 1 to 3ml per 100g per minute. Organ tissues are usually considered as blood supply-dependent (e.g., heart and brain) and blood supply-independent (e.g., abdominal organs, kidneys, skin, and resting muscle) for oxygen delivery – meaning the latter WILL receive fixed amounts to maintain its functioning while the former requires changes to blood flow depending on various unusual situations. For example, in massive blood loss, the body will try to maintain blood flow into heart and brain rather than skin and muscle to maintain life. The blood flow is set in the body for proper functioning of organs and every time we try to change that flow, a healthy body will re-align that flow depending on the importance of the organ systems functions. So, when you do a shoulder stand or candle pose, the initial sudden change to the body position will be caught by the receptors in the blood vessels and heart which will re-align the flow to organs of importance, thereby maintaining critical functions that are required for health. Which means, the blood flow to the skin including the scalp, will be re-aligned to its required flow and DOES NOT increase to face and scalp or brain as India’s pseudoscience peddler mentions. In heavy aerobic exercise and changes to temperature related sweating or certain disease conditions, the skin blood can increase. Yoga is not a proper exercise as it is not an aerobic activity. Now Sarvangasana and blood flow – a study showed that heart and blood flow responses were NOT AFFECTED with this pose in healthy people. Even a complete head stand, called Sirsasana does not increase blood flow to the brain, forget the scalp skin, because of blood delivery homeostasis due to autoregulatory mechanisms. The claims for effects of Yoga on specific organs are complete bluff – a public duping started by B K S Iyengar who took Yoga to the international stage. Even in his authoritative books, he does not mention shoulder stand or candle pose to be useful for hair growth. In fact, he [nonsensically] mentions that shoulder stand will improve “thyroid health” (it does not), controls asthma (it does not), reduces disease of the throat (it does not) and prevents common cold (it does not, because common cold is caused by a virus, and not dependent on whether you stand, sit, lie down, and hang yourself upside down). Also, note that Sarvangasana (shoulder stand), Sirsasana (head stand) and Padmasana (lotus position) are the most common Yoga poses reported to cause an injury. In those with high blood pressure or heart disease, these poses may become life threatening. You can see those here here and here Yoga, especially shoulder or head stands do not improve skin health or increase hair growth by increasing blood flow. In fact, Yoga does nothing specific for organ systems functions since such evidence does not exist. A lot of pseudoscience peddlers who sympathize with Yoga will mislead you with many such magical benefits. So then, what specific exercise or action improves hair growth? We do not really know. There is some evidence, even though weak, for standardized scalp massages: good evidence for scalp cooling (prevents hair loss, may promote regrowth especially in chemotherapy patients) Speak with your Dermatologist on skin and hair health queries and not National-level baby-face poster boys of misinformation.
0:35

Yoga and improved skin health and hair growth? India’s pseudoscience poster boy, Ranveer, aka Beerbiceps gets it embarrassingly wrong. Let us break it down. I am sorry this is lengthy, because – as per Brandolini's Law (aka the Bullshit Asymmetry Principle): It takes a lot more energy to refute bullshit than to produce it. Check out this video. In it, Ranveer “pseudoscience peddler” Allahbadia with over 8 million followers on YouTube and Instagram bullshits everyone in just 35 seconds. He showcases some major female movie celebrities and tells the viewers that the secret to their skin and hair is that they perform Yoga every day, especially a Yoga pose called the “Sarvangasana” or shoulder-stand or candle pose. His “scientific” explanation? The stance increases blood flow the scalp and head, and improves skin health and hair growth. This is utter nonsense. What happens to the blood flow, heart, head, and brain region when someone takes an upside-down stance? For that, you must know the meaning of one word – Homeostasis. Homeostasis is a self-regulating process by which human body maintains internal stability in its organ functions while adjusting to changing external conditions. This is also consists of “autoregulation,” the method by which an organ or tissue maintains blood flow despite a change in perfusion due to external (eg: body position changes) or internal (block in blood vessels) conditions. For example, we are normally supposed to walk on two legs or rest by sitting down or lying down. The heart rate, blood flow to all organs including scalp and brain is all maintained depending on the importance and metabolic activity of that organ. For example, at rest, highest proportion of blood flow is received by the liver (nearly 25% of cardiac output) which is 100ml/min per 100g liver weight. The brain receives 50ml/min per 100g weight, while the skin receives 1 to 3ml per 100g per minute. Organ tissues are usually considered as blood supply-dependent (e.g., heart and brain) and blood supply-independent (e.g., abdominal organs, kidneys, skin, and resting muscle) for oxygen delivery – meaning the latter WILL receive fixed amounts to maintain its functioning while the former requires changes to blood flow depending on various unusual situations. For example, in massive blood loss, the body will try to maintain blood flow into heart and brain rather than skin and muscle to maintain life. The blood flow is set in the body for proper functioning of organs and every time we try to change that flow, a healthy body will re-align that flow depending on the importance of the organ systems functions. So, when you do a shoulder stand or candle pose, the initial sudden change to the body position will be caught by the receptors in the blood vessels and heart which will re-align the flow to organs of importance, thereby maintaining critical functions that are required for health. Which means, the blood flow to the skin including the scalp, will be re-aligned to its required flow and DOES NOT increase to face and scalp or brain as India’s pseudoscience peddler mentions. In heavy aerobic exercise and changes to temperature related sweating or certain disease conditions, the skin blood can increase. Yoga is not a proper exercise as it is not an aerobic activity. Now Sarvangasana and blood flow – a study showed that heart and blood flow responses were NOT AFFECTED with this pose in healthy people. Even a complete head stand, called Sirsasana does not increase blood flow to the brain, forget the scalp skin, because of blood delivery homeostasis due to autoregulatory mechanisms. The claims for effects of Yoga on specific organs are complete bluff – a public duping started by B K S Iyengar who took Yoga to the international stage. Even in his authoritative books, he does not mention shoulder stand or candle pose to be useful for hair growth. In fact, he [nonsensically] mentions that shoulder stand will improve “thyroid health” (it does not), controls asthma (it does not), reduces disease of the throat (it does not) and prevents common cold (it does not, because common cold is caused by a virus, and not dependent on whether you stand, sit, lie down, and hang yourself upside down). Also, note that Sarvangasana (shoulder stand), Sirsasana (head stand) and Padmasana (lotus position) are the most common Yoga poses reported to cause an injury. In those with high blood pressure or heart disease, these poses may become life threatening. You can see those here here and here Yoga, especially shoulder or head stands do not improve skin health or increase hair growth by increasing blood flow. In fact, Yoga does nothing specific for organ systems functions since such evidence does not exist. A lot of pseudoscience peddlers who sympathize with Yoga will mislead you with many such magical benefits. So then, what specific exercise or action improves hair growth? We do not really know. There is some evidence, even though weak, for standardized scalp massages: good evidence for scalp cooling (prevents hair loss, may promote regrowth especially in chemotherapy patients) Speak with your Dermatologist on skin and hair health queries and not National-level baby-face poster boys of misinformation.

TheLiverDoc™

496,339 görüntüleme • 3 yıl önce