Analysis Of Outcomes Research Articles

Pancreatitis in Patients with Cancer Receiving Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis.

Immune checkpoint inhibitors (ICIs) occasionally cause immune-related adverse events (AEs), which pose challenges to the continuation of treatment. Although ICIs are widely used in patients with cancer, studies reporting immune-mediated pancreatitis remain scarce. We performed a systematic review and meta-analysis to address current knowledge gaps and provide clinical guidance for ICI-associated pancreatitis and lipase elevation. We searched PubMed/Medline, Embase, and Web of Science for phase 3 randomized controlled trials (RCTs) evaluating ICIs. The incidence of any-grade and grade 3-5 pancreatitis/lipase elevation was calculated. Then, we performed a random-effect model meta-analysis to pool the odds ratios (ORs) of these outcomes using RCTs evaluating the addition of an ICI to systemic therapy to assess the effect of ICIs on pancreatic AEs. A systematic review of the treatment of ICI-related pancreatitis was also conducted. The incidence analysis included 81 articles (79 RCTs) comprising 36,871 patients. The incidence of treatment-related pancreatitis was 0.68% (any-grade) and 0.32% (grade 3-5). Meta-analysis revealed that the addition of ICI therapy significantly increased any-grade (OR 2.12, 95% confidence interval [CI] 1.45-3.11, p < 0.001) and grade 3-5 pancreatitis (OR 1.76, 95% CI 1.01-3.08, p < 0.05) with low heterogeneity among ICI subtype subgroups (any-grade: I2 = 0%, p = 0.99; grade 3-5: I2 = 0%, p = 0.63). In analysis of treatment outcome among 146 patients from 53 articles, glucocorticoids were used in 80.6% (n = 108/134) and ICIs were discontinued in 76.5% (n = 101/132; permanent discontinuation: 62.5% [n = 35/56]). The overall rate of pancreatitis appears low, but the addition of ICI therapy significantly increased the incidence of pancreatitis. These findings provide insight into the incidence and treatment of pancreatitis associated with ICIs.

Unveiling ficolins: diagnostic and prognostic biomarkers linked to the Tumor Microenvironment in Lung Cancer

BackgroundFicolins (FCNs) are a family of proteins, comprising FCN1, FCN2 and FCN3, and integral to the immune system which have been implicated in the onset and progression of tumors. Despite their recognized roles, a comprehensive analysis of FCNs in lung cancer remains elusive.MethodsWe employed a variety of bioinformatics tools, including UCSC, SangerBox, Ualcan, cBioPortal, String, Metascape, GeneMANIA, TIDE, CTD, and CAMP databases to investigate the differential expression, diagnostic and prognostic significance, genetic alterations, functional enrichment, immune infiltration, and potential immunotherapeutic implications of FCN1, FCN2, and FCN3 in lung squamous cell carcinoma (LUSC) and lung adenocarcinoma (LUAD). Additionally, RT-qPCR and immunohistochemistry were utilized to validate the expressions of FCNs at the mRNA and protein levels in LUSC and LUAD.ResultsOur comprehensive bioinformatic analysis, supported by RT-qPCR and immunohistochemistry, revealed that the expressions of FCN1, FCN2 and FCN3 were consistently downregulated in both LUSC and LUAD tumor tissues. FCNs demonstrated significant diagnostic potential for LUSC and LUAD, with the area under the receiver operating characteristic curve (AUC) for FCN1 and FCN3 exceeding 0.90. Furthermore, FCN2 and FCN3 showed a strong negative correlation with overall survival (OS) in LUSC, whereas FCN1 and FCN2 were positively correlated with OS in LUAD, suggesting their prognostic value in lung cancer. Gene enrichment analysis indicated that FCNs were predominantly associated with the complement system and complement activation pathways. Immune infiltration analysis further revealed a significant positive correlation between FCNs and the presence of neutrophils and resting mast cells. Our analysis of immunotherapy outcomes revealed a significant disparity in the immunophenoscore (IPS) among lung cancer patients treated with immune checkpoint inhibitors (ICIs), distinguishing those with high FCN expression from those with low FCN expression. Additionally, we identified small molecule compounds related to FCNs and drugs pertinent to LUSC and LUAD.ConclusionFCNs held promise as diagnostic and prognostic biomarkers for LUSC and LUAD. This study also elucidated the relationship of FCNs with the tumor microenvironment, offering novel insights into the immunotherapeutic landscape for LUSC and LUAD.

