Alternative Options Research Articles

Bedside preoperative predictors of difficult laryngeal exposure in microlaryngeal surgery.

Successful microlaryngeal surgery relies on an adequate laryngeal exposure. Recognizing the likelihood of challenging exposure prior to microlaryngeal surgery may assist in selecting the appropriate surgical approach and even prompt consideration of alternative treatment options. We aim to apply the mini-Laryngoscore, a preoperative assessment tool, to our study population and incorporate novel variables to optimize the prediction model. This single-center prospective cohort study included 80 consecutive patients undergoing elective microlaryngeal surgery, from January 1, to June 30, 2023. Each patient underwent a presurgical evaluation of 15 parameters and an intraoperative scoring of the anterior commissure visualization. These parameters were assessed for their association with difficult laryngeal exposure, using multiple logistic regression analysis. We created a novel prediction model for DLE and compared it with the existing model, the mini-Laryngoscore. Out of 80 patients, 24 (30%) patients had difficult laryngeal exposure, including 3 cases (3.8%) in which visualization of the anterior commissure was not possible. A large neck diameter (OR, 1.4; CI 1.1-1.9) and the presence of upper teeth (OR, 8.9; CI 1.3-62.8) were independent risk factors for a difficult laryngeal exposure, while a larger interincisors gap was the only independent protector factor (OR, 0.3; CI 0.1-0.8). The logistic regression model combining these three independent risk factors displayed a high discriminative value AUC = 0.89 (CI 0.81-0.97). The predictive performance of the mini-Laryngoscore was 0.73 (CI 0.62-0.85). Combining two parameters from the mini-Laryngoscore (upper jaw dental state and interincisors gap distance) with neck circumference measurement can accurately predict the risk of difficult laryngeal exposure.

TREM1/DAP12 based novel multiple chain CAR-T cells targeting DLL3 show robust anti-tumour efficacy for small cell lung cancer.

Small cell lung cancer (SCLC), recognized as the most aggressive subtype of lung cancer, presents an extremely poor prognosis. Currently, patients with small cell lung cancer face a significant dearth of effective alternative treatment options once they experience recurrence and progression after first-line therapy. Despite the promising efficacy of immunotherapy, particularly immune checkpoint inhibitors in non-small cell lung cancer (NSCLC) and various other tumours, its impact on significantly enhancing the prognosis of SCLC patients remains elusive. DLL3 has emerged as a compelling target for targeted therapy in SCLC due to its high expression on the membranes of SCLC and other neuroendocrine carcinoma cells, with minimal to no expression in normal cells. Our previous work led to the development of a novel multiple chain chimeric antigen receptor (CAR) leveraging the TREM1 receptor and DAP12, which efficiently activated T cells and conferred potent cell cytotoxicity. In this study, we have developed a DLL3-TREM1/DAP12 CAR-T (DLL3-DT CAR-T) therapy, demonstrating comparable anti-tumour efficacy against SCLC cells in vitro. In murine xenograft and patient-derived xenograft models, DLL3-DT CAR-T cells exhibited a more robust tumour eradication efficiency than second-generation DLL3-BBZ CAR-T cells. Furthermore, we observed elevated memory phenotypes, induced durable responses, and activation under antigen-presenting cells in DLL3-DT CAR-T cells. Collectively, these findings suggest that DLL3-DT CAR-T cells may offer a novel and potentially effective therapeutic strategy for treating DLL3-expressing SCLC and other solid tumours.

Recent Advances in the Development of Polymyxin Antibiotics: 2010-2023.

The polymyxins are nonribosomal lipopeptides produced by Paenibacillus polymyxa and are potent antibiotics with activity specifically directed against Gram-negative bacteria. While the clinical use of polymyxins has historically been limited due to their toxicity, their use is on the rise given the lack of alternative treatment options for infections due to multidrug resistant Gram-negative pathogens. The Gram-negative specificity of the polymyxins is due to their ability to target lipid A, the membrane embedded LPS anchor that decorates the cell surface of Gram-negative bacteria. Notably, the mechanisms responsible for polymyxin toxicity, and in particular their nephrotoxicity, are only partially understood with most insights coming from studies carried out in the past decade. In parallel, many synthetic and semisynthetic polymyxin analogues have been developed in recent years in an attempt to mitigate the nephrotoxicity of the natural products. Despite these efforts, to date, no polymyxin analogues have gained clinical approval. This may soon change, however, as at the moment there are three novel polymyxin analogues in clinical trials. In this context, this review provides an update of the most recent insights with regard to the structure-activity relationships and nephrotoxicity of new polymyxin variants reported since 2010. We also discuss advances in the synthetic methods used to generate new polymyxin analogues, both via total synthesis and semisynthesis.

