Advanced Treatment Options Research Articles

Real-World Clinical Outcomes Among Triple-Class Exposed Multiple Myeloma Patients and Subgroups in the US Oncology Network

Introduction: Despite the development of advanced treatment options, multiple myeloma (MM) remains an incurable disease. Most MM patients ultimately relapse and require further treatments. MM patients who are triple class exposed (TCE) to immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and anti-CD38 monoclonal antibodies have particularly poor outcomes and reduced probability to transition to a next therapy option. In the past few years, several novel therapies including Chimeric Antigen Receptor T-cell (CAR-T) therapies and bispecific antibody therapies became available for TCE patients in the later line setting. Using latest data, this study aims to characterize MM patients treated in US Oncology Network, who were TCE with at least 4 prior lines of therapy (4+ prior LOTs), and to describe their characteristics, treatment patterns, and clinical outcomes. Because treatment history such as penta-drug exposure status (at least two PIs, at least two IMiDs, and at least one anti-CD38) and patient characteristics such as race (White and African American) are known to impact disease outcomes, the impact of these subgroups on treatment to discontinuation or death (TTD) and time to next treatment or death (TTNT) were also evaluated. Methods: Patients with MM who were TCE with 4+ prior LOTs were identified retrospectively from the iKnowMed (iKM) oncology EMR database of the US Oncology Network. Those eligible initiated the next line of therapy (index date) from July 3, 2019 (when additional new treatment options became available) through April 3, 2023, and were followed to the earliest of death, last activity, or end of the study period. Clinical outcomes including TTD and TTNT were analyzed and estimated using the Kaplan-Meier method. Results: A total of 561 TCE patients with 4+ prior LOTs were included in the study, including 95 (16.9%) African American, 387 (69.0%) White, and 310 (55.3%) patients who were penta-drug exposed before index. Key demographic and clinical characteristics are listed in Table 1. The mean (SD) number of prior lines of therapy for the overall TCE & 4+ prior LOTs MM patients before index date was 4.6 (1.2). Prior to the index date, most patients were exposed to daratumumab (99.8%), lenalidomide (95.4%), bortezomib (93.2%), pomalidomide (77.7%), and carfilzomib (61.9%). Excluding corticosteroids, the most common index treatments were pomalidomide- (34.4%), daratumumab- (32.2%), and carfilzomib- (29.1%) based regimens. The most frequently used therapy were triplets (55.1%), followed by doublets (29.3%) and quadruplets (11.9%). CAR-T therapies were not captured in the data, and only 3 patients received bispecific antibody therapy. The estimated median (95% CI) TTD and TTNT in months for the overall TCE with 4+ prior LOTs MM patients were 4.2 (3.9, 5.1) and 6.5 (5.5, 7.4), respectively. TTD and TTNT estimates for the three subgroups are listed in Table 2. Conclusions: This study demonstrates there are limited effective treatment options for heavily treated MM patients in the US Oncology Network. Novel therapies have not been widely used. Clinical outcomes in these patients remain poor, as demonstrated by the short TTD and TTNT. More than half of the patients in the study were penta-drug exposed, a subgroup that showed even worse clinical outcomes than the overall patient group. Racial disparity was also observed, with African American patients appearing to have shorter TTD and TTNT than White patients. The findings highlight the continued need for effective treatments for heavily treated MM patients, including those with demonstrated particularly poor outcomes. Studies investigating innovative therapies to improve the outcomes for these patients are in process.

Real-World Treatment Patterns and Clinical Outcomes Among Triple-Class Exposed and B-Cell Maturation Antigen (BCMA) Exposed Multiple Myeloma Patients