Efficacy of the informed consent process for surgical procedures: a review of the literature

Background: Informed consent is a communication process between a patient and their healthcare team to acquire a patient’s approval to undergo a medical intervention. It is essential to the delivery of legal, safe, and patient-centred health care. Despite this, it is often inadequately implemented in clinical practice which frequently contributes to patients having little understanding and can lead to unfavourable outcomes. Furthermore, interventions to improve the consent process are not well recognized. Ultimately, the evaluation of these factors in this review will be of relevance in improving patient-centred care. Objectives: Explore degree of understanding and retention of information amongst surgical patients during the informed consent process, identify outcomes of obtaining inadequate informed consent, and evaluate interventions that improve comprehension of surgical treatment. Methods: The first electronic search was conducted through EBSCOhost to identify relevant literature on MEDLINE, Academic Search Complete, and CINAHL Plus. A second search was completed through PubMed. Exclusion and inclusion filters were applied, and duplicates removed, which yielded 200 articles. Title/Abstract screening yielded 15 articles which have then undergone full text review to assess for eligibility. This generated the 10 articles used in this review. Results: Surgical patients have poor comprehension with regards to the benefits, risks, and alternatives of their procedure. Although most patients receive some information about their procedure, this was not suited to their personal goals and needs. Surgical patients also greatly benefited from interventions that were assessed to increase patient understanding and improve the informed consent process. Conclusion: Informed consent is poorly delivered based on the analysis of patient understanding and outcomes. Further research on interventions to improve these elements are recommended as previous studies show notable improvement.

Sexual function and fertility in young female adults surgically treated for anorectal malformations

PurposeThe aim was to investigate sexual function and fertility in female adults operated on for anorectal malformations (ARM).MethodsThis was a cross-sectional questionnaire-based study including female adult patients treated for ARM at our institution between 1994 and 2003. Sexual function in females was assessed using the Profile of Sexual Function (PFSF). Additional questions regarding fertility were answered by the participants. Patient characteristics were retrospectively retrieved from the medical records and descriptive statistics were used for analysis. Sexual function outcomes were compared to a control group from a previously published group of females. Composite outcome analysis was performed using previously published data to determine the potential impact of bowel function and health-related quality of life on sexual function. The ethics review authorities approved the study.ResultsA total of 14 of 30 (46.7%) females responded to the questionnaires and had a mean age of 21.1 years (range 18–26). No association was found between PFSF and age or bowel function (Bowel Function Score), however, a strong correlation was found between PFSF and health-related quality of life (HRQoL) with a Spearman correlation of ρ 0.82 (p = 0.0011). The general satisfaction question was strongly associated with their total PFSF score (ρ = 0.71, p = 0.0092). Except for the “desire” item, the females in this cohort did not have significantly worse sexual function than the control population(p = 0.015). Ten of fourteen (71.4%) females had had their sexual debut at a mean age of 16.3 years and two of these women (20%) have been pregnant. All females had had menarche at a mean age of 12.7 years.ConclusionSexual function in adult females was comparable to healthy controls except for the “desire” item where the cohort reported poorer outcomes. The cohort’s sexual function had a direct association with their reported HRQoL where individuals with worse HRQoL also reported poorer sexual function.Level of evidenceIII

How is ISO14001:2015 boosting the spread of product‐oriented environmental management practices?

AbstractThis research sheds light on the impact of the International Organization for Standardization (ISO) 14001:2015 standard, particularly in its role in driving life cycle perspective (LCP) and effectively integrating product‐oriented environmental management practices (POEMPs) within manufacturing sectors. Addressing this research gap, our analysis utilizes a worldwide sample of 1951 medium and large enterprises from the Thomson Reuters environmental, social and governance (ESG) database to compare the integration of POEMPs, in certified and non‐certified companies, before and after the ISO14001 standard update with a quantitative approach. The findings reveal a higher adoption rate of the seven POEMPs analyzed among certified companies before the publication of the standard. However, its LCP‐focused revision elevates only the implementation of three of them. This highlights a predominant selection effect over the intended treatment effect of the new standard and challenges the assumption that certification to the new version represents an advance in companies' product‐related environmental strategies. The originality of this research lies in its critical analysis of the practical outcomes of ISO14001:2015, pointing the disconnection between certification and the incorporation of POEMPs into environmental management systems. It highlights the need to strengthen implementation mechanisms and provides a nuanced understanding of the role of the standard in driving environmental progress.

Functional outcome and histologic analysis of late onset total type brachial plexus injury treated with intercostal nerve transfer to median nerve with local umbilical cord-derived mesenchymal stem cells or secretome injection: a double-blinded, randomized control study.