Immediate rehabilitation of severely atrophic maxillae using conventional and extended length subcrestal angulated (ELSA) implants: A retrospective analysis of 187 implants in 33 patients with up to three years of function.

The purpose of this study was to evaluate and determine clinical outcomes and survival rates of straight and extended length subcrestal angulated (ELSA) implants (20-24mm lengths) placed for immediate (up to 72h post-operative) or delayed rehabilitation (4 months post-operative) of severely atrophic maxillae. Prosthetic treatment consisted of interim and definitive implant-supported fixed implant-supported prostheses with up to 3 years of function. A retrospective analysis was conducted of 38 patients (five dropped out; final total was 33), treated between 2017 and 2019 in a private practice. Extended length subcrestal angulated (ELSA) implants and conventional endosseous straight implants (Southern Implants, Irene, South Africa) with (fixed) full arch prostheses were used to restore patients with edentulous maxillae immediately (within 72hs) or delayed (4 months). ELSA implants have subcrestal angulations of 24° and 36° of the restorative platforms, external hexagon crestal anti-rotation abutment connections, and lengths between 18 and 26mm. Implant loading was determined by implant insertion torque values (as determined on the surgical units); 120Ncm was the threshold level for immediate loading. Clinical and radiographic examinations were done that recorded the clinical outcomes of implants and prostheses. SPSS was used to process the data. Thirty-three patients and 187 implants were included with follow-up periods of at least 12 months (range 12-36 months). The mean age of the study population was 62.6 ± 8.4 years old (at the time of implant placement). Thirty-three patients (86.8%) were followed for 12 months; 13 patients (39.4%) were followed for 24-35 months; 9 patients (27.3%) were followed for 36 months. In total, 13 implants in six patients failed secondary to sinus infections. Mean bone levels (MBLs) were respectively: 0.88±2.12mm at loading, -1.53±2.03mm at 12 months, -2.26±1.45mm at 24 months, and -2.54±1.46mm at 36 months. The ELSA implants showed significantly lower (p = 0.014) MBL at 36 months than did the conventional implants. One hundred thirty-seven implants were placed and loaded within 72h; 50 implants were placed and loaded 4 months post placement. The combined implant survival rates were 93.0% at 12 months, 91.1% at 24 months, and 100% at 36 months. The ELSA implants showed significantly lower (p = 0.014) MBLs at 36 months when compared to the conventional implants. The results of this retrospective clinical chart review indicated that the use of ELSA implants placed into anterior maxillae and nasal crests with accentuated distal tilts (>30°) and simultaneous sinus augmentation provided favorable outcomes for prosthetic rehabilitation in patients with severe atrophic maxillae. ELSA implants placed with simultaneous sinus augmentation are an alternative option to zygomatic implants (ZI) when immediate loading is prescribed. Sinus infections were thought to be the proximate causes of all implant failures. Further long-term clinical studies are warranted with larger patient populations.

Learning to cope with the reality of endometriosis: A mixed-methods analysis of psychological therapy in women with endometriosis.

Despite the need and uptake of mental health support by women with endometriosis, no research to date has explored their experience of psychological therapy. We aimed to understand the factors that predict engagement in psychological therapy by Australian women with endometriosis and to qualitative explore their experience of psychological support. Mixed-methods design. A total of 200 women with self-reported endometriosis were recruited from the community. We explored; (1) the demographic and clinical predictors of engagement in psychological therapy, (2) the psychological approaches that seem most valuable to women in the management of endometriosis and (3) their experience engaging in psychological therapy for endometriosis. Nearly half of women reported to have seen a psychologist within the past year, particularly for pain. Younger age (OR, .94; 95% CI, .886-.993), depressive symptoms (OR, 1.05; 95% CI, 1.002-1.099), and working part time compared to full time (OR, 2.17, 95% CI, 1.012-4.668), increased the likelihood of engaging in psychological therapy. Template thematic analysis identified three themes; (1) endometriosis and pain have multi-faceted psychological effects, (2) psychological support is sought to adjust and live with endometriosis and (3) there are helpful and unhelpful psychological tools for women with endometriosis. Our findings support the use of psychological therapy in the management of endometriosis, and the need for psychological therapy to acknowledge the chronicity and impact of symptoms, to enlist multidisciplinary support and to consider alternative options. Further advocacy is required to educate women on the benefits of psychological therapy for endometriosis.

Attention Autism™ training for occupational therapists: a pilot study

Purpose At present, there is no reference to Attention Autism (AA) as a framework and therapeutic tool with autistic children in occupational therapy (OT) literature. By way of introducing AA as a potential intervention to the OT community, this study aims to investigate the extent to which participation in a two-day AA training could contribute to increasing confidence and inspire changes in practice for Irish occupational therapists (OTs) supporting autistic children. Design/methodology/approach A pilot study design with mixed qualitative and quantitative methods was used to evaluate the impact of a two-day AA training on six OTs. The OTs support autistic children throughout Ireland across public, private and voluntary sectors. They completed brief, non-standardised questionnaires 2 weeks before the training (Time 1) and again 12 weeks post (Time 2) training session. At Time 2, additional exploratory questions were answered by OTs regarding their use of AA in practice. Findings This explorative study’s quantitative findings presented percentage change increases within three areas of confidence for all OTs. These include establishing attention, motivating and developing functional skill goals with autistic children. One of the participants did not score any change in confidence in a fourth area, building rapport, however, the five other participants scored percentage change increases. Qualitative data provided by participants showed that they were implementing AA in practice since attending the training. Five of the participants reported positive experiences of using AA and one participant reported the programme was not suitable for her caseload because of their level of understanding and need. Research limitations/implications This was a small, exploratory, practice-based study. As this is the first study exploring this area of practice for OTs, to the best of the authors’ knowledge, there were no standardised methods of assessment available, therefore a self-designed survey was used by the author which had a limited number of open-ended questions and four Likert scale questions. This study was also limited in that there was one main researcher who also delivered the two-day AA training. The sample data set was small which resulted in the limitation of the choice of methods used to analyse the quantitative data. Percentage changes were used as the only available and reliable method for a small data set. Originality/value Findings of this study, despite their preliminary nature, indicate that AA training may be a useful professional development consideration for OTs who provide a service for autistic children. Further AA research in OT is required including larger and more rigorous studies. An alternative training option of The Curiosity Programme may be considered for OTs supporting children who may not yet be ready to participate in AA.

Indocyanine green-enhanced transpupillary thermotherapy for juxtapapillary retinal capillary hemangioblastoma.

To study the clinical presentation and treatment outcomes of indocyanine green-enhanced transpupillary thermotherapy (ICG-TTT) for treatment-naïve juxtapapillary retinal capillary hemangioblastoma (JRCH). A prospective interventional case series. The technique involved ICG dye infusion 45 seconds prior to application of TTT. The main study outcomes were local tumor control, resolution of subretinal fluid (SRF), and improvement in best-corrected visual acuity (BCVA). Eight eyes of seven patients (5 males and 2 females) were included. The mean age was 26 years (range: 5-56 years). Systemic evaluation revealed von-Hippel Lindau (VHL) disease in five patients. The most common location was the temporal aspect of the optic disc (5 eyes). The mean basal diameter was 2.9 mm (range: 1-8 mm), and tumor thickness was 1.4 mm (range: 1-4 mm). All eight eyes were treated with multiple sessions of ICG-TTT (mean: 3 sessions). Six eyes received adjuvant intravitreal injection of dexamethasone implant (4 eyes) and/or bevacizumab (4 eyes). Post treatment, six eyes (75%) had tumor regression with reduction of SRF. One eye had a partial response with persisting SRF, and one eye showed poor response to TTT for which external beam radiotherapy was performed. At the last follow-up (median: 11 months; range: 6-29 months), the BCVA remained stable in seven eyes and improved in one eye (hand motion to 20/40). Multiple ICG-TTT sessions can be considered as an alternative treatment option for JRCH with effective local tumor control and SRF resolution.

Body constitutions of traditional Chinese medicine caused a significant effect on irritable bowel syndrome.

