Clinics and Practice

Background: Previous studies have demonstrated the benefits of virtual reality (VR) as an intervention tool guided by specialists. However, little is known about whether VR may pose risks in uncontrolled environments. Considering its implications for clinics and practice, this study aimed to assess the potential risks of a 3D VR simulation on postural control in young adults. Methods: Seventy-nine community-dwelling young adults completed a VR program using a head-mounted display that simulated a 3D roller-coaster ride while standing. Postural control was assessed using a force platform measuring frontal and lateral sway, center-of-pressure sway area, and frontal and lateral imbalance speed. The assessments were conducted with and without VR. Statistical analyses were performed using paired comparisons. Significance was set at 5%. Effect sizes (ESs) are reported. Results: Engaging in a VR roller-coaster simulation increased the participants’ imbalance in terms of frontal sway (p = 0.001; ES = 0.919), center-of-pressure sway area (p = 0.001; ES = 0.849), frontal imbalance speed (p = 0.001; ES = 0.910), and lateral imbalance speed (p = 0.001; ES = 0.663). No significant difference was observed in the lateral sway (p = 0.383). During VR exposure, 25% of the participants showed a clinically significant increase in postural instability. Despite having normal baseline parameters, participants with higher postural instability showed greater deterioration in postural control during VR exposure than those with lower postural instability. Conclusions: A 3D VR simulation affected several measures of postural control in community-dwelling young adults. Precautions should be taken when engaging in VR without appropriate specialist supervision.

Background/Objectives: Cancer of unknown primary (CUP) remains a significant challenge in the field of oncology. Despite advances elsewhere in the field, there have been few advances in the treatment of CUP and correspondingly no improvements in patient survival. Recent studies utilizing molecular profiling, including next-generation sequencing (NGS), and molecularly targeted treatment of CUP have shown some promising initial results, but have yet to be integrated into the standard of care in most jurisdictions. This study aimed to assess the use of molecular characterization and targeted treatment of patients with CUP treated at Princess Margaret Cancer Centre (PMCC). Methods: This study is a retrospective audit of patients with CUP treated between January 2019 and April 2024 to build understanding of the accessibility and use of these molecular tools. Results: We found that 82% of the 28 patients identified received NGS analysis, though all received the results late in their disease course and all accessed molecular profiling via either clinical trials, a charitable access programme, or a privately source outside of the hospital network. Only 13% of the patients who received molecular analysis received any modification of care as a result of this profiling, and only as third line of treatment. Conclusions: Our data highlights a lag between current understanding and current practice, and identifies a possible area for improvement of patient care by standardizing the use of molecular analysis in the early workup and targeted therapy in the treatment of CUP.

Objectives: The goal of this study is to establish the incidence of high on-treatment platelet reactivity (HTPR) to aspirin and clopidogrel in patients undergoing carotid stenting and to evaluate the efficacy of ticagrelor and ticlopidine in patients with HTPR to clopidogrel. Methods: In a single institutional setting spanning eight years, every consecutive patient who underwent carotid artery stenting was incorporated into a study. Subsequently, a retrospective analysis of their platelet function was executed. Prevalence of high on-treatment reactivity to aspirin, clopidogrel, ticlopidine and ticagrelor was assessed. Platelet function testing was conducted by light transmission aggregometry and Multiplate^®. Results: A total of 216 patients were tested for antiplatelet therapy efficacy. The high on-treatment reactivity to clopidogrel was observed in 68 patients (31.4%). No patients with high on-treatment reactivity to ticagrelor or ticlopidine were observed. There was a significant reduction in platelet reactivity with ticagrelor (p < 0.000) and ticlopidine (p < 0.000) in patients with HTPR to clopidogrel. Conclusions: High on-treatment platelet reactivity to clopidogrel is common in patients undergoing carotid artery stenting. Ticagrelor is a viable alternative to overcome HTPR to clopidogrel. These findings suggest that platelet function testing can identify patients who may benefit from tailored antiplatelet therapy in reducing thromboembolic complications after carotid stenting.