Intercostal nerve transfer is a surgical technique used to restore function in patients with total brachial plexus injury. Stem cell and secretome therapy has been explored as a potential treatment for brachial plexus injuries. This study aimed to compare the functional and histologic outcome of intercostal nerve transfer to median nerve with local stem cells or secretome injection in total type brachial plexus injuries. This was a double-blinded, randomized controlled study (RCT). We included patients with neglected total type brachial plexus injury (BPI) who underwent nerve transfer and local injection of either umbilical cord-derivedmesenchymal stem cells (UC-MSC) or secretome into median nerve-flexor digitorum superficialis (FDS) neuromuscular junction (NMJ). We measured preoperative and 8-month postoperative FDS muscle strength, SF-36, DASH score, and histologic assessment. We then analyzed the difference outcome between those two groups. A total of 15 patients were included in this study. Our study found that after nerve transfer and implantation with either UC-MSC or secretome, significant postoperative improvements were observed in physical functioning, role limitations, energy/fatigue, emotional well-being, social functioning, pain, general health, and DASH scores, particularly in the overall cohort and the secretome group. When we compared the mean difference of clinical outcome from preoperative to postoperative between UC-MSC and secretome groups, the UC-MSC group showed better improvement of health change in SF-36 subgroup compared to secretome group. From the analysis, there was no significant difference in the histologic outcomes (inflammation, regeneration, and fibrosis) in overall cohort between preoperative and postoperative cohort. There was also no significant difference in mean change of the histologic outcomes (inflammation, regeneration, and fibrosis) preoperative and postoperatively between UC-MSC and secretome groups. Implantation of either UC-MSC or secretome along with nerve transfer may provide clinical improvement, while to achieve histologic improvement, further conditioning should be performed.

Macronutrient Intake during Complementary Feeding in Very Low Birth Weight Infants Comparing Early and Late Introduction of Solid Foods: A Secondary Outcome Analysis

Background/Objectives: Very low birth weight (VLBW) infants may require enhanced nutrition, even during complementary feeding. However, there are limited data on macronutrient intake during this period, particularly concerning the individual timing of the introduction of solid foods in a representative VLBW infant population. Methods: This prospective observational study analyzed macronutrient intake in VLBW infants with a gestational age &lt; 32 weeks based on whether solid foods were introduced early (&lt;17 weeks corrected age (CA)) or late (≥17 weeks corrected age) Nutritional intake was analyzed using a 24 h recall at 6 weeks CA and 3-day dietary records at 12 weeks, 6, 9, and 12 months CA. Results: In total, 115 infants were assigned to the early and 82 to the late group. The timing of solid food introduction did not affect macronutrient intake, except for a lower fat and higher carbohydrate intake (% of energy) in the early group at 12 weeks and 6 months CA: early vs. late, fat—12 weeks: 47.0% vs. 49.0%, 6 months: 39.2% vs. 43.3%; carbohydrates—12 weeks: 44.9% vs. 43.2%, 6 months: 51.3% vs. 48.0%. Apart from docosahexaenoic acid (DHA) and arachidonic acid (AA), dietary intake recommendations were met in both groups. While nutrient intakes varied significantly between breastfed and formula-fed infants, those with comorbidities exhibited similar nutrient intake levels compared to those without. Conclusion: Our findings suggest adequate macronutrient intakes in VLBW infants irrespective of the timing of solid introduction. However, there is a notable need to enhance dietary intakes of DHA and AA. Future research is crucial to assess whether current nutrient intakes are sufficient for VLBW infants with comorbidities.

Repetitive subconcussion results in disrupted neural activity independent of concussion history

Abstract Concussion is a public health crisis which results in a complex cascade of neurochemical changes that can have life changing consequences. Subconcussions are generally considered less serious, but we now realise repetitive subconcussions can lead to serious neurological deficits. Subconcussions are common in contact sports, and the military where certain personnel are exposed to repetitive occupational blast overpressure. Postmortem studies show subconcussion is a better predictor than concussion for chronic traumatic encephalopathy – a progressive and fatal neurodegenerative tauopathy, only diagnosable postmortem – thus, an in vivo biomarker would be transformative. Magnetoencephalography captures the dynamics of neuronal electrochemical action, and functional MRI shows that functional connectivity is associated with tauopathy patterns. Therefore, both imaging modalities could provide surrogate markers of tauopathy. In this cross-sectional study, we examined the effects of repetitive subconcussion on neuronal activity and functional connectivity using magnetoencephalography and functional MRI, and on neurological symptoms and mental health in a military sample. For magnetoencephalography and outcome analyses, 81 participants were split into ‘high’ and ‘low’ blast exposure groups using the generalized blast exposure value: n=41 high blast (26.4–65.7 years; 4 females); n=40 low blast (28.0–63.3 years; 8 females). For fMRI, two high blast male participants without data were excluded: n=39 (29.6–65.7 years). Magnetoencephalography revealed disrupted neuronal activity in participants with a greater history of repetitive subconcussions, including: neural slowing (higher delta activity) in right fronto-temporal lobes and subcortical regions (hippocampus, amygdala, caudate, pallidum, thalamus), and functional dysconnectivity in the posterior default mode network (lower connectivity at low and high gamma). These abnormalities were independent of concussion or traumatic stress history, and magnetoencephalography showed functional dysconnectivity not detected in functional MRI. Besides magnetoencephalography changes, those with higher blast exposure had poorer somatic and cognitive outcomes, with no blast-related differences in mental health or associations between neurological symptoms and neuronal activity. This study suggests that repetitive subconcussions have deleterious effects on brain function and that magnetoencephalography provides an avenue for both treatment targets by identifying affected brain regions and in prevention by identifying those at risk of cumulative subconcussive neurotrauma.