According to the theory of traditional Chinese medicine (TCM), all types of body constitutions, except for the Gentleness (ie, the control group in our study), have disease susceptibility and affect the disease development process. This study attempted to investigate the relationship between TCM body constitutions and irritable bowel syndrome (IBS). This cross-sectional study was based on Taiwan Biobank (TWB) and collected clinical data from 13 941 subjects aged 30 to 70. The results of the study showed that subjects with Yang-deficiency (N = 3161 subjects, odds ratio [OR] = 2.654, 95% CI = 1.740-3.910), Ying-deficiency (N = 3331 subjects, OR = 1.096, 95% CI = 0.627-1.782) or Stasis (N = 2335 subjects, OR = 1.680, 95% CI = 0.654-3.520) were more likely to have IBS. If the subjects with two or more TCM body constitutions: Yang-deficiency + Ying-deficiency (OR = 3.948, 95% CI = 2.742-5.560), Yang-deficiency + Stasis (OR = 2.312, 95% CI = 1.170-4.112), Ying-deficiency + Stasis (OR = 1.851, 95% CI = 0.828-3.567), or Yang-deficiency + Ying-deficiency + Stasis (OR = 3.826, 95% CI = 2.954-4.932) were also prone to IBS. These results confirmed the high correlation between TCM body constitutions and IBS. Because the current treatment for IBS is not entirely satisfactory, integrated traditional Chinese and Western medicine might provide patients with an alternative treatment option to alleviate IBS.

Stereotactic Radiation Therapy in Early Non–Small Cell Lung Cancer and Interstitial Lung Disease

Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. To prospectively assess the benefits and toxic effects of SABR in this patient population. This prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled. Patients were treated with SABR to a dose of 50 Gy in 5 fractions every other day. The study prespecified that SABR would be considered worthwhile if median overall survival-the primary end point-was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted. Thirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P < .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration). In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. ClinicalTrials.gov Identifier: NCT03485378.

Prospective evaluation of single-dose aminoglycosides for treatment of complicated cystitis in the emergency department.

Antimicrobial resistance among Enterobacterales continues to be a growing problem, particularly in those with urinary infections. Previous studies have demonstrated safety and efficacy with the use of single-dose aminoglycosides in uncomplicated cystitis. However, data in complicated infections are limited. Single-dose aminoglycosides may provide a convenient alternative for those with or at risk for resistant pathogens causing complicated urinary infections, especially when oral options are unavailable due to resistance, allergy, intolerance, or interactions with other medications. This study evaluated the safety and effectiveness of single-dose aminoglycosides in treatment of complicated cystitis in the emergency department (ED). This was a multicenter, prospective study performed between July 2022 and March 2023 of patients who met criteria for complicated cystitis and were otherwise stable for discharge at an academic ED. Primary outcomes were clinical or microbiologic failure within 14 days of treatment. Safety was assessed by review of adverse events. Descriptive statistics were used. Thirteen patients were included. Complicating factors were male sex (n = 4), kidney stone (n = 2), urinary catheter (n = 6), recent urologic procedure (n = 1), urinary hardware (n = 1), antibiotic allergy precluding use of alternate oral options (n = 4), immunocompromised status (n = 2), and <1-year history of multidrug-resistant organisms on urine culture (n = 8). Eleven patients (85%) had positive urine cultures in the preceding 12 months with no oral antimicrobial option. Eight patients (62%) received amikacin (median dose 15 mg/kg), four patients (31%) received gentamicin (median dose 5 mg/kg), and one patient (8%) received tobramycin (5 mg/kg) for treatment. Ten patients (77%) reported resolved urinary symptoms after treatment and 11 patients (85%) reported no new urinary symptoms since discharge. No patient required hospital admission for treatment failure, and no adverse events were noted. Single-dose aminoglycosides appear to be a reasonably effective and safe treatment for complicated cystitis, which avoided hospital admission in this cohort.

A D-vine copula-based quantile regression towards merging satellite precipitation products over rugged topography: a case study in the upper Tekeze–Atbara Basin

Abstract. Precipitation is a vital key element in various studies of hydrology, flood prediction, drought monitoring, and water resource management. The main challenge in conducting studies over remote regions with rugged topography is that weather stations are usually scarce and unevenly distributed. However, open-source satellite-based precipitation products (SPPs) with a suitable resolution provide alternative options in these data-scarce regions, which are typically associated with high uncertainty. To reduce the uncertainty of individual satellite products, we have proposed a D-vine copula-based quantile regression (DVQR) model to merge multiple SPPs with rain gauges (RGs). The DVQR model was employed during the 2001–2017 summer monsoon seasons and compared with two other quantile regression methods based on the multivariate linear (MLQR) and the Bayesian model averaging (BMAQ) techniques, respectively, and with two traditional merging methods – the simple modeling average (SMA) and the one-outlier-removed average (OORA) – using descriptive and categorical statistics. Four SPPs have been considered in this study, namely, Tropical Applications of Meteorology using SATellite (TAMSAT v3.1), the Climate Prediction Center MORPHing Product Climate Data Record (CMORPH-CDR), Global Precipitation Measurement (GPM) Integrated Multi-satellitE Retrievals for GPM (IMERG v06), and Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks (PERSIANN-CDR). The bilinear (BIL) interpolation technique was applied to downscale SPPs from a coarse to a fine spatial resolution (1 km). The rugged-topography region of the upper Tekeze–Atbara Basin (UTAB) in Ethiopia was selected as the study area. The results indicate that the precipitation data estimates with the DVQR, MLQR, and BMAQ models and with traditional merging methods outperform the downscaled SPPs. Monthly evaluations reveal that all products perform better in July and September than in June and August due to precipitation variability. The DVQR, MLQR, and BMAQ models exhibit higher accuracy than the traditional merging methods over the UTAB. The DVQR model substantially improved all of the statistical metrics (CC = 0.80, NSE = 0.615, KGE = 0.785, MAE = 1.97 mm d−1, RMSE = 2.86 mm d−1, and PBIAS = 0.96 %) considered compared with the BMAQ and MLQR models. However, the DVQR model did not outperform the BMAQ and MLQR models with respect to the probability of detection (POD) and false-alarm ratio (FAR), although it had the best frequency bias index (FBI) and critical success index (CSI) among all of the employed models. Overall, the newly proposed merging approach improves the quality of SPPs and demonstrates the value of the proposed DVQR model in merging multiple SPPs over regions with rugged topography such as the UTAB.

Analysing the competitiveness of industries using the Analytical Hierarchy Process and Porter’s model: A case of Durgapur city

Declining contribution to employment of the steel industry, which used to be the number-one sector in the city of Durgapur (India), leads to a search for alternative employment sources. The article aims to identify the criteria and sub-criteria to reveal the business competence through Porter’s model and ranking of business competence of each industry through the analytical hierarchy process (AHP) for Durgapur. Porter’s Five Forces Framework is used as the methodological basis to find the best alternate industry option based on their competitive position and provides the framework and subsequent criteria to analyse competitiveness. The key research method is the analytical hierarchy process that helps to measure the criteria qualitatively. The empirical evidence comes from the survey of 126 respondents: 36 experts who are well-versed in the industrial development of the city and fixed the weightage of the criteria through the AHP, and 90 industry-specific experts provide the range value for each criterion for each industry, which is used to generate the final value. The paper demonstrates the quantitative framework to establish the competition level of major industries in Durgapur, the strategic framework to support the industrial transition, and a brief about their dual nature of competition. We have figured out nine employment-generating industrial sectors within the city of Durgapur, among which are steel production, information technology (IT), education, healthcare, etc. The IT industry was found to be the most competitive sector that provided additional employment opportunities; it was followed by non-metal production, healthcare, and education.

Epicardial left atrial appendage clipping versus direct oral anticoagulant to reduce stroke risk in non-paroxysmal atrial fibrillation (LAA-CLIP): rationale, design and study protocol for a multicentre randomised controlled trial

IntroductionThe prevalence of atrial fibrillation (AF) is increasing globally, and stroke prevention is the key to reduce the morbidity and mortality related to AF. Currently, direct oral anticoagulants (DOACs) are...

Features of tattoo-associated cutaneous lymphoid hyperplasia on reflectance confocal microscopy and line-field confocal optical coherence tomography.

The popularity of tattoos has led to an increase in associated skin reactions, including complications such as infection, allergic reactions and rare conditions such as tattoo-induced cutaneous lymphoid hyperplasia (CLH). CLH is a benign lymphoproliferative reaction with clinical features resembling malignant cutaneous lymphomas. Non-invasive diagnostic tools like reflectance confocal microscopy (RCM) and the new line-field confocal optical coherence tomography (LC-OCT) are being studied in dermatology better to understand the morphological patterns of many dermatological diseases. Between September 2021 and May 2023, patients with suspicious lesions for tattoo-related CLH were analysed using RCM and LC-OCT before confirming the diagnosis of CLH through skin biopsy and histopathological examination. The study included five cases of CLH. It focused on the analysis of high-quality LC-OCT images/videos and RCM images to investigate the features of CLH in tattooed individuals. Most (80%) cases exhibited a mixed T and B lymphocyte infiltration subtype, while 20% showed a predominant T infiltration subtype. RCM and LC-OCT revealed characteristic features, including architectural disarray, fibrosis, lymphoid infiltrates, and pigment deposits in the epidermis and dermis. Non-invasive tools such as RCM and LC-OCT are valuable in diagnosing tattoo-related CLH. While skin biopsy remains the current standard for diagnosis, RCM and LC-OCT can serve as helpful adjuncts in identifying the most representative area for biopsy. They may potentially become alternative diagnostic options in the future, offering benefits in terms of cost, diagnostic efficiency, aesthetics and patient satisfaction as the prevalence of tattoo-related adverse reactions continues to rise.

Comparison of prognostic outcomes between endoscopic submucosal dissection and surgical treatment for early gastric cancer: a retrospective cohort study

Background and aimThe optimal management strategy for early gastric cancer (EGC) a topic of contention. This study aims to compare the prognostic outcomes of endoscopic submucosal dissection (ESD) and surgical treatment in patients diagnosed with EGC.MethodsIn thisretrospective cohort study, we analyzed data from539 patients diagnosed with EGC between January 2012 and December 2020 from two centers. We compared Clinicopathological features, procedure-related complications, recurrence rate, overall survival, and disease specific survival between the 262 patients who underwent ESD and the 277 patients who underwent surgical treatment. ESD procedures were conducted using a dual knife by experienced endoscopists, while surgical treatments included laparoscopic or open gastrectomy. Regular ollow-up examinations were conducted post-treatment.ResultsThe two groups exhibited comparable baseline characteristics. Multivariable Cox regression analysis identified vascular invasion as a risk factor for worse recurrence-free survival (RFS), and overall survival (OS) in patients with early gastric cancer. The ESD group experienced fewer overall postoperative complications compared to the surgical treatment group. Kaplan-Meier curves demonstrated no significant differences in recurrence rate or overall survival between the two groups.ConclusionsBoth ESD and surgical treatment emerged as safe and effective approaches for managing EGC. The choice of treatment should be tailored to individual patient factors. ESD can be considered an alternative treatment option for selected patients who are not suitable candidates for surgery. Further studies are warranted to determine the long-term outcomes of ESD and surgical treatment for EGC.

Abstract A098: Microenvironment-regulated matrix Gla protein drives ovarian cancer stemness

Abstract The clinical evolution of ovarian cancer (OC), with peritoneal dissemination, tumor relapse and chemoresistance, seems to be accounted for by a small population of ovarian cancer stem cells (OCSC), thus making them an attractive target for more efficacious treatments. However, this could only be achieved through the detailed characterization of the molecular and functional traits of this elusive cell subpopulation. Therefore, the identification of novel OCSC-associated targets and therapeutic approaches may offer alternative treatment options. We established a new platform of patient-derived organotypic models of OC and found that Matrix Gla Protein (MGP) was upregulated in cancer cells upon contact with the peritoneal tumor microenvironment. MGP is classically known as a vitamin K-dependent calcium chelator, mainly associated with the inhibition of tissue calcification and cardiovascular disease. In addition, MGP is also aberrantly expressed in different cancer types, but the biological mechanisms that regulate its functional contribution to cancer progression is still unknown. Our transcriptomic profiling of primary OCSC versus their non-stem counterpart pointed to MGP as a potential driver of cancer stemness. Indeed, we obtained evidence that MGP promotes, and is required for, stemness-associated biological features in vitro and in animal models, including sphere formation and tumor initiation. MGP was also implicated in the regulation of the expression of several key genes involved in stemness and/or EMT. Finally, MGP was upregulated in OC patients following chemotherapy, suggesting that the protein may be involved in OCSC-driven chemoresistance. The molecular mechanisms underlying MGP-regulated OCSC pathophysiology were investigated by RNA sequencing experiments on MGP-manipulated OC cells, which unveiled genetic networks and pathways that are orchestrated by MGP to promote OCSC function. The biological role of MGP in OC provides novel insight into the biology of OCSC, thus defining new pathways involved in OC stemness and paving the way to innovative therapeutic strategies for OC eradication. Citation Format: Valentina Nieddu, Valentina Melocchi, Chiara Battistini, Giulia Franciosa, Michela Lupia, Jesper Olsen, Nicoletta Colombo, Fabrizio Bianchi, Ugo Cavallaro. Microenvironment-regulated matrix Gla protein drives ovarian cancer stemness [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A098.

Technical, economic and ecological assessment of European sustainable aviation fuels (SAF) production

AbstractMultiple options for sustainable alternatives to fossil kerosene have been assessed. The route using biomass gasification, hotgas cleaning, hydrogen addition (derived from water electrolysis using renewable power), Fischer-Tropsch synthesis and product upgrading towards ASTM D7566 certified SAF has technical, economic and environmental advantages to be discussed in detail. The technical assessment shows carbon resp. energy efficiency of fuel production at 61% resp. 55%. The economic assessment of brown-field installations in Finland predicts costs in the range of 1.00 €2019/l. For the evaluation of 200 MWth biomass plus 160.2 MWe grid power plant size, an electricity price and biomass price of 42 €2019/t and 51 €2019/MWh were assumed, respectively. The environmental assessment shows a global warming potential reduction of 91% (corresponds to 8.8 gCO2-eq./MJFuel,LHV) compared to fossil fuel using Finnish wind energy and biomass residues, far better than the required 65% GWP reduction of the European RED II regulation. Based on the techno-economic and environmental assessment of the preferred FT route, a European deployment potential between 10 and 60 Mt/a SAF seems achievable in early 2030 years. The authors propose to implement appropriate regulation with high urgency.

Platform for Stop-based Carpooling

This paper introduces a transformative stop-based carpooling app designed to address the limitations of existing solutions. By strategically placing designated stops, such as bus stops, our innovative model restricts ride creation and participation exclusively between these stops, ensuring consistent availability, mitigating privacy concerns, and providing users with alternative transportation options. Through a comprehensive study in a representative urban setting, we examine the impact on car occupancy rates, traffic reduction, and user satisfaction, highlighting the model's ability to cater to diverse user needs. The integration with existing public transport systems extends its eco-friendly footprint, while strategically placed stops enhance coverage in areas with fewer active drivers, overcoming the limitations of conventional carpooling solutions. This paper contributes a blueprint for a sustainable and efficient shared mobility system, showcasing the potential of the stop-based approach in revolutionizing urban transportation.

Gasless robot-assisted transaxillary hemithyroidectomy (RATH): learning curve and complications

PurposeGasless robot-assisted transaxillary hemithyroidectomy (RATH) is regarded as an alternative surgical option for thyroid operations. However, the associated steep learning curve is a clinical concern. This study evaluated the learning curve of RATH for surgeons without experience of endoscopic surgery and the early surgical outcomes of RATH.MethodsWe conducted a retrospective study of patients who underwent gasless RATH and conventional hemithyroidectomy (CH) at Sun Yat-sen University Cancer Center, Guangzhou, China, from June 2021 to August 2022. The learning curve and early surgical outcomes of gasless RATH were evaluated. And the early surgical outcomes of gasless RATH were compared to CH.ResultsIn total, 105 patients who underwent gasless RATH and 104 patients who underwent CH were matched and assessed. The cumulative sum techniques (CUSUM) analysis showed that the peak point of gasless RATH operative time occurred at the 31st case. No clear single peak was identified in the CUSUM plot for drainage amount and blood loss. No significant difference in perioperative complications was observed between these two groups. Moreover, the number of postoperative patients who got sense of thyroid area traction were fewer in the gasless RATH group (n = 11, 10.5%) than in the CH group (n = 32, 30.8%).ConclusionGasless RATH can be considered as an alternative approach to the conventional open procedure, as it is an easy remote access technique, with shorter learning curves and certain advantage such as less sense of thyroid area traction.

Robust Estimation of the Tail Index of a Single Parameter Pareto Distribution from Grouped Data

Numerous robust estimators exist as alternatives to the maximum likelihood estimator (MLE) when a completely observed ground-up loss severity sample dataset is available. However, the options for robust alternatives to a MLE become significantly limited when dealing with grouped loss severity data, with only a handful of methods, like least squares, minimum Hellinger distance, and optimal bounded influence function, available. This paper introduces a novel robust estimation technique, the Method of Truncated Moments (MTuM), pecifically designed to estimate the tail index of a Pareto distribution from grouped data. Inferential justification of the MTuM is established by employing the central limit theorem and validating it through a comprehensive simulation study.