Introduction: Despite the development of advanced treatment options, multiple myeloma (MM) remains an incurable disease. Most MM patients relapse and require further treatments. B-cell maturation antigen (BCMA) targeted immunotherapy is a novel MM therapy class that is now available to heavily pre-treated relapse/refractory MM (R/R MM) patients, who were triple class exposed (TCE) to proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and anti-CD38 monoclonal antibodies. As BCMA therapies continue to be further utilized and become an integral part of MM treatment, the proportion of TCE patients who are also BCMA exposed (TCE+BCMA exposed) is expected to grow. However, the clinical outcomes of TCE+BCMA exposed RRMM patients have not been previously assessed. The objective of this study was to evaluate the real-world outcomes of TCE+BCMA exposed MM patients who started a subsequent LOT, describing their characteristics, treatment patterns, and clinical outcomes. Subgroups of penta-drug exposed (at least two PIs, at least two IMiDs, and at least one anti-CD38) patients, as well as White and African American patients were also evaluated as penta-drug exposure status and race were known to impact clinical outcomes. Methods: Adult patients with MM who were TCE+BCMA exposed and started a subsequent LOT starting from July 03, 2019 (when additional new treatment options became available) were selected from the Komodo Healthcare Map (a US claims dataset) and were followed until the earliest of death, last claim, or end of study period (December 31, 2022). Index date was defined as the start date of the subsequent LOT following TCE and BCMA exposure. Descriptive statistics were provided for patient characteristics and treatment patterns. Clinical outcomes including time to treatment discontinuation or death (TTD) and time to next treatment or death (TTNT) were estimated using the Kaplan-Meier method. Results: A total of 344 TCE+BCMA exposed patients, who received the next LOT were included in the study, including 152 (44.2%) patients who were penta-drug exposed before index, 57 (16.6%) African American, and 185 (53.8%) White patients. Key baseline demographic characteristics and treatment history for the overall group and the three subgroups are listed in Table 1. The mean (SD) and median number of prior LOTs for the overall group before index date were 5.7 (1.7) and 6.0, respectively. The most prevalent prior treatments before the index date for the overall group were daratumumab (99.1%), belantamab mafadotin (91.9%), pomalidomide (84.3%), carfilzomib (83.1 %), bortezomib (76.2%) and lenalidomide (72.1%). Excluding corticosteroids, the most frequently used index treatments (i.e., treatment used post TCE+BCMA exposure) were carfilzomib- (21.9%), bortezomib- (20.8%), pomalidomide- (18.3%), and belantamab mafadotin- (18.3%) based regimens. The median (95% confidence interval [CI]) TTD was 3.7 (3.3, 4.4) months, and the median (95% CI) TTNT was 6.4 (5.5, 7.6) months. TTD and TTNT estimates for the three subgroups are listed in Table 2. Conclusions: To our knowledge, this is the first real-world study of treatment patterns and outcomes for TCE+BCMA exposed MM patients who started a subsequent LOT. The findings showed that this group of heavily pretreated MM patients were often retreated with the same therapies or therapies in the same classes, as they have limited effective treatment options. TCE+BCMA exposed patients exhibited poor clinical outcomes, as demonstrated by the rapid treatment discontinuation and moving on to the next treatment shortly after initial treatment. Many patients were already penta-drug exposed, and they appear to have worse clinical outcomes than the overall patient group. A shorter TTD was observed, and a trend for shorter TTNT was observed among African American patients than White patients. The findings highlight the continued need for effective treatments for heavily treated MM patients and particularly those with poor outcomes.

Advanced Metrics and Early Predictors of Cardiogenic Shock.

Cardiogenic shock (CS) can be defined as a range of illnesses that describes a state where cardiac output, which is the blood volume ejected from the left ventricle every minute that leads to tissue perfusion of nutrients, is insufficient in providing adequate oxygenation to the systemic circulation. The incidence of CS on admission has increased in recent years, with the six- and 12-month mortality rates remaining unchanged. The purpose of this literature review is to bring forth several parameters that have been utilized in the past 10 years to predict CS mortality. Further studies to implement these parameters in management algorithms, along with early screenings and advanced treatment options such as mechanical cardiac assist devices, can improve the mortality associated with CS. This literature-based review was conducted by evaluating current research focusing on the clinical presentation of CS and predictors of CS. PubMed served as the primary database for article retrieval due to access. Two searches were conducted: One for clinical presentations and advanced metrics for CS and another for early predictors for CS. Thirteen articles regarding clinical presentation and seven articles regarding early predictors were selected. Three tools/scores and five laboratory tests were identified that allowed clinicians to prognosticate outcomes in patients suffering from CS based on clinical and laboratory presentations. Examining these predictors will allow earlier intervention in the development of CS and potentially help lower the mortality rate of CS. The eventual creation of a scoring system that incorporates multiple metrics discussed in this review can provide the most accurate prognosis of CS, which can lead to more targeted interventions.

Selinexor Synergistically Promotes the Antileukemia Activity of Venetoclax in Acute Myeloid Leukemia by Inhibiting Glycolytic Function and Downregulating the Expression of DNA Replication Genes.

The BCL-2 inhibitor venetoclax has been widely used in the treatment of acute myeloid leukemia (AML); however, AML patients treated with venetoclax gradually develop resistance. The exportin-1 (XPO1) inhibitor selinexor can synergistically promote the antileukemia activity of venetoclax, but the mechanism remains unclear. Annexin V/7-aminoactinomycin D assays were used to examine the effects of a combination of venetoclax and selinexor (VEN+SEL) on AML cell lines and primary AML cells. RNA sequencing and oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) determinations by a Seahorse XF analyzer were employed to investigate the molecular mechanism of the toxicity of the VEN+SEL combination to AML cells. The cytotoxicity of NK cell combined with VEN+SEL combination was assessed in vitro using flow cytometry. VEN+SEL enhanced the apoptosis of AML cells (KG-1A and THP-1) and primary AML samples in vitro. The ECAR and OCR results demonstrated that the VEN+SEL combination significantly inhibited glycolytic function. RNA sequencing of THP-1 cells demonstrated that DNA replication-related genes were downregulated after treatment with the VEN+SEL combination. This study indicated that selinexor can synergistically enhance the antileukemia activity of venetoclax in AML cells in vitro by inhibiting glycolytic function and downregulating DNA replication-related genes. Based on our experimental data, combining selinexor with venetoclax is an appropriate advanced treatment option for AML patients.

STING activation counters glioblastoma by vascular alteration and immune surveillance

Glioblastoma (GBM) is an aggressive brain tumor with a median survival of 15 months and has limited treatment options. Immunotherapy with checkpoint inhibitors has shown minimal efficacy in combating GBM, and large clinical trials have failed. New immunotherapy approaches and a deeper understanding of immune surveillance of GBM are needed to advance treatment options for this devastating disease. In this study, we used two preclinical models of GBM: orthotopically delivering either GBM stem cells or employing CRISPR-mediated tumorigenesis by adeno-associated virus, to establish immunologically proficient and non-inflamed tumors, respectively. After tumor development, the innate immune system was activated through long-term STING activation by a pharmacological agonist, which reduced tumor progression and prolonged survival. Recruitment and activation of cytotoxic T-cells were detected in the tumors, and T-cell specificity towards the cancer cells was observed. Interestingly, prolonged STING activation altered the tumor vasculature, inducing hypoxia and activation of VEGFR, as measured by a kinome array and VEGF expression. Combination treatment with anti-PD1 did not provide a synergistic effect, indicating that STING activation alone is sufficient to activate immune surveillance and hinder tumor development through vascular disruption. These results guide future studies to refine innate immune activation as a treatment approach for GBM, in combination with anti-VEGF to impede tumor progression and induce an immunological response against the tumor.

SOCS-JAK-STAT inhibitors and SOCS mimetics as treatment options for autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis.

Autoimmune diseases arise from atypical immune responses that attack self-tissue epitopes, and their development is intricately connected to the disruption of the JAK-STAT signaling pathway, where SOCS proteins play crucial roles. Conditions such as autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis exhibit immune system dysfunctions associated with JAK-STAT signaling dysregulation. Emerging therapeutic strategies utilize JAK-STAT inhibitors and SOCS mimetics to modulate immune responses and alleviate autoimmune manifestations. Although more research and clinical studies are required to assess their effectiveness, safety profiles, and potential for personalized therapeutic approaches in autoimmune conditions, JAK-STAT inhibitors and SOCS mimetics show promise as potential treatment options. This review explores the action, effectiveness, safety profiles, and future prospects of JAK inhibitors and SOCS mimetics as therapeutic agents for psoriasis, autoimmune uveitis, systemic lupus erythematosus, and autoimmune encephalitis. The findings underscore the importance of investigating these targeted therapies to advance treatment options for individuals suffering from autoimmune diseases.

Diagnosis and treatment of obesity disease in older adults

In Japan, the proportion of older adults with obesity is rising, highlighting the need for specialized medical care for older adults with obesity. The Japan Society for the Study of Obesity (JASSO) defines 'obesity' as excessive fat storage in adipose tissue with body mass index (BMI) ≥ 25 kg/m2, and "Obesity Disease" as a condition with health disorders associated with obesity and/or visceral fat accumulation.The term 'high-degree obesity' applies to those with BMI≥ 35 kg/m2, and "Obesity Disease" with high-degree obesity is defined as "high-degree Obesity Disease".While the diagnostic criteria for "Obesity Disease" are same regardless of age group, older adults have unique problems. For example, BMI may not accurately reflect fat mass due to age-related height changes and other factors like edema. There's also an 'obesity paradox' in the older adults, where higher BMI may correlate with reduced mortality, though visceral fat is a risk factor.Weight reduction goal is 3% or more of body weight in 3-6 months for "Obesity Disease" and 5-10% or more for "high-degree Obesity Disease" . Management may include calorie-controlled diets and resistance exercises to prevent bone and muscle loss. Advanced treatment options like bariatric/metabolic surgery are also available for "high-degree Obesity Disease" .Recent guidelines from the Japan Geriatrics Society and JASSO provide insights into managing "Obesity Disease" among older adults, considering specific issues like dementia and functional decline. Future therapy need to evolve and provide individualized approaches to manage obesity for older adults.

Complications of Intrathecal Baclofen Pump Therapy: An Institutional Experience from Saudi Arabia.

The intrathecal baclofen pump (ITB) is one of the advanced treatment options in the management of spasticity. This retrospective cohort study was conducted to identify the complications of ITB treatment at a tertiary care rehabilitation facility. Various demographic and technical factors were analyzed, which are less often reported in the literature. All patients with ITB who had their refill at the ITB clinic between November 2019 and March 2020 were included. Of 48 patients, 17 patients had 18 (37.5%) ITB-related complications. Catheter-related complications were most common, whereas loss of efficacy (16.7%) and baclofen withdrawal (14.5%) were the most common outcomes of complications. Only catheter occlusion had a significant relationship with the pattern of spastic quadriparesis (p = 0.001). Gender, rehabilitation diagnosis, patients' residence, and facility of ITB placement did not have significant association. Similarly, age, distance from hospital, disease onset, ITB therapy duration, and baclofen dose were not statistically significant in relation to ITB-related complications.

Outreach dental care programme for older adults using long-term care services in Hong Kong: A qualitative study.

To explore the effects and improvement needs of an outreach dental care programme (ODCP) for older adults using residential care or daycare services from the perspectives of the caregivers, the dentists and administrative staff involved in the implementation of the ODCP. A qualitative study was conducted through semi-structured interviews with three stakeholders, long-term care (LTC) facility caregivers, administrative staff and dentists working for the ODCP. Combined maximum variation and snowball sampling strategies were adopted, and 22, 9 and 7 participants were interviewed from each stakeholder, respectively. The interviews were conducted via telephone, which were audio-recorded and transcribed verbatim for analysis. NVivo software was used for storing and analysing the data. Data analysis was conducted continuously during the study. Most participants opined that the ODCP benefited older adults by raising their oral health conditions and awareness. However, they complained of the complicated administrative procedures, unmet dental treatment needs, inefficient coordination, unclear work guidelines and shortage of dental manpower. More advanced dental treatment options, better coordination among different parties, simpler administrative processes and better incentives for dentists were proposed to further improve the programme. According to the stakeholders, ODCP seems beneficial to older adults using LTC services. Further improvements in the scope of dental treatments, cooperation between the outreach dental teams and caregivers, and streamlining of the administrative process are needed for the provision of effective outreach dental care to satisfy the unmet treatment needs of older adults who use LTC services. Better incentives are needed to attract and retain dentists.

A Prospective Multicenter Study of a Weekly Application Regimen of Viable Human Amnion Membrane Allograft in the Management of Nonhealing Diabetic Foot Ulcers.

Diabetic foot ulcers (DFUs) pose a significant clinical challenge for providers and patients, and often precede devastating complications such as infection, hospitalization, and amputation. Therefore, advanced treatment options are needed to facilitate the healing of chronic DFUs and improve outcomes in this high-risk population. Cryopreserved viable human amnion membrane allograft (vHAMA) has shown great promise in the treatment of recalcitrant DFUs as a supplement to standard of care (SOC). Placental grafts are rich in extracellular matrix proteins, growth factors, and cytokines, which can induce angiogenesis and dermal fibroblast proliferation, resulting in accelerated healing. In this prospective, multicenter single arm trial, 20 patients with nonhealing DFUs received weekly application of vHAMA, in addition to SOC, for up to 12 weeks. The primary study endpoint was proportion of healed wounds at 12 weeks. Secondary endpoints included proportion of wounds healed at 6 weeks, time to heal, and percentage area wound reduction. Subjects were evaluated for ulcer healing and assessed for adverse events at every treatment visit. At study conclusion, 85% of patients receiving vHAMA healed. Ten wounds healed (50%) by 6 weeks, and 17 wounds (85%) healed by 12 weeks. The mean time to heal was 46.6 days (95% CI: 35.1-58.0), and the average number of vHAMAs used was 5.4 (SD: 3.25). The mean PAR was 86.3% (SD: 40.51). Aseptically processed, cryopreserved vHAMA should be considered as a safe and effective option for DFUs refractory to SOC therapy.

Illuminating Hope for Mental Health: A Drug Review on Lumateperone.

This drug review provides a comprehensive analysis of a novel antipsychotic called lumateperone, marketed as Caplyta. Lumateperone gained FDA approval in 2019 for treating schizophrenia and later, in 2021, for treating bipolar depression. The review begins by delving into lumateperone's mechanism of action, which involves the partial agonism of the dopamine D2 receptor as well as its unique effects on the dopamine transporter, N-methyl-D-aspartate (NMDA) receptor, and serotonin transporter. Additionally, the study examines lumateperone's distinctive pharmacokinetics. Moreover, this review assesses lumateperone's metabolic profile and highlights its favorable outcomes regarding mean body weight, BMI, and waist circumference, surpassing those of other second-generation antipsychotic medications. The study explicitly emphasizes the efficacy and safety of lumateperone in treating schizophrenia and bipolar depression associated with bipolar I and II disorders. An extensive investigation of multiple clinical trials provides compelling evidence of lumateperone's advantages over existing antipsychotic medications. The review also acknowledges the limitations of lumateperone compared to other antipsychotics. In conclusion, this drug review underscores the importance of further research to uncover the additional limitations of lumateperone while acknowledging its promising benefits and potential for advancing treatment options.

Detecting Apoptotic Human Lens Epithelial Cells With Transmission Electron Microscopy.

Introduction Cataract formation is a prevalent issue worldwide, and understanding the cellular processes involved is crucial to advancing treatment options. The scope of the study was to explore the presence of apoptotic cells in the lens epithelium of Greek patients with senile cataracts using transmission electron microscopy (TEM). Methods Twenty-one patients with senile cataracts were included in this cross-sectional study, and their anterior lens capsules were thoroughly examined. The presence of apoptosis was ultrastructurally investigated, and its association with age, gender, biomicroscopic type of cataract, the coexistence of exfoliation syndrome (XFS), diabetes mellitus, and glaucoma was statistically correlated. Results We detected apoptotic cells in nine of the 21 patients. Morphological features indicative of apoptosis in the nuclei included degradation, nuclear membrane irregularity, reduction of nuclear volume, condensation, and margination of chromatin. The cytoplasm either appeared denser or contained vacuoles. Budding with membrane blebbing and pinopode-like projections were frequently observed. Apoptotic cells appeared smaller, exhibiting loose connections with neighboring cells and the basement membrane (BM). Interestingly, apoptotic bodies were also detected. Conclusions None of the examined risk factors showed a connection to apoptosis, whereas neighboring lens epithelial cells (LECs) phagocytose apoptotic bodies, seemingly assumed the role of macrophages. Comparing apoptosis rates between populations with different sun exposure levels could help reveal the relationship between ultraviolet B radiation exposure, apoptosis, and cataract formation.

An integrated approach to remove endocrine-disrupting chemicals bisphenol and its analogues from the aqueous environment: a review.

Bisphenol A (BPA) is a well-known endocrine-disrupting chemical (EDC) used as a plastic enhancer in producing polycarbonate resins to manufacture hard plastics. Due to strict limitations on the manufacturing and utilization of BPA, several bisphenol substitutes, bisphenol F (BPF), bisphenol S (BPS), and bisphenol AF (BPAF), have been developed to replace it in various applications. Because of their widespread use in food containers, infant bottles, and reusable water bottles, bisphenols (BPs) have been identified in different environmental circumstances, including drinking water, seawater, industrial effluent, and endocrine systems such as human blood, urine, and breast milk. However, locating and analyzing them in different conditions has proven to be challenging. Therefore, there is a need to reduce the prevalence of BPs in the environment. The significance of advanced treatment options for treating and eliminating BPA and its alternatives from water bodies are reviewed. Also, the research gaps and future scopes are discussed in this review article. According to the literature survey, adsorption and photocatalytic degradation provide synergistic benefits for environmental challenges because of their substantial adsorption Q5 capacity, high oxidation capability, and low cost compared to alternative individual treatment options.

Hypertrophic Cardiomyopathy in a Latin American Center: A Single Center Observational Study.

Hypertrophic cardiomyopathy (HCM) is a complex disorder that includes various phenotypes, leading to different manifestations. It also shares different disadvantages typical of rare diseases, including limited recognition, lack of prospective studies assessing treatment, and little or delayed access to advanced treatment options. Reliable data about the prevalence and natural history of cardiomyopathies in South America are lacking. This study summarizes the features and management of patients with HCM in a university hospital in Colombia. This was an observational retrospective cohort study of patients with HCM between January 2010 and December 2021. Patient data were analyzed from an institutional cardiomyopathy registry. Demographic, paraclinical, and outcome data were collected. A total of 82 patients during the study period were enrolled. Of these, 67.1% were male, and the mean age at diagnosis was 49 years. Approximately 83% were in NYHA functional class I and II, and the most reported symptoms were dyspnea (38%), angina (20%), syncope (15%), and palpitations (11%). In addition, 89% had preserved left ventricular ejection fraction (LVEF) with an asymmetric septal pattern in 65%. Five patients (6%) had alcohol septal ablation and four (5%) had septal myectomy. One patient required heart transplantation during follow-up. Sudden cardiovascular death was observed in 2.6%. The overall mortality during follow-up was 7.3%. HCM is a complex and heterogeneous disorder that presents with significant morbidity and mortality. Our registry provides comprehensive data on disease courses and management in a developing country.

Experimental and computational analyses for advanced wastewater treatment by volcanic rocks.

Treating and reusing wastewater is a promising alternative for the water shortage problem. The advanced treatment of such water can provide a good source for plant irrigation and other applications and reduce the demand for the available freshwater resources. This alternate is highly recommended for arid and semi-arid counties. In this research, volcanic rock (VR) is introduced as an advanced and low-cost treatment option for wastewater. The volcanic rock was adopted as an adsorption tool for removing impurities from the secondary treated wastewater effluents. The study relies on experimental work on a lab scale. Many parameters were investigated such as loose and compacted layered samples, and pretreated methods for the rocks including soaking in clean water or heating for different temperatures. Simulation work also was adopted to validate the experimental results. The study results showed a decline in most physiochemical properties of wastewater after adding VR compared with the control sample. A notable removable for the measurements of the biological oxygen demand and chemical oxygen demand (COD) from wastewater in the presence of VR was observed, which may introduce it as a tool for the advanced treatment of wastewater. The numerical results depicted the experimental data and reflected the effectiveness of the VR-based geomaterial filter for the treatment of wastewater. PRACTITIONER POINTS: Prewashing process for volcanic rock (VR) exhibited an improvement in its removal efficiency ranged between 18% to 98% as for TDS and removal of NO3 - , respectively. Heating samples does not improve the removable properties of VR. A notable removable for biological oxygen demand and COD by 96% and 99%, respectively, for some cases from wastewater, may introduce the VR as a tool for advanced treatment of wastewater. The numerical test results are in consistent with the experimental behavior of the VR and reflect the effectiveness of the VR-based geomaterial filter for the treatment of wastewater.

FTP5.14 A comparison of robotic and laparoscopic surgery in the management of benign and malignant general surgical conditions

Abstract Background Robotic surgery is a relatively novel approach to minimally invasive surgery. The ability for greater precision, control and visualisation offers an advanced treatment option. This study compared the clinical outcomes for general surgical patients undergoing robotic and laparoscopic surgery. Methods A retrospective analysis of 172 surgical patients undergoing surgery for malignant and benign conditions was conducted. Analysis of demographics, pre-, intra-, and post-operative care and complication rate was studied. Patients were divided into three groups: Colorectal cancer (CRC), inflammatory bowel disease (IBD), and general (diverticular disease, rectal prolapse and hernia repairs). Results This study compared 114 robotic surgeries to 58 laparoscopic procedures for general surgery patients. Among the robotic patients, 83 were treated for CRC, 20 for IBD and 11 in the general group; sigmoid cancer (42.2%) and Crohn's disease (75%) were the most common pathologies respectively. In the laparoscopic group, 69% were treated for CRC and 31% for IBD. Robotic surgery had a longer median operation time of 255 minutes compared to 250 minutes for laparoscopic surgery, but shorter average hospital stays (6.2 days vs 11 days) and lower 30-day readmission rates (7.9% vs 17.2%). Fewer robotic patients required blood transfusions (1.8%) than laparoscopic patients (8.6%). One laparoscopic patient required conversion to open surgery, and the mortality rate was 0% across all groups. Conclusion Robotic surgery has been found to have shorter hospital stays, fewer complications, and fewer readmissions compared to laparoscopic surgery for a variety of pathologies. These findings suggest that it may be a superior approach to minimally invasive surgery.

Intraosseous venous malformation of the zygoma: Case report and pooled analysis

The objective of this study is to provide a comprehensive summary of the clinical and radiological features of zygomatic intraosseous venous malformations (IVM), as well as its treatment strategies. The aim is to establish preoperative diagnostic bases that will aid in the identification of zygomatic IVM and facilitate the implementation of effective treatment.Four cases of pathologically diagnosed zygomatic IVM with typical clinical and radiological features were reported. They exhibited comparable clinical and radiological features, and the En bloc excision and reconstruction yielded satisfactory outcome. Pooled data analysis was performed with additional 74 cases collected from 63 previous studies. The results revealed a higher incidence of zygomatic IVMs in middle-aged females, with swelling, pain and ocular dysfunction being the typical clinical manifestations. The characteristic radiological features of these lesions were well-defined, round bony structures with specific internal trabecular patterns. A diagnostic flow-chart assisting the differential diagnosis of IVM was established. En bloc excision was deemed the most advantageous treatment option, as it presented minimal risk of haemorrhaging and no instances of recurrence. The decision to pursue reconstruction was contingent upon the extent of the defect. Alloplastic material has emerged as the most frequently employed reconstruction material in recent reports.The summarized characteristics of zygomatic IVM and the proposed diagnostic and treatment strategies, derived from the pooled analysis of reported cases, may help to improve diagnosis and management in further clinical practice.

Two-team Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection Using Transanal Approach for Rectal Cancer: A Retrospective Study.

Lateral lymph node dissection is a locally advanced rectal cancer treatment option. Despite its complexities, such as prolonged operative time and increased blood loss, a transanal approach with an abdominal approach may help mitigate these drawbacks. Between July 2013 and June 2022, 40 patients underwent radical laparoscopic surgery with lateral lymph node dissection for rectal cancer. Among them, 29 and 11 patients underwent total mesorectal excision and lateral lymph node dissection without transanal approach (conventional surgery) and with transanal approach (two-team surgery), respectively. The clinical findings, surgical outcomes, pathology results, and prognoses of conventional and two-team surgeries were retrospectively compared. Compared to conventional surgery, two-team surgery involves increased organ and nerve resections, shorter operation time (286 vs. 548 min, p<0.001), and less blood loss (20 vs. 158 ml, p<0.001). Although postoperative complications were similar between groups, the two-team surgery group had a shorter hospital stay (p=0.006). Pathologically, all patients who underwent two-team surgery had a distal resection margin of at least 20 mm, and no recurrence was observed. With conventional surgery, 63.6% of patients had a 10-19 mm margin, and 36.4% had a margin of ≥20 mm, except for abdominoperineal resection. Total mesorectal excision and lateral lymph node dissection with the transanal approach as a two-team surgery are safe and feasible. Two-team surgery resulted in better outcomes than conventional surgery regarding operative time, blood loss, shorter postoperative hospital stay, and adequate distal resection margin.

CPD &amp; its decreasing trend: A questionnaire survey in among dentists in Maharashtra

The trend of cast partial dentures (CPD) is decreasing day by day. The aim of this survey was to know the deceleration about use of CPDs. Descriptive survey. This survey consist of eight questions regrading the use of CPDs by the dentists in Maharashtra which was sent to them through electronic communication. The reason behind the downtrend of CPDs is advanced treatment options such as implants, fixed partial dentures. Also, high fabrication cost and aesthetics are other factors responsible for it.

Defining Myeloma and Advancing Treatment Options: A Conversation Between S. Vincent Rajkumar and Lale Kostakoglu.

Lale Kostakoglu, MD, MPH, a professor of radiology and medical imaging at the University of Virginia School of Medicine (Charlottesville), talked with Vincent Rajkumar, MD, the Edward W. and Betty Knight Scripps Professor of Medicine at the Mayo Clinic (Rochester, MN) about his collaborative work in