A Diffusion Modeling-Based System for Teaching Dance to Digital Human

The introduction of artificial intelligence (AI) has triggered changes in modern dance education. This study investigates the application of diffusion-based modeling and virtual digital humans in dance instruction. Utilizing AI and digital technologies, the proposed system innovatively merges music-driven dance generation with virtual human-based teaching. It achieves this by extracting rhythmic and emotional information from music through audio analysis to generate corresponding dance sequences. The virtual human, functioning as a digital tutor, demonstrates dance movements in real time, enabling students to accurately learn and execute dance postures and rhythms. Analysis of the teaching outcomes, including effectiveness, naturalness, and fluidity, indicates that learning through the digital human results in enhanced user engagement and improved learning outcomes. Additionally, the diversity of dance movements is increased. This system enhances students’ motivation and learning efficacy, offering a novel approach to innovating dance education.

Comparative analysis of functional outcomes in arthroscopic repair for traumatic and non-traumatic rotator cuff injuries

BackgroundThe impact of the etiology of rotator cuff injury (RCI) on outcomes after rotator cuff repair remains unclear. This study aimed to evaluate the postoperative outcomes of patients with RCIs of different etiologies and identify the risk factors affecting prognosis.MethodsThis study included 73 patients with RCI who underwent arthroscopic rotator cuff repair. The patients were categorized into either a traumatic group or a non-traumatic group based on their history of trauma. Preoperative and postoperative assessments included shoulder range of motion, muscle strength, and physical examination findings specific to the shoulder for both groups. Clinical differences between arthroscopic repair of traumatic and non-traumatic RCIs were evaluated using univariate analysis. Logistic regression analysis determined independent risk factors for rotator cuff repair prognosis.ResultsAmong the 73 patients, 31 were in the traumatic group and 42 in the non-traumatic group, with a minimum postoperative follow-up of 12 months and a mean follow-up of 13.8 months. The duration of the disease was significantly longer in the non-traumatic group compared with the traumatic group (P < 0.001). The mean tear area was more significant in the traumatic group than in the non-traumatic group (P = 0.003), and the preoperative pain level and functional scores were better in the non-traumatic group compared with the traumatic group. Postoperatively, there were no differences between the two groups regarding scores, joint mobility, strength, and complications. At 12 months postoperatively, multivariate regression analysis indicated that full-layer tear (OR = 5.106, 95% CI: 1.137–22.927, P = 0.033), fat infiltration (OR = 6.020, 95% CI: 1.113–32.554, P = 0.037), and tear area (OR = 6.038, 95% CI: 2.122–17.177, P < 0.001) significantly affected the University of California at Los Angeles (UCLA) score.ConclusionCompared with non-traumatic RCI, traumatic RCI presents with more pronounced pain and impaired joint function preoperatively yet demonstrates comparable postoperative clinical outcomes. Full-layer tears, fat infiltration, and large tear areas are unfavorable factors affecting rotator cuff repair, and postoperative rehabilitation management of these patients should be emphasized.

Analysis of Early Surgical Treatment of Incorrectly Consolidated Gunshot Fractures of the Scapula

Objective. The objective of our study was to analyze the structure of incorrectly consolidated gunshot fractures of the scapula and early outcomes of surgical treatment. Material and Methods. We analyzed 10 cases of incorrectly consolidated gunshot fractures of the scapula in Ukrainian Armed Forces servicemen, received as a result of combat operations, and early outcomes of surgical treatment. The main indications for surgical treatment were as follows: severe impairment of function of the upper limb due to pain, fractures of the articular surface of the scapula with displacement of fragments over 2 mm, fractures of the acromion with displacement of more than 8 mm, and damages to muscles and skin. In addition to radiography in standard projections, preoperative examination included computed tomography (CT). Evaluation of functional outcomes was carried out within 1 to 4 months according to the Oxford Shoulder Score (OSS) scale. The average period of postoperative survey was 2.6 months. Results. Incorrect consolidation of fractures was caused by a long period of preoperative preparation and conservative treatment of wounds in patients due to openness and infection of bullet wounds in 2 patients and shrapnel wounds because of mortar, artillery, tank and rocket attacks in 8 patients. Staged treatment until wound healing was carried out in hospitals and military hospitals of Ukraine using VAC (Vacuum-Assisted Closure) devices. Four cases were right-sided and six were left-sided; 7 of 10 cases were intra-articular fractures with displacement of fragments of the articular surface by 2 mm or more. The average duration of injury at the time of surgery was 4.2 months (range from 2 to 8 months). In addition to eliminating displacements and deformities of incorrectly consolidated fractures and osteosynthesis of fragments, the treatment included replacing the soft tissue defect of the shoulder and shoulder girdle with a non-free thoracodorsal musculocutaneous flap on a neurovascular pedicle in 3 of 10 patients. Seven patients had an isolated wound to the scapula area. Three of 10 patients had a combined wound to the scapula with a defect of the humeral head, upper third of the humerus, and acromial end of the clavicle. These patients underwent implantation of an articulating spacer, restoration of the configuration of the proximal end of the humerus, and reconstruction of the rotator muscles to make possible the shoulder joint arthroplasty. The average value according to the results of a survey of patients on the OSS scale was 20.2 (±4.39) points before surgery and 34.1 (±7.56) points after surgery, which can be considered a good result according to the OSS scoring system. Conclusions. The analysis of the early outcomes showed that reconstructive treatment of gunshot old fractures of the scapula creates biomechanical prerequisites for restoring the function of the upper limb, reduces pain syndrome, and allows for active postoperative rehabilitation.

Differentiated Approach to Surgical ­Treatment of Gunshot Diaphyseal Shin Fractures

Background. The roots of problems in the treatment of gunshot fractures to extremities lay in the high-energetic character of these traumas, the frequency of infectious complications, high rate of slow consolidations, and occurrence of pseudoarthroses and bone tissue lesions. Objective. The objective of the study was to improve the treatment results of patients with gunshot fractures of the shin bones based on the development of a differentiated approach to the treatment of such injuries. Material and Methods. The study is based on the results of examination and treatment of 128 patients with dominant combat shin traumas. The patients were divided into two groups. The first group (control group) included 68 patients who underwent treatment with an external fixation device (EFD). The second group (study group) included 60 patients who underwent the extrafocal osteosynthesis replaced by an internal, mostly intramedullary one. To assess the functional outcomes of treatment, we applied the LEFS (Lower Extremity Functional Scale) in the dynamics of the therapy, namely in 3, 6, 12, and 18 months after the injury. Results. Mean values in both groups during the first two to three weeks showed no statistically significant difference, and their average score according to the LEFS scale was 15.75 points. The most significant differences were observed in the period from 6 to 12 months after the injury, 39.4±2.4 (EFD) and 57.3±2.1 (intramedullary nailing). After 18 months, excellent results showed 20.7% of patients from the study group and 15.8% of the control group (61 – 80 LEFS scores). Good results had 43.2% and 33.1%, respectively (41 – 60 LEFS scores). 28.1% and 39.3%, respectively, showed satisfactory results (21 – 40 LEFS scores). Poor results showed 8.0% of patients of the study group and 11.8% of the control group (p&lt;0.05). Conclusions. The analysis of treatment outcomes of patients with gunshot diaphyseal shin fractures demonstrates that conversion, when used according to indications and following criteria to the replacement of the method of fixation, reduces the incidence of complications in both the early and late postoperative periods, fastens consolidation of gunshot diaphyseal shin fractures by 4.5±2.3 weeks, reduces the frequency of fracture consolidation disorders by 10.6%, and improves the functional results of the patients by 15.0%.

The Impact of Neoadjuvant versus Adjuvant Chemotherapy on Survival Outcomes in Locally Advanced Breast Cancer

The utility of neoadjuvant chemotherapy is expanding in the treatment of breast cancer. Although individual trials have shown comparable survival between patients receiving neoadjuvant and adjuvant chemotherapy, large-scale data analyses for outcomes in patients with locally advanced breast cancer (LABC) are lacking. We conducted an individual-level statistical analysis using patients from six randomized controlled trials (RCTs) investigating survival outcomes with neoadjuvant versus adjuvant chemotherapy in breast cancer by abstracting and analyzing only the patients with LABC. Individual patient data for 779 patients with LABC were collected from six RCTs. Overall and disease-free survival rates were compared between patients receiving neoadjuvant vs. adjuvant chemotherapy with the Cox hazard model and log-rank statistics. Since chemotoxicity causing delays to surgical care is a potential drawback of neoadjuvant chemotherapy, local cohort data were then employed to assess the actual incidence of this, along with the causes behind any delays to surgery in patients receiving neoadjuvant chemotherapy. A time interval from neoadjuvant chemotherapy to surgery of &gt;8 weeks was investigated in a local cohort of 563 patients, representing all locally treated patients receiving neoadjuvant chemotherapy between 2006 and 2019. The statistical analysis demonstrated no overall or disease-free survival differences in LABC patients receiving neoadjuvant vs. adjuvant chemotherapy (p = 0.96 and 0.74, respectively). Within our cohort, 31 (5.5%) patients treated with neoadjuvant chemotherapy experienced a delay of &gt;8 weeks to surgery, with only 13 (2.3%) attributed to chemotherapy-related complications. Our study provides further support for the paradigm shift towards delivering chemotherapy for breast cancer patients in the neoadjuvant setting.

Utility of Adrenomedullin in Predicting Outcomes in Patients with Acute Febrile Illness in the Tropics: A Prospective Observational Study.

Acute febrile illnesses (AFI) such as dengue, leptospirosis, and scrub typhus start with fever, but some patients can deteriorate rapidly. Identifying these patients at risk is necessary to ensure early referral. The study's objective was to assess the utility of serum adrenomedullin (ADM) as a biomarker in predicting outcomes in adult AFI patients presenting to the emergency department (ED). In this prospective observational study, all consecutive patients admitted with AFI through the ED between June 2023 and February 2024 were assessed for eligibility. Clinical and laboratory findings were noted. The serum samples sent routinely for biochemical tests were used to calculate ADM levels at admission and 48 hours later (whenever possible). Clinically relevant outcome variables were collected for all patients. The utility of ADM in predicting 7-day mortality was evaluated for primary outcome analysis using a stepwise binary logistic regression. A total of 181 patients were recruited, with dengue (n = 91, 50%) being the most common diagnosis. The median sequential organ failure assessment score at admission was 5 (IQR: 3-10). The 7-day mortality was 26 (14%, 95% CI: 9.3-19.5). The median admission ADM levels and difference in ADM levels at 48 hours were significantly higher in those who died by day 7. Adrenomedullin levels at admission were found to be an independent predictor of 7-day mortality (adjusted odds ratio: 1.002, 95% CI: 1.001-1.004, P = 0.005). High ADM levels can be used for early referral in patients with tropical AFI. There is a need to explore the utility of antibodies targeting ADM in clinical studies.

Analysis of bleeding outcomes in patients with hypoproliferative thrombocytopenia in the A-TREAT clinical trial.

Despite prophylactic platelet transfusions, hypoproliferative thrombocytopenia is associated with bleeding; historical risk factors include hematocrit (HCT) 25%, activated partial thromboplastin time 30 s, international normalized ratio 1.2, and platelets 5000/μL. We performed a post hoc analysis of bleeding outcomes and risk factors in participants with hematologic malignancy and hypoproliferative thrombocytopenia enrolled in the American Trial to Evaluate Tranexamic Acid Therapy in Thrombocytopenia (A-TREAT) and randomized to receive either tranexamic acid (TXA) or placebo. World Health Organization (WHO) grade 2+ bleeding occurred in 46% of 330 participants, with no difference between the TXA (44%) and placebo (47%) groups (p = 0.66). Overall, the most common sites of bleeding were oronasal (18%), skin (17%), gastrointestinal (11%), and genitourinary (11%). Among participants of childbearing potential, 28% experienced vaginal bleeding. Platelets ≤5000/μL and HCT < 21% (after adjusting for severe thrombocytopenia) were independently associated with increased bleeding risk (HR 3.78, 95% CI 2.16-6.61; HR 2.67, 95% CI 1.35-5.27, respectively). Allogeneic stem cell transplant was associated with nonsignificant increased risk of bleeding versus chemotherapy alone (HR 1.34, 95% CI 0.94-1.91). The overall rate of WHO grade 2+ bleeding was similar to previous reports, albeit with lower rates of gastrointestinal bleeding. Vaginal bleeding was common in participants of childbearing potential. Platelets ≤5000/μL remained a risk factor for bleeding. Regardless of platelet count, bleeding risk increased with HCT < 21%, suggesting a red blood cell transfusion threshold above 21% should be considered to mitigate bleeding. More investigation is needed on strategies to reduce bleeding in this population.

Beyond Conventional Imaging: A Systematic Review and Meta-Analysis Assessing the Impact of Computed Tomography Perfusion on Ischemic Stroke Outcomes in the Late-Window.

Non-contrast CT (NCCT) and CT angiogram (CTA) have become essential for endovascular treatment (EVT) in acute stroke. Patient selection may improve when CT perfusion imaging (CTP) is also added for patient selection. We aimed to analyze the effects of implementing CTP in acute ischemic stroke (AIS) patients' treatment to assess whether stroke outcomes differ in the late window. We searched the PubMed, Embase, and Web of Sciences databases to obtain articles related to CTA and CTP in EVT. Collected patient data was split into two groups: the CTP and control (NCCT+CTA) cohorts. Primary outcomes evaluated were modified Rankin Scale (mRS) scores, symptomatic intracranial hemorrhages (sICH), mortality, and successful recanalization. There were 14 studies with 5,809 total patients in the final analysis: 2,602 received CTP and 3,202 were in the control group. CTP/CTA patients showed significantly lower rates of 90-day stroke-related mortality (OR: 0.72, 95% CI 0.60-0.87, p<0.01) and significantly higher successful recanalization (OR: 1.42, 95% CI 1.06-1.94, p<0.01) compared to CTA-only patients. Analysis of other outcomes including functional independence (mRS 0-2), critical times, and intracranial hemorrhages were non-significant (p > 0.05). The study highlights the usefulness of CTP-guided therapy as a supplementary tool in EVT selection in the late window. Although the addition of CTP resulted in lower mortality, the favorable outcomes did not improve. Further evidence is required to establish a clearer understanding of the potential advantages or limitations of incorporating CTP in stroke imaging.

Effectiveness of the Walkbot system in patients with infantile cerebral palsy

BACKGROUND: Estimating the effectiveness of robotic mechanotherapy is crucial in the rehabilitation of children with cerebral palsy. AIM: To evaluate the effectiveness of the Walkbot robotic complex (Walkbot, Korea) in children with cerebral palsy. MATERIALS AND METHODS: The study included 35 patients with infantile cerebral palsy who received courses of rehabilitation therapy based on the state autonomous institution “City Children’s Polyclinic No. 7.” A comparative analysis of the functional motor outcomes between two groups of children with cerebral palsy was performed. Group 1 was treated with locomotor therapy on the Walkbot, whereas group 2 was not prescribed with the apparatus. RESULTS: The effect of using the Walkbot mechanotherapeutic complex on functional motor outcomes in patients with infantile cerebral palsy was evaluated. Better dynamics of the level of motor skills development on the GMFM-66 scale was noted in group 1 (by 6.8% in group 1 and 4.1% in group 2; p=0.006). The Hauser index (p=0.05) indicated an improvement in locomotor function, which increased the level of independence in everyday life according to the FIM scale (p=0.044), compared to the data of children in the control group. Attaining the effect depends on the number of procedures and total number of rehabilitation courses. CONCLUSION: Children with cerebral palsy who received the Walkbot therapy have better motor outcomes, primarily relating to locomotor function.

Spring-Assisted Cranioplasty in Unicoronal Synostosis: Analysis of Outcomes

Background: Spring-assisted cranioplasty and successful long-term outcomes for sagittal synostosis has been well described in recent literature. However, there is a paucity of data regarding the application of springs to unicoronal synostosis. Unicoronal synostosis (UCS) presents unique challenges in its causation of skull base scoliosis and orbital asymmetry. Many surgeons feel that the fronto-orbital advancement and vault remodeling is the most effective and reliable strategy to counteract these changes. Here we present our experience and outcomes with spring cranioplasty for unicoronal synostosis. Materials and methods: A retrospective review of non-syndromic unicoronal synostosis patients undergoing spring-assisted cranioplasty was performed. Preoperative and postoperative intracranial volume (ICV), orbital volume (OV), orbital height (OH), orbital width (OW), midface twist (MFT), and skull-base twist (SBT) were measured from DICOM CT data. Analysis was performed with Materialize software (Leuven, Belgium). Paired t-tests were performed using Excel. Results: Ten patients (5 females, 5 males) had springs placed at 100.1 days (avg). Average ICV: preop: 608.2 ± 101.4 cc, postop: 995.2 ± 166.1 cc. Differences in orbital volume and height in the preop affected orbit versus non-affected orbit was significant ( P = .01, P ≤ .001 respectively) whereas no significant difference between the two sides postoperatively was observed ( P = .19, P = .58 respectively). Average preop MFT was 81.1 ± 2° and postop was 87.6 ± 2.6° and preop SBT was 171.9 ± 2.7° and postop was 177.6 ± 2.6°; both showing significant improvement after spring cranioplasty (both P ≤ .001). Conclusion: Our experience and early outcomes with spring cranioplasty for UCS demonstrates that when used in younger patients (&lt;5 months) cranial springs can be a safe and effective strategy to minimize skull base scoliosis, facial scoliosis, and orbital asymmetry, as well as increase intracranial volume. Although long-term data needs to be assessed, we are optimistic that early correction of cranial base scoliosis will translate to stable results as patients reach dentoskeletal maturity.

Short-Term Outcomes Analysis Comparing Open, Lap-Assisted, Totally Laparoscopic, and Robotic Total Gastrectomy for Gastric Cancer: A Network Meta-Analysis

Background/Objectives: Total gastrectomy (TG) is the cornerstone treatment for gastric cancer (GC). While open TG (OTG) with D2 lymphadenectomy remains the gold standard, alternative techniques such as lap-assisted TG (LATG), totally laparoscopic TG (TLTG), and robotic TG (RTG) have been reported with promising outcomes. The present analysis aimed to compare the short-term outcomes of different techniques for TG comprehensively in the setting of GC. Methods: A systematic review and network meta-analysis were performed. The primary outcomes were overall complications (OC), severe postoperative complications (SPCs), and anastomotic leak (AL). Pooled effect-size measures included risk ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrIs). Results: Sixty-eight studies (44,689 patients) were included. Overall, 52.4% underwent OTG, 6.5% LATG, 39.2% TLTG, and 1.9% RTG. Both TLTG (RR 0.82; 95% CrI 0.73–0.92) and RTG (RR 0.75; 95% CrI 0.59–0.95) showed a reduced rate of postoperative OC compared to OTG. SPCs and AL RR were comparable across all techniques. Despite the longer operative time, LATG, TLTG, and RTG showed reduced intraoperative blood loss, time to first flatus, ambulation, liquid diet resumption, and hospital stay compared to OTG. Conclusions: Minimally invasive approaches seem to be associated with improved OC and functional outcomes compared to OTG.

8527 The Role Of SGLT2 Inhibitors In Outcomes After LVAD Implantation

Abstract Disclosure: L. Carafone: None. S. McNitt: None. I. Goldenberg: None. J. Alexis: None. Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are important medications in the treatment of diabetes mellitus, however they offer several additional benefits, including improved heart failure outcomes in patients with and without diabetes. The role of SGLT2i in heart failure outcomes for patients who receive left ventricular assist device (LVAD) implantation is not known. Right heart failure, in particular, is a frequent complication and major contributor to morbidity and mortality after LVAD implantation. SGLT2i have been increasingly used in patients who undergo LVAD implantation, however it is unknown whether right heart failure events post-LVAD implantation are meaningfully impacted by SGLT2i use. Objective: The purpose of this study was to evaluate the role of SGLT2i in outcomes after LVAD implantation. The primary endpoint was the onset of a first right heart failure (RHF) event following LVAD implantation. Secondary endpoints included recurrent RHF, first and recurrent hospitalization for RHF, and all-cause mortality. Methods: The study population comprised all consecutive patients who received a HeartMate 3 LVAD implantation at the medical center from 9/25/2015 through 9/1/2023 who are included in the institution’s LVAD Database. Both patients who received and did not receive a SGLT2i were included. A time-dependent model was used to evaluate treatment with SGLT2i as a time-dependent variable. Multivariable propensity score matching was used in the analysis of outcomes. Results: A total of 399 patients were analyzed, which included 175 patients who received SGLT2i and 224 patients who did not receive SGLT2i. Cox proportional hazards regression, employing propensity score stratification, demonstrated SGLT2i use was not associated with a statistical significant effect in the primary endpoint of a first occurrence of RHF event (HR = 1.41, 95% CI = 0.77-2.61, p = 0.268). Similarly, SGLT2i use was not associated with secondary outcomes, including recurrent RHF (HR = 1.28, 95% CI = 0.76-2.16, p = 0.360), first or recurrent hospitalization for RHF (HR = 0.38, 95% CI = 0.11-1.33, p = 0.131 and HR = 0.63, 95% CI = 0.27-1.46, p = 0.285, respectively), and all-cause mortality (HR = 0.90, 95% CI = 0.44-1.83, p = 0.771). Presence or absence of diabetes diagnosis did not significantly impact outcomes. Conclusions: The observational data in this study suggest no incremental benefit of SGLT2i for right heart failure or mortality outcomes after LVAD implantation, however large-scale prospective studies are needed to evaluate the role of SGLT2i in this setting. Further elucidating the role of these medications in LVAD outcomes will be critical in clinical decision-making regarding use of SGLT2i in this population. Presentation: 6/1/2024