Anatomical Status Research Articles

The emerging role of PET/CT scanning in the treatment planning of ovarian cancer: A mini-review

AbstractGiven the many obstacles faced during the treatment of ovarian cancer, usually due to diagnosis at advanced stages, it is crucial to use different means to plan the therapeutic procedure in order to achieve optimal results. Positron emission tomography–computed tomography (PET/CT) is a recent hybrid method of medical imaging that can provide various information on the anatomic and biochemical status of a tumor, as well as possible metastases and hence provide better insights to clinicians for the therapeutic procedure. To this end, the present mini-review explores the role of PET/CT scanning in planning surgical procedures, systemic anticancer therapy and radiotherapy and summarizes the current status of studies that examine the use of PET/CT in the personalized therapy of ovarian cancer. Nonetheless, more clinical and observational studies are required to further verify the use of PET/CT in planning therapeutic procedures for patients with ovarian tumors.

68Ga]FAPI PET for Imaging and Treatment Monitoring in a Preclinical Model of Pulmonary Fibrosis: Comparison to [18F]FDG PET and CT.

This study aimed to evaluate the feasibility of using [68Ga]-fibroblast-activating protein inhibitor (FAPI) positron emission tomography (PET) imaging for diagnosing pulmonary fibrosis in a mouse model. We also examined its value in monitoring treatment response and compared it with traditional [18F]-fluorodeoxyglucose (FDG) PET and computed tomography (CT) imaging. A model of idiopathic pulmonary fibrosis was established using intratracheal injection of bleomycin (BLM, 2 mg/kg) into C57BL/6 male mice. For the treatment of IPF, a daily oral dose of 400 mg/kg/day of pirfenidone was administered from 9 to 28 days after the establishment of the model. Disease progression and treatment efficacy were assessed at different stages of the disease every week for four weeks using CT, [18F]FDG PET, and [68Ga]FAPI PET (baseline imaging performed at week 0). Mice were sacrificed and lung tissues were harvested for hematoxylin-eosin staining, picrosirius red staining, and immunohistochemical staining for glucose transporter 1 (GLUT1) and FAP. Expression levels of GLUT1 and FAP in pathological sections were quantified. Correlations between imaging parameters and pathological quantitative values were analyzed. CT, [18F]FDG PET and [68Ga]FAPI PET revealed anatomical and functional changes in the lung that reflected progression of pulmonary fibrosis. In untreated mice with pulmonary fibrosis, lung uptake of [18F]FDG peaked on day 14, while [68Ga]FAPI uptake and mean lung density peaked on day 21. In mice treated with pirfenidone, mean lung density and lung uptake of both PET tracers decreased. Mean lung density, [18F]FDG uptake, and [68Ga]FAPI uptake correlated well with quantitative values of picrosirius red staining, GLUT1 expression, and FAP expression, respectively. Conclusions: Although traditional CT and [18F]FDG PET reflect anatomical and metabolic status in fibrotic lung, [68Ga]FAPI PET provides a means of evaluating fibrosis progression and monitoring treatment response.

Abstract PO3-03-05: Clinical outcomes in early-stage TNBC according to HER2-low status

Abstract Background: Clinical outcomes according to HER2 immunohistochemistry (IHC) in patients with early-stage HER2-negative breast cancer have differed across studies. For early-stage TNBC (eTNBC), less representation of this subtype in cohorts studied to date has limited interpretation of results. We sought to evaluate outcomes according to HER2 IHC in a multi-institutional cohort of patients (pts) with eTNBC who received neoadjuvant therapy (NAT). Methods: Pts diagnosed with stage I-III TNBC (including HR-low; ER and PR < 10%) who received NAT and underwent surgery between 1/1/16-6/30/19 were identified across three institutional prospective databases. HER2 was defined as low (1+ or 2+/ISH non-amplified) or HER2-0 according to local testing at diagnosis. Pathological complete response (pCR) was defined as no residual invasive disease in breast and axilla. Multivariable logistic regression was used to compare pCR rates (HER2-low vs HER2-0) adjusting for age at diagnosis, race, anatomic clinical stage, germline BRCA1/2 (gBRCA), histology, HR status and receipt of anthracycline and taxane NAT. Recurrence-free (RFS), distant recurrence-free (DRFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards model was used to estimate adjusted hazard ratios. Results: A total of 978 pts were identified of which 388 (39.7%) had HER2-low and 590 (60.3%) had HER2-0 tumors at diagnosis. Median age was 50.3 (range: 21.0-83.4) yrs. 174 (17.8%) pts had HR-low tumors. 142 (14.5%) pts had a known gBRCA mutation. 790 pts (80.8%) received anthracycline- and taxane NAT. No significant differences were observed in age, race, gBRCA, histology, HR status (low vs negative), clinical tumor size, or type of NAT between HER2-low and HER2-0 groups. Clinical nodal positivity was higher in HER2-low (55.2%) vs HER2-0 (46.6%), p=0.011. No significant difference in pCR was observed between HER2-low (32.0%) and HER2-0 (32.7%) groups, adjusted p=0.928. Among pts with residual disease (RD) post-NAT with HER2 IHC also available in the RD sample, 244/363 (67.2%) had concordant HER2 status. 70/225 (31.1%) of HER2-0 tumors at diagnosis had IHC expression post-NAT (66 HER2-low, 4 HER2-positive); 48/138 (34.8%) of HER2-low tumors at diagnosis were HER2-0 post-NAT. At a median follow-up of 3.1 yrs, RFS did not significantly differ between HER2-low vs HER2-0 pts with pCR (p=0.368) or in those with RD post-NAT (p=0.573). Similarly, DRFS did not differ according to HER2 category for pts with pCR (p=0.509) or RD (p=0.812), nor did OS for pts with pCR (p=0.514) or RD (p=0.285) (Table 1). Conclusion: In a large cohort of pts with eTNBC treated with NAT, HER2-low status was not associated with pCR or survival after adjusting for clinical factors. High rate of discordance in HER2 IHC between diagnostic and RD post-NAT was observed, highlighting the importance of repeat IHC testing in serial samples given the development of antibody drug conjugates for HER2-low breast cancer. Table 1. RFS, DRFS and OS by HER2 expression Citation Format: Ana Garrido-Castro, Danielle Brandes Zakon, Qingchun Jin, Michael Grimm, Akshara Singareeka Raghavendra, Melissa Hughes, Mathew Cherian, Julie Vincuilla, Tonia Parker, Paolo Tarantino, Elizabeth Mittendorf, Tari King, Vicente Valero, Debu Tripathy, Bhuvaneswari Ramaswamy, Sara Tolaney, Nabihah Tayob, Nancy Lin, Daniel Stover, Carlos Barcenas. Clinical outcomes in early-stage TNBC according to HER2-low status [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-03-05.

Prediction of foveal microstructure and visual outcomes following surgery for idiopathic macular hole: An assessment using spectral-domain optical coherence tomography.

To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes. A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI. Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704. In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.

Anatomic and functional status of the uterus after transcervical myomectomy

Anatomic and functional status of the uterus after transcervical myomectomy

Aspirin use and head and neck cancer survival and recurrence.

Head and neck cancer (HNC) has low 5-year survival, and evidence-based recommendations for tertiary prevention are lacking. Aspirin improves outcomes for cancers at other sites, but its role in HNC tertiary prevention remains understudied. HNC patients were recruited in the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (SPORE) from 2003 to 2014. Aspirin data were collected through medical record review; outcomes (overall mortality, HNC-specific mortality, and recurrence) were collected through medical record review, Social Security Death Index, or LexisNexis. Cox proportional hazards models were used to evaluate the associations between aspirin use at diagnosis (yes/no) and HNC outcomes. We observed no statistically significant associations between aspirin and cancer outcome in our HNC patient cohort (n = 1161) (HNC-specific mortality: HR = 0.91, 95% CI = 0.68-1.21; recurrence: HR = 0.94, 95% CI = 0.73-1.19). In analyses stratified by anatomic site, HPV status, and disease stage, we observed no association in any strata examined with the possible exception of a lower risk of recurrence in oropharynx patients (HR = 0.60, 95% CI 0.35-1.04). Our findings do not support a protective association between aspirin use and cancer-specific death or recurrence in HNC patients, with the possible exception of a lower risk of recurrence in oropharynx patients.

Clinical Outcomes in Sebaceous Carcinoma: A Retrospective Two-Center Cohort Study.

Sebaceous carcinoma (SC) is a rare, potentially recurrent, and life-threatening cutaneous malignancy that can be associated with Muir-Torre syndrome (MTS), a DNA mismatch repair-driven genodermatosis. Earlier studies examining factors associated with recurrence have focused on periocular tumors only. Examine outcomes of SC and identify factors associated with recurrence. Retrospective study from 2 tertiary care centers. Sixty-seven cases from 63 patients were identified, including 7 cases of MTS and 13 arising in the context of immunosuppression. Fifty-five cases (82.1%) were treated with complete circumferential peripheral and deep margin assessment (CCPDMA) methods. Five recurrences developed during the postoperative period. On univariate analysis, periocular location (odds ratio [OR] 7.6, p = .0410), and lesion size ≥2 cm (OR 9.6, p = .005) were associated with recurrence, whereas CCPDMA (OR 0.052, p = .0006) was inversely associated with recurrence. On multivariate analysis, only lesion size ≥2 cm (OR 9.6, p = .0233) and CCPDMA approaches (OR 0.052, p = .007) were significant. Non-complete circumferential peripheral and deep margin assessment methods and large lesion size were independent risk factors predicting recurrence, whereas anatomic subtype and MTS status were not. These findings can assist in identifying SC cases that may benefit from more aggressive treatment and closer surveillance.

Influence of Shading and Anatomical Structure of the Stem Cutting on Rooting Performance of Fig (Ficus Sp.)

Fig (Ficus sp.) belongs to tropical and subtropical climates which have great potential for the commercial cultivation. Cutting is the most common and effective method of propagation for figs which is influenced by different exogenous and endogenous factors. In this light, a study was conducted to observe the responses of stem cutting of fig (Ficus sp.) of one exotic and two indigenous varieties (Teen- Ficus carica; wild fig- Ficus hispida and joggo fig- Ficus racemosa) in respect of duration of shade and anatomical status of stem. The study was laid in Completely Randomized Design (CRD) with two factors (duration of shade and cultivars) and three replications of the treatments. The four different treatments of shade duration were as T1= open or control, T2=3 days of shading, T3= 6 days of shading and T4= 9 days of shading. Data were collected on root and sprout growth of the cuttings at weekly interval from two weeks of planting the cuttings in sand filled plastic cups. When the duration of shading increased, the teen (Ficus carica) showed the longest sprout (1.59 mm) and root (2 mm) as well as maximum number of root (5.67) and sprout (2.33). Better rooting performance was found in teen and it was very low in wild fig. A relationship between rooting performance and anatomical structure was clearly observed in this study. Long period of shading has positive effect on number and length of sprout in teen and wild fig. On the other hand, short period of shading minimized the days required for sprouting in teen Presence of thin cuticle, thin trichome and the absence of druses crystal in ground tissue and medulla also enhanced the performance of stem cutting of teen.

Effect of Dietary Fenugreek Seeds and Synbiotic on the Physiological Anatomical, Immunological Attributes and Antioxidant Status in Stressed Chickens

This experiment was conducted to explore the effect of fenugreek seeds (FSP) and synbiotic (SP) powders in diet as antioxidant factors on antioxidative, physiological, immunological indicators of serum and anatomical properties during exposing to the oxidative stress (OS) induced by hydrogen peroxide (H2O2) in drinking water of broiler chickens from 2nd until 35th day of age. Totally, 300 chicks Ross 308 at one day old of age were randomly allocated into five treatments with three equal replicates in each treatment (20 chicks/replicate). The treatments were distributed into negative control without feed additives (T1) whereas T2 was adding 1 ml (0.5%) of H2O2 per 1 L of drinking water as stressed positive control. The dietary additive (0.5%) each of FSP and SP was added in stressed groups (T3 and T4), respectively and dietary combination of 0.25% both FSP and SP was added in stressed group (T5). The results referred that T3, T5 and T1 registered an increased level in catalase (p≤0.05) and glutathione peroxidase (p≤0.01) activity and there was increased amounts in superoxide dismutase and packed cells volume in T4, T5 and T1 (p≤0.01) in comparison to T2. The T3, T4, T5 and T1 achieved a decreased malondialdehyde (p≤0.05) with considerable decrease (p≤0.01) in heterophils/lymphocytes ratio, uric acid, creatinine, alanine and aspartate aminotransferases compared with T2. In comparison to T2, all stressed treatments and T1 had high antibody titers against Newcastle disease (p≤0.05) and infectious bursal disease (p≤0.01). Moreover, high proportional weights of lung and heart (p≤0.01) were in T5 whereas T1 achieved high (p≤0.01) kidneys weight and large intestine length. Thus, dietary FSP and SP supplement added synergistically or individually could promote antioxidant status, regulate liver and kidney function, and improve immune system of stressed chickens.

Carotid Endarterectomy for Asymptomatic Stenosis Based on Duplex Ultrasound Alone Achieves Equivalent Perioperative and Long-Term Outcomes Relative to Advanced Imaging Based Endarterectomy

The purpose of this study is to compare both perioperative as well as long-term outcomes of patients undergoing carotid endarterectomy (CEA) for asymptomatic carotid bifurcation stenosis based on duplex ultrasound in isolation relative to a combination of duplex and more advanced imaging. All CEA in the VQI between January 2003 and May 2022 were queried. We identified 171,816 CEAs in the database. Exclusions were symptomatic carotid lesion (57,742), lack of imaging documentation (908), lack of advanced imaging status (1,816), simultaneous additional arterial intervention in the carotid, coronary, or peripheral arterial system (n=4,118), and anatomic high-risk status for CEA (n=4,071). Included patients were then placed into 1 of 2 cohorts: patients undergoing CEA based on duplex imaging alone (n=33,437) and those undergoing CEA based on advanced imaging (CTA, MRA, or invasive angiography) with or without duplex (n=69,715). We performed multivariable analysis for the following outcomes utilizing CEA based on duplex in isolation as 1 of the variables: perioperative neurological ischemic event utilizing binary logistic regression; combined 90-day mortality and neurological ischemic event utilizing binary logistic regression; neurological event in long-term follow-up with date of surgery serving as time zero; time dependent Cox regression analysis; mortality in long-term follow-up utilizing time-dependent Cox regression. Carotid endarterectomy based on duplex alone and CEA based on advanced imaging had essentially equivalent rates of 90-day mortality (0.9% vs. 1.0%, P=0.108); combined perioperative neurological event and 90-day mortality (2.0% vs. 2.2%, P=0.042); and, return to the operating room (1.6% vs. 1.7%, P=0.154). On multivariable analysis CEA based on advanced imaging was noted to have a slightly higher absolute rate of perioperative neurological event without achieving multivariable significance (1.3% vs. 1.2%, adjusted odds ratio 1.11 (0.98-1.25), P=0.092. CEA based on advanced imaging had a higher rate of neurological event after index hospital admission relative to duplex in isolation (hazard ratio (HR) 1.44 (1.31-1.60), P<0.001). However, the absolute percentage difference was just 0.5% (1.6% vs. 2.1%). CEA based on duplex alone was associated with a slightly increased risk of mortality in LTFU (HR 1.16 (1.11-1.21), P<0.001). At 5years the absolute risk of mortality was less than 1% different between the cohorts. Performing CEA for asymptomatic bifurcation stenosis based on duplex ultrasound alone is a safe practice which achieves clinically equivalent perioperative and long-term freedom from cerebral ischemia and mortality relative to CEA based on advanced imaging. This has potential implications for health care cost saving as well as avoidance of radiation and iodinated contrast.

0008 The endogenous circadian system provides for enhanced coronary microvascular function in the morning

Abstract Introduction Major adverse cardiovascular events occur most commonly in the morning compared to other times of the day or night. Evaluation of coronary microvascular reserve perfusion can be used to reflect the anatomic and functional status of the coronary vascular system, both of which contribute to major adverse cardiovascular events. Prior work suggests that coronary microvascular function is attenuated in the morning, but whether the circadian system contributes to this attenuation is unknown. Methods To determine if the circadian system drives the morning attenuation in coronary microvascular function, we studied 13 healthy participants (8 females, 5 males; 42+/-13 years [mean+/-SD]) in a 5-day forced desynchrony protocol in dim light, where all behaviors and measurements were distributed across the 24-hour cycle. Coronary microvascular function was evaluated by vasodilator myocardial contrast echocardiography, sequentially 16 hours apart, corresponding to each participant’s morning, evening and night. We analyzed time-intensity data to calculate microvascular flux rate (beta) at rest and during hyperemia for each measurement. Circadian phases were calculated based on individual dim-light melatonin onsets. We grouped data into three ~8-hour circadian bins corresponding to each participant’s morning, evening and night. Mixed model analyses were used to determine if there were significant differences between data collected in the circadian morning compared to the other times while controlling for the measurement schedule and between-subject variability. Results There were no significant time-dependent differences in echocardiographic indices of ventricular function, including stroke volume, cardiac output, or myocardial work. Contrary to our hypothesis, hyperemic perfusion was lowest in the evening rather than the morning (2.49 /s vs. 2.82 /s, p=0.042) but not different between morning and night (also 2.82 /s, p=0.96). Conclusion In healthy people, there is no circadian-system-driven morning attenuation in coronary microvascular function: indeed, the circadian system facilitates coronary vascular flow in the morning, possibly to accommodate the anticipated behaviorally driven increases in myocardial demand after awakening. Support (if any) NIH KL2TR002370, R01HL163232, R35HL155681, R01HL140577, R01HL130046, R01HL078610, R01HL156948, K01HL146992, K01HL151745, ULTR00128, Sleep Research Society Foundation, Oregon Institute of Occupational Health Sciences.

Técnicas de Neuroimagenología en la Cuantificación de la Neuroplasticidad en Pacientes con Enfermedad Vascular Cerebral

Neuroimaging techniques provide relevant information of the functional and anatomical status of the human brain. This information is of particular importance when a pathology, like stroke, produces a brain injury. In stroke patients, it has been determined that neuroplasticity is the primary recovery mechanism of the lost motor function. Due to worldwide high prevalence, especially in developing countries, it is necessary to continue the research of the recovery mechanisms involved in this pathology. To this end, functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) are two of the most used neuroimaging techniques. In stroke patients, fMRI allows the analysis of the neural activity produced by the execution of motor tasks, whereas DTI provides structural information of the brain anatomy. In this narrative review, multiple studies that employ these neuroimaging techniques for quantification of neuroplasticity changes in stroke patients after undergoing a neurorehabilitation program are presented. Better understanding of these neuroplasticity changes would allow researchers to design and provide more beneficial rehabilitation schemes to stroke patients.

Deep Learning Enabled Perceptive Wearable Sensor: An Interactive Gadget for Tracking Movement Disorder

AbstractBiosignals of diverse body posture contain a key information about the physiological, kinesiological, and anatomical status of human body that can facilitate in early assessing the neurological maladies such as Parkinson's disease, multiple sclerosis, and other neurological disorders. Early detection and timely intervention of specific diagnosis for curing the disorders is considered as one of the effective step of diagnosis. Existing technologies of capturing human movements have the limitations of low latencies, bulky counterpart, cost‐intensive, and power consuming. A highly sensitive (≈440 mV N−1), confirmable, