1st Follow-up Research Articles

Prognostic value of follow-up hemodynamics after initial treatment in pulmonary arterial hypertension

Abstract Background Hemodynamic variables such as right atrial pressure (RAP), cardiac index (CI) and mixed venous oxygen saturation (SvO2) have consistently been associated with survival in pulmonary arterial hypertension (PAH). The prognostic importance of hemodynamics after treatment initiation seems to be superior to baseline evaluation and stroke volume index (SVI) emerged as an independent prognostic parameter. New PAH treatments are, however, able to improve exercise capacity without increasing CI or SVI. Purpose The aim of this work was to define the prognostic role of follow-up hemodynamic parameters in a population of patients with idiopathic, hereditary, drug-induced PAH (I/H/D-PAH) and PAH associated with connective tissue disease (CTD-PAH) and congenital heart disease (CHD-PAH). Methods Treatment naïve PAH patients were assessed at baseline and at 1st follow-up (3-4 months after starting PAH-specific therapy; 1st F-UP) with 6-minute walk distance (6MWD), World Health Organization functional class (WHO-FC) and right heart catheterization (RHC). Collected hemodynamic parameters were: RAP, systolic, diastolic and mean pulmonary artery pressure (s/d/mPAP), CI, SVI, SvO2, pulmonary vascular resistance (PVR), pulmonary arterial compliance (PAC), cardiac efficiency (CE), pulmonary arterial elastance (Ea), resistance–compliance product (RC), right ventricular (RV) power, and RV stroke work index (RVSWI). The primary outcome was all cause death. We used stepwise Cox regression to assess variables obtained at baseline and at 1st F-UP. Results 794 patients with PAH were enrolled (54% I/H/D, 28% CTD, 18% CHD). A primary outcome occurred in 54% of patients over a median follow-up duration of 5.8 (2.4–11) years. In a multivariable model considering only baseline variables, no hemodynamic variables independently predicted prognosis but RAP. At first follow-up RHC (n=706), WHO-FC, 6-minute walk distance, RAP, and Ea were independently associated with death, adjusted for age, gender, and etiology of PAH. Because hemodynamic variables were highly correlated, we compared multivariable Cox regression models adding only variables with a correlation coefficient <0.6. In these models, RAP, Ea, PAC, CE, PVR, SvO2, CI, and SVI at follow-up RHC were independent predictors of death (Table). Conclusions Ea and right atrial pressure were the hemodynamic variables independently associated with death at 1st F-UP RHC after initial PAH treatment. These findings suggest that beyond improving RV function, RV afterload reduction can be considered a further treatment target.Table

A randomized controlled clinical trial of the performance of three bioactive endodontic cements in primary molar teeth diagnosed with reversible pulpitis: 1-year follow-up study

ObjectivesThe objective of this clinical trial was to evaluate and compare the clinical and radiographic successes of three bioactive endodontic cements (BEC) including novel portland cement-based material releasing fluoride, resin-modified silicate glass cement, and pure tricalcium silicate-based cement—in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping. MethodsEighty-six (86) participants with previously untreated first and second primary molars were included in this study. The teeth were randomly allocated into three groups: pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride. Cavities were capped with the assigned cement after caries excavation using standard protocols. The teeth that underwent treatment were restored using glass ionomer cement and composite resin. Clinical and radiographic evaluations were performed at 1, 6, and 12 months. The data were analyzed using Pearson chi-square, Kruskal–Wallis H and Z test (P = 0.05). ResultsThe success rate was 88 % (n = 25) in the pure tricalcium silicate-based cement group, 88.5 % (n = 26) in the resin-modified silicate glass cement group, and 100 % (n = 25) in the novel portland cement-based material releasing fluoride group. The differences at the 1st, 6th, and 12th month follow-up visits were not statistically significant among the groups (P > 0.05). No difference was found between the integrity of the resin composite restorations overlying pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride according to the USPHS criteria. ConclusionsNovel portland cement-based material releasing fluoride can be considered an alternative for preserving the tooth, as it showed a high success rate in treating primary molars diagnosed with reversible pulpitis via indirect pulp capping. Clinical significanceNovel Portland cement-based material releasing fluoride could be beneficial in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping.

Goal Setting Moderates Behavior Change Outcomes in College Students After an Online Health Coaching Intervention

ABSTRACT Background Health coaching sessions that incorporate goal setting may help improve college students' health behaviors. Purpose This study examined whether specific goal-setting practices moderated changes in health behaviors during an online wellness intervention in college students. Methods Participants were 90 college students recruited from one US university. The intervention was a one-hour virtual one-on-one health coaching session where participants set two goals for either physical activity (Metabolic Equivalent Task (MET)-minutes or MET-minutes), nutrition, sleep, or stress management. Self-reported baseline behaviors were collected, and follow-up surveys were completed at 6- and 12-weeks. Mixed effects models examined behavior change outcomes across the follow-up timepoints while testing the moderating effect of goal setting using interactions. Results The Goal×Time interaction was significant for moderate MET-minutes at 1st follow-up (b = 443, p = .003), and for total MET-minutes at the 2nd follow-up (b = 717, p = .047). The Goal×Time interaction was also significant for stress management at 1st follow-up (Odds Ratio = 7.3, p = .042). Discussion Participants who set physical activity and stress management goals had significantly higher physical activity and utilized more stress management techniques. Translation to Health Education Practice The use of specific goal-setting strategies for physical activity and stress management is recommended during online health coaching sessions. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars.

Evaluation of cosmetic outcomes in breast reconstruction patients undergoing radiotherapy using an anomaly generative adversarial network model

Considering the rising prevalence of breast reconstruction followed by radiotherapy (RT), evaluating the cosmetic impact of RT is crucial. Currently, there are limited tools for objectively assessing cosmetic outcomes in patients who have undergone reconstruction. Therefore, we validated the cosmetic outcome using a previously developed anomaly Generative Adversarial Network (GAN)-based model and evaluated its utility. Between January 2016 and December 2020, we collected computed tomography (CT) images from 82 breast cancer patients who underwent immediate reconstruction surgery followed by radiotherapy. Among these patients, 38 received immediate implant insertion, while 44 underwent autologous breast reconstruction. Anomaly scores (AS) were estimated using an anomaly GAN model at pre-RT, 1st follow-up, 1-year (Post-1Y) and 2-year (Post-2Y) after RT. Subsequently, the scores were analyzed in a time-series manner, considering reconstruction types (implant versus autologous), RT techniques, and the incidence of major complications. The median age of the patients was 46 years (range 29–62). The AS between Post-1Y and Post-2Y demonstrated a positive relationship (coefficient 0.515, P < 0.001). The AS was significantly associated with objective cosmetic indices, namely Breast Contour Difference (P = 0.009) and Breast Area Difference (P = 0.004), at both Post-1Y and Post-2Y. Subgroup analysis stratified by type of breast reconstruction revealed significantly higher AS values in patients who underwent prosthetic implant insertion compared to those with autologous reconstruction at all follow-up time points (1st follow-up, P = 0.001; Post-1Y, P < 0.001; and Post-2Y, P < 0.001). A threshold AS of ≥ 1.9 was associated with a 10% predicted risk of developing major complications. The feasibility of an AS generated by a GAN model for predicting both cosmetic outcomes and the likelihood of complications following RT has been successfully validated. Further investigation involving a larger patient cohort is warranted.

Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial

Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.

COMPARISON OF TOTAL EXTRAPERITONEAL (TEP) AND EXPANDED VIEW TOTAL EXTRAPERITONEAL (eTEP) METHODS AT INGUINAL HERNIA REPAIR

Abstract Background Laparoscopic hernia repair has been accepted as first-line treatment for inguinal hernia by major surgical institutions today, with low complication and recurrence rates. The aim of this prospective clinical study, we compared two different laparoscopic approaches in terms of technical ease, patients' early postoperative quality of life, pain management, complication and early recurrence rates. Method Patients with inguinal hernia who were planned to undergo laparoscopic hernia repair were randomized and operated with total extraperitoneal repair (TEP) and extended view total extraperitoneal repair (eTEP) methods in July and August 2023. During the postoperative follow-up, 24th-hour pain scores and 24th-hour quality of life scores were noted with a visual analogue scale (VAS) and quality of recovery test (QoR T15). At the 1st week outpatient clinic follow-up, their pain scores were questioned with VAS. They were checked by physical examination for complications or early recurrence. Patients were called for follow-up at the 1st and 3rd months after the surgery. Results The number of fixative staples was significantly higher in TEP group (p &amp;lt; 0.001). The operation time was significantly shorter in eTEP group (p: 0.031). Time to return to work was significantly longer in TEP group (p: 0.024). VAS scores on the 1st postoperative day were found to be significantly lower in eTEP group (p &amp;lt; 0.001), no significant difference was detected in the 1st week scores. The QoR test scores on the first postoperative day were significantly higher in eTEP group (p:0.006). The difference between number of patients with seroma, ecchymosis or hematoma was not significant in two groups. Conclusions Both methods we used did not make a significant difference in the incidence of complications. On the other hand, we revealed that eTEP method may be more advantageous in terms of ease of surgery, patients' quality of life in the early period.

Antibody longevity and waning following COVID-19 vaccination in a 1-year longitudinal cohort in Bangladesh

COVID-19 vaccines have been effective in preventing severe illness, hospitalization and death, however, the effectiveness diminishes with time. Here, we evaluated the longevity of antibodies generated by COIVD-19 vaccines and the risk of (re)infection in Bangladeshi population. Adults receiving two doses of AstraZeneca, Pfizer, Moderna or Sinopharm vaccines were enrolled at 2–4 weeks after second dosing and followed-up at 4-monthly interval for 1 year. Data on COVID-like symptoms, confirmed COVID-19 infection, co-morbidities, and receipt of booster dose were collected; blood was collected for measuring spike (S)- and nucleocapsid (N)-specific antibodies. S-specific antibody titers reduced by ~ 50% at 1st follow-up visit and continued to decline unless re-stimulated by booster vaccine dose or (re)infection. Individuals infected between follow-up visits showed significantly lower S-antibody titers at preceding visits compared to the uninfected individuals. Pre-enrolment infection between primary vaccination dosing exhibited 60% and 50% protection against reinfection at 5 and 9 months, respectively. mRNA vaccines provided highest odds of protection from (re)infection up to 5 months (Odds Ratio (OR) = 0.08), however, protection persisted for 9 months in AstraZeneca vaccine recipients (OR = 0.06). In conclusion, vaccine-mediated protection from (re)infection is partially linked to elevated levels of S-specific antibodies. AstraZeneca vaccine provided the longest protection.

Pseudomyopia treated with auricular point sticking combined with periocular needle-embedding therapy and prevention of true myopia: a multicenter randomized controlled trial.

To observe the clinical effect and safety of auricular point sticking combined with periocular needle-embedding therapy for pseudomyopia and prevention of true myopia. A total of 269 children with pseudomyopia were randomized into an observation group (134 cases, 2 cases dropped out) and a control group (135 cases, 5 cases dropped out). In the control group, the healthy education was provided. In the observation group, besides the intervention as the control group, the auricular point sticking was delivered at gan (CO12), pi (CO13), xin (CO15) and yan (LO5) on one ear in each treatment, combined with periocular needle-embedding technique at bilateral Cuanzhu (BL 2), Yuyao (EX-HN 4) and Sibai (ST 2). There were 2 weeks of interval after 4 weeks of treatment. One course of treatment was composed of 6 weeks and 2 courses were required. Separately, before treatment, after 6 and 12 weeks of treatment, and after 12 weeks (the 1st follow-up visit) and 24 weeks (the 2nd follow-up visit) of treatment completion, the spherical equivalent (SE), SE progression, axial length (AL) progression, accommodative amplitude (AMP), the score of the TCM symptom and the general symptom were observed in the two groups. The safety and compliance were evaluated in the two groups. After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, SE increased when compared with that before treatment in the two groups (P<0.05), and AMP was larger than that before treatment in the observation group (P<0.05). After 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the progression of SE was slower in the observation group compared with that in the control group (P<0.01, P<0.001). After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the progression of AL in the observation group was lower than that of the control group (P<0.05, P<0.01, P<0.001); and in the 1st and 2nd follow-up visits, AMP of the observation group was larger when compared with that in the control group (P<0.05, P<0.001). After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the total scores of TCM symptom and general symptom were reduced in comparison with those before treatment in the observation group (P<0.05); after 6 and 12 weeks of treatment, the total scores of TCM symptom and general symptom were lower than those before treatment in the control group (P<0.05). In the 1st and 2nd follow-up visits, the difference of the total score of TCM symptom and general symptom in the observation group was larger than that of the control group (P<0.05). In the observation group, compared with the control group, the scores for pale/dark complexion in the 1st and 2nd follow-up visits and that for lassitude in the 2nd follow-up visit were lower (P<0.05), the score for poor concentration after 12 weeks of treatment and that for poor sleep and memory in the 2nd follow-up visit were lower (P<0.05). There were no adverse reactions in the two groups. The compliance was 98.5% in the observation group and was 96.3% in the control group, without statistical difference (P>0.05). On the basis of health education, auricular point sticking combined with periocular needle-embedding therapy can effectively prevent from true myopia, control the increase of SE, delay the growth of AL and improve AMP in children with pseudomyopia. This compound therapeutic regimen can relieve the general symptom and comprehensively prevent from myopia through multiple approaches, with high safety and satisfactory compliance.

Clinical Efficacy of Oxcarbazepine compared with Carbamazepine in terms of Pain Relief in the Management of Trigeminal Neuralgia

Background: Despite various pharmacological drugs used for the treatment of Trigeminal Neuralgia (TN), the clinical efficacy of carbamazepine with oxcarbazepine in terms of pain relief particularly in Pakistani population is poorly studied. This study aimed to compare the efficacy of carbamazepine with oxcarbazepine for treating Trigeminal Neuralgia. Objective: To compare oxcarbazepine with carbamazepine in the management of trigeminal neuralgia in terms of mean pain. Study Design: Quasi-Experimental study. Settings: Fauji Foundation Hospital, Rawalpindi Pakistan. Duration: 06 months i.e. 30th Apr 2018 to 30th Oct 2018. Methods: This single-centre, prospective clinical study was conducted on 70 patients diagnosed with TN. Patients were divided into two groups; Group A: Control group (n = 35), in which patients were given Carbamazepine 200mg twice a day upto1800mg and Group B: an Experimental group (n = 35), in which the patients receive Oxcarbazepine (300mg BD daily up-to 1800mg). The clinical parameters were evaluated by a self-reported questionnaire. Pain level was assessed at 1st and 2nd month follow-up using a Visual Analog Scale. Results: The mean postoperative pain was measured for both groups. Although the mean pain score at 1st follow-up month was similar for Group A (5.2±1.0) and B (4.9±1.1), p=0.328, higher clinical efficacy was observed in 2nd follow-up month for Group B– Oxcarbazepine (3.1±0.8) when compared with Group A– Carbamazepine (5.14±0.8) in terms of mean pain score that was statistically significant p&lt;0.001. Conclusion: This study concludes that in term of pain relief, Oxcarbazepine appears to be a more effective as compared to Carbamazepine in the treatment of TN.

Tooth Brushing Learning Methods: Differential or Conventional? – A Randomized Controlled Clinical Trial

Introduction: Proper tooth brushing is a complicated process for children. Therefore, the aim of this study was to investigate the effect of differential learning to improve tooth brushing in children. Methods: In this prospective, controlled, single-blinded, randomized clinical trial, 58 children between 3 and 8 years of age (mean: 5.7 ± 1.5 years; 29 female) were randomly assigned to test or control group through the child’s self-drawing of an unlabeled envelope from a box. All children received oral hygiene instructions and information in these sealed envelopes and were asked to follow the corresponding instructions at home for 28 days. Children in the test group received instructions with exercises using the differential learning method, whereas the children in the control group received the usual tooth brushing instructions. Results: At baseline and planned follow-ups after 4 and 12 weeks, plaque and gingival indices (QHI, PBI) were recorded in both groups by 2 calibrated and blinded investigators. At baseline, there were no significant differences between the test and control groups regarding plaque and gingival indices (QHI: 4.1 ± 0.5 vs. 4.1 ± 0.4; p = 0.7; PBI: 0.6 ± 0.3 vs. 0.6 ± 0.3; p = 0.7). At the 1st and 2nd follow-up, both groups showed improved oral health indices, but there was an overall better improvement in the test group. While the difference in gingival indices was statistically significant in the 1st recall (PBI/test: 0.1 ± 0.2 vs. control: 0.3 ± 0.2; p < 0.001), the difference in plaque indices was not (QHI/test: 2.1 ± 0.9; control: 2.6 ± 0.9; p = 0.07). At the 2nd recall (mean week = 19.5 weeks), the test group showed statistically significant and clinically relevant better oral health indices than the control group (2nd recall, QHI/test: 2.1 ± 0.9 vs. control: 3.2 ± 1; p < 0.001; PBI/test: 0.1 ± 0.2 vs. control: 0.5 ± 0.2; p < 0.001). Conclusion: In conclusion, differential learning leads to oral hygiene improvement in children with high caries risk and initially poor oral hygiene, which was superior to the conventional learning method through repetition in the medium term.

Evaluation of the efficacy and safety of a herbal formulation for rheumatoid arthritis – A non-inferiority randomized controlled trial

Ethnopharmacological relevanceRheumatoid arthritis (RA) is a diverse disease characterized by a variable, progressive course of articular and extra-articular symptoms that are linked with pain, disability, and mortality. The exact cause of rheumatoid arthritis is still being investigated, and there is no cure for this debilitating, persistent, painful disease. Qurs-e-Mafasil, a herbal Unani preparation, is regarded as a potent treatment for Waja'al-Mafasil, a condition clinically similar to rheumatoid arthritis, but scientific evidence is scarce. Aim of the studyThis study aimed to assess the non-inferiority of Qurs-e-Mafasil compared to celecoxib in the treatment of patients with rheumatoid arthritis. Materials and methodsThis randomized controlled trial was conducted on seventy patients diagnosed with rheumatoid arthritis between the ages of 35 and 55 years. The participants were randomly allocated in a ratio of 3:2, with 42 participants in the test group and 28 participants in the control group. The test group was administered 2 tablets (each having 500 mg) of Qurs-e-Mafasil, while the control group was administered 1 capsule of Celecoxib 100 mg. Both medications were delivered for four weeks. The primary outcome measure was European League Against Rheumatism (EULAR) response criteria based on Disease Activity Score-28 (DAS28) assessed before and after therapy, whereas the secondary outcome measure was the change in joint pain severity as determined by a 100 mm Visual Analog Scale (VAS) at baseline and each follow-up. The safety of the interventions was evaluated based on adverse event monitoring at each follow-up and laboratory tests including hemogram, Liver Function Tests (LFTs), Kidney Function Tests (KFTs), and a complete urine examination performed at baseline and after four weeks of treatment. ResultsThe per-protocol analysis was done on 50 participants (30 in test group and 20 in control group) who completed the study duration. Thus, at the conclusion of the trial, participants in the test and control groups had either a moderate or no response based on EULAR response criteria. The odds ratio for no response versus moderate response between the test and the control groups was 0.71 (95% CI: 0.20–2.55) with p = 0.744. Moreover, the observed mean differences in VAS scores between the test and the control groups at 1st, 2nd, 3rd, and final follow-up were −0.33 (95% CI: −6.65 to 5.99, p = 0.916), 0.50 (95% CI: −5.63 to 6.63, p = 0.870), 2.42 (95% CI: −2.95 to 7.78, p = 0.370), and 3.00 (95% CI: −1.82 to 7.84, p = 0.219), respectively. ConclusionsThe differences in primary and secondary outcomes between the two groups indicate that Qurs-e-Mafāsil, a herbal Unani formulation containing Zingiber officinale Roscoe rhizome, Colchicum luteum Baker root, Piper nigrum L. fruit, and Withania somnifera (L.) Dunal. root, is comparable to celecoxib in the treatment of rheumatoid arthritis.

The long-term effects of topical latanoprost 0.005% treatment on pupillary functions: A 2-year longitudinal study.

To investigate the long-term effects of topical latanoprost 0.005% treatment on pupillary functions in early-stage primary open-angle glaucoma (POAG) eyes using automated pupillometry. This prospective study involved 20 eyes of 20 treatment-naive subjects with early-stage POAG. After comprehensive ophthalmic examination, static and dynamic pupillometry measurements were performedbefore treatment, at the 1st follow-up visit (1.10 ± 0.30 months) and the 2nd follow-up visit (25.85 ± 10.26 months) after treatment initiation. Dynamic parameters included resting diameter (mm), amplitude (mm), latency (ms), duration (ms), and velocity (mm/s) of pupil contraction and dilation. Static pupillometry parameters were pupil diameter (PD, mm) in high-photopic, low-photopic, mesopic and scotopic conditions. The velocity of pupil dilation significantly decreased during the 1st visit (p = 0.008) and the 2nd visit (p = 0.0003) of treatment compared to the pre-treatment visit. The resting PD was also significantly higher after the 1st visit (p = 0.003) and the 2nd visit (p = 0.001) compared to the pre-treatment visit. However, the difference in resting PD measured between the 1st and 2nd visits did not reach statistical significance (p = 0.065). There were no significant changes in other dynamic parameters (p > 0.05 for all). Additionally, a mild, but not significant, mydriatic effect was observed in PD measurements under scotopic, mesopic and low photopic lighting conditions after follow-up. None of the static and dynamic parameters correlate with age, changes in intraocular pressure (IOP) or mean deviation (MD) values of visual field tests. The long-term topical latanoprost 0.005% treatment in early-stage POAG has a slight mydriatic effect on the pupil. Further longitudinal clinical studies with larger patient cohorts are necessary to better understand the effects of latanoprost on pupillary functions.

Value of computed tomography-based lipiodol retention pattern in the assessment of hepatocellular carcinoma complete response following conventional transarterial chemoembolization

BackgroundConventional transarterial chemoembolization (cTACE) has emerged as a major treatment modality for unresectable hepatocellular carcinoma (HCC). Efforts have recently been made to identify biomarkers of HCCs that can potentially predict the response of lesions to transarterial chemoembolization (TACE) therapy. The goal of these efforts is to simplify the decision-making process on whether a patient should choose cTACE or pursue other treatment options. Among these, computed tomography (CT) based lipiodol retention analysis has shown promise in providing valuable insights into post-TACE outcomes. This study aimed to investigate the value of CT-based lipiodol retention pattern in predicting recurrence after a state of complete response (CR) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) guideline post-cTACE.MethodsFrom January 2022 to June 2023, a cohort of 30 patients with 40 HCCs who received a primary cTACE session were identified. The study included patients who underwent 1st cTACE session with no more than three HCCs. Ten HCC lesions were eliminated owing to different reasons (illustrated in the flow chart). Tumor response was evaluated based on mRECIST on 1st follow-up CT with a particular focus on tumors demonstrating a complete response. Patterns of lipiodol retention within these tumors were categorized as complete lipiodol retention pattern (C-Lip), covering the whole tumor, or incomplete lipiodol retention pattern (I-Lip). Recurrence was defined when reappearance of enhancement on arterial-phase images of the treated lesion with subsequent washout on portal/delayed phase images occurred corresponding to findings of restricted diffusion on follow-ups DCE-MRI.ResultsA total of 30 HCCs with a CR were classified into 21 (70%) with C-Lip and 9 (30%) with I-Lip. After a median follow-up of 6.00 ± 2.27 months (3–9 months), 8/9 (88.9%) I-Lip and 5/21 (23.8%) C-Lip showed recurrence on follow-up (DCE-MRI), (p < 0.01), with no significant difference in the time of progression (mean 5.57 ± 2.69 for C-Lip vs. 6.00 ± 2.27 months for I-Lip, with (p < 0.5).ConclusionsHCCs exhibit complete lipiodol retention alongside mRECIST CR possess a reduced susceptibility of recurrence, thereby potentially benefiting from MRI during subsequent evaluations. Conversely, the presence of incomplete lipiodol retention in conjunction with mRECIST CR is an indication of a high risk of recurrence and may require further treatment.

Evaluation of Efficacy of Herbert Bone Screw and Lag Screw in Management of Oblique Mandibular Fractures: A Prospective Randomized Comparative Study.

To assess the efficacy of Herbert cannulated bone screw versus Lag screw in fixation of oblique mandibular fractures. Study composed of two groups of 20 patients each and descriptive statistics were performed with p value set at 0.05 with confidence interval of 95%. Group A was treated by Titanium Lag screws; while, Group B was treated by Titanium Herbert Cannulated Bone Screws for the management of oblique mandibular fractures. Postoperatively, all the patients were evaluated clinically and radiographically by recording the incidence of complications (if any) which included trismus, neurosensory deficit, swelling, infection. Parameters such as occlusal discrepancy, rigid fixation (interfragmentary gap) and duration of surgery were also recorded for all the patients. All the patients were followed for a period of three months. Difference in mouth opening was found to be statistically significant during 1st month follow-up (p-Value-0.002). Postoperatively, the mean interfragmentary gap in Group A was significantly more than Group B (p-Value-0.000). Other parameters like neurosensory deficits, occlusal discrepancies, chewing efficiency, stability of fractured fragments and post-operative complications in terms of swelling, hardware exposure, radiolucency surrounding screw and wound dehiscence did not show any statistically significant difference. The obtained results showed that both lag screws and Herbert cannulated bone screws fulfill the treatment goals of adequate reduction, fixation and stabilization of oblique mandibular fractures. Herbert screws have shown to have better results in terms of interfragmentary gapreduction as compared to lag screws.

The factors affecting rehabilitation to society of emergency department based post-suicidal care program recipients

The aim of this study is to investigate the factors affecting rehabilitation to society of Emergency Department (ED) based post-suicidal care program recipients. This prospective observational study was conducted at the ED of a general hospital in Seoul between March 2018 and October 2020. Patients who agreed to ED based post-suicidal care were followed up after 2 and 4 months and classified into a rehabilitated group and a non-rehabilitated group respectively. We analyzed the patients’ demographic data and suicide-related data. We used the Chi-square test or the Fisher’s exact test, the student’s t-test and multivariate logistic regression analysis. A total of 86 patients were included in this study. Factors that disturb rehabilitation of suicidal attempters were the presence of a housemate, a history of psychiatric admission, an acute disease or disability on 1st follow-up and the presence of a housemate, educational level and 1st non-rehabilitation on 2nd follow-up on univariate analysis. Multivariate logistic regression analysis showed that the absence of a housemate and 1st rehabilitation were associated with rehabilitation. This study shows that fast rehabilitation is important for rehabilitation of suicidal attempters and the presence of housemate can be a risk factor for non-rehabilitation.

The Effect of Absorbable vs. Non-absorbable Fixation on Early Complications in Laparoscopic Transabdominal Preperitoneal (TAPP) Inguinal Herniorrhaphy

Objective : This study has compared the postoperative pain, scrotal edema, seroma, bleeding or other complications between two patient groups getting laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy and where absorbable and non-absorbable fixations (3/0 prolene suture) were used in mesh fixation compared with such complications as hematoma, urinary retention, and recurrence. Materials and Methods : 44 male patients getting laparoscopic TAPP herniorrhaphy method were included in this study. According to the material used for mesh fixation, they were divided into two groups getting absorbable or non-absorbable fixations. The age, gender, hernia type and direction according to the Nyhus Classification , and the fixation material used intraoperatively were all recorded for patients. 1st week, 1st month and 6th month postoperative checks were made. Early complications at the postoperative period were compared between groups. Patients gave written and informed consent before surgery. Findings : Of the 44 patients, absorbable fixation devices were placed in 27 and non-absorbable ones in 17. At the 1st week follow-up, scrotal edema was diagnosticated in 3 patients in the absorbable group and in 2 in the non-absorbable ; seroma in 5 patients in the absorbable group and in 2 in the non-absorbable ; mild pain in 3 patients in the absorbable group and in 5 in the non-absorbable. A significant relationship was not statistiscally found between the presence or absence of scrotal edema, or of seroma, pain intensity and the fixation material used (p&gt;0.05). Conclusion : A significant difference was not found when early complications were statistically compared between the patients getting laparoscopic TAPP herniorrhaphy and having used absorbable and non-absorbable fixation devices. It seems both fixation materials can be used safely.

Effects of Early Mobilization on Pain Among Children Post Appendectomy at Children Hospital Lahore

Early mobilization means interval starting with initial physiologic mobilization and continuing through the hospital stay. Mobilization includes the activities that help critical patients to move, and ambulate with or without assistance using a walker and/or support from staff. Objective: To assess the effect of Early Mobilization on pain and wound healing among children post appendectomy. Methods: A randomized control study was conducted from December 2022 to August 2023 at the Children hospital Lahore. The target population consisted of children undergone appendectomy at Children hospital Lahore. A random sample of n=26 was recruited. Validated tool was used for data collection from participants to assess the pain in the control and interventional group. Initially, Pre-assessment was conducted to obtain pain scores, then the intervention as early mobilization was provided to the interventional group while the control group was observed with usual care. After the intervention in the post assessment, the data were collected from the control and interventional group to compare the effect of intervention. Results: The study results revealed that after the intervention, the assessment at 1st follow-up showed somewhat significant difference in control and interventional group scores of pains. A significant mean difference was found on pain between control and interventional group scores at the 2nd follow up where z (-2.056) =, p value=0.040. Conclusions: Overall, these findings suggest that early mobilization intervention has a positive and statistically significant impact on reducing mean pain scores.

NIMG-50. TOTAL TUMOR CELLULARITY AND CELLULAR GROWTH RATES ESTIMATED USING A RADIO-PATHOMIC AI MODEL PREDICTS PROGNOSIS AND RESPONSE TO CYTOTOXIC THERAPY IN RECURRENT GBM

Abstract PURPOSE A radio-pathomic machine learning model trained with postmortem tissue samples has recently been developed to estimate tumor cellularity from standard anatomic MR images (Bobholz SA et al. AJNR 2022). The aim of this study was to use this externally developed, machine learning-based model to assess the impact of tumor cellularity and changes in cellularity on survival in recurrent glioblastoma (rGBM) treated with standard cytotoxic therapies. METHODS We retrospectively evaluated 22 cases of rGBM treated with chemotherapy. Radio-pathomic maps of predicted tumor cellularity were generated using the radio-pathomic model using pre- and post-contrast T1-weighted MR images, T2-weighted FLAIR images and apparent diffusion coefficient calculated from diffusion-weighted imaging. Total cellularity was estimated by integrating the cellularity measures within a contrast-enhancing tumor volume of interest. Cellularity growth rates (CGRs) were computed using three pre-treatment scans and available post-treatment scans. Tumor cellularity and CGRs were assessed in terms of their impact on overall survival (OS) using log-rank analysis. RESULTS Patients with baseline tumor cellularity &amp;lt; 8.89x108 cells and those with pre-treatment CGR &amp;lt; 7.55x106 cells/day showed significantly longer OS than those with higher cellularity or CGRs (P = 0.001 and 0.008, respectively). Patients with cellularity &amp;lt; 8.90x108 cells at the 1st follow-up (one month after treatment), those with cellularity at 2nd follow-up &amp;lt; 8.89x108 cells (two months after treatment), post-treatment CGR &amp;lt; 1.51x107 cells/day, and change in CGR after treatment &amp;lt; +5.91x106 cells/day showed significantly longer OS than those with higher values (P = 0.03, &amp;lt; 0.001, &amp;lt; 0.001, = 0.02, respectively). CONCLUSION These preliminary results suggest the potential value of estimating total cellularity within the enhancing tumor as a biomarker for prognosis prediction and cytotoxic therapy effect evaluation in rGBM. Additional analyses with more cases and treatments are warranted.

Creation and evaluation of oral anticancer agent (OAA) management resources for a thematic quality improvement program.

380 Background: The Hematology/Oncology Pharmacy Association (HOPA) supported a 6-month American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) for its members focused on oral anticancer agent (OAA) management. HOPA’s Oral Chemotherapy Collaborative (OCC) developed 3 resources for use – an OAA program/practice self-assessment, OAA self-reported adherence guide, and OAA dashboard reporting guide. The purpose of this study is to describe resource development and feedback provided by participants. Methods: Three resources were developed by HOPA OCC. The OAA program/practice self-assessment was created based on Michigan Oncology Quality Consortium (MOQC’s) pre-existing OAA self-assessment with the goal of helping practices assess gaps in care and focus area during quality improvement (QI). The OAA adherence guide focused on the clinic-based patient-facing assessment of OAA adherence that identified three recommended adherence surveys and guidance based on responses. Finally, the OAA dashboard guide was created to help sites track their workload and quality-based metrics and included 2 sections – Administrative and Outcome/Quality Metrics. Resources were provided to teams during the 6-month program and feedback related to their usefulness was requested following programming in June 2023. Results: The sample includes 9 respondents from 7 of 9 participating sites. The majority of respondents found the self-assessment to be useful and would recommend its use (Table). Participants ranked the 1-item adherence question as their top preference for self-reported adherence. Of the dashboard administrative metrics, OAA volume, prescription capture rate, and visits were most selected as useful. For the dashboard outcome/quality metrics, number of interventions, patient reported outcomes, time from OAA prescribed to dispense date, prescribed date to start date, prescribed date to 1st follow-up, percent patients receiving education, percent patients with follow-up within defined time period, and percent patients with OAA adherence assessed were most useful. Resources, priority, information technology, and time were most selected as barriers to implementation of the resources. 100% of survey respondents indicated they were likely to recommend participating in the HOPA-ASCO QTP programming. Conclusions: Overall, the thematic programming with resources from HOPA’s OCC was useful. Multiple barriers exist to incorporate best practice aspects of OAA program implementation.[Table: see text]

Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention.

Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention. We performed a single-center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention. We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow-up was 50 days (interquartile range [IQR]: 20, 91) and last follow-up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23-69.88, p = 0.03). Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow-up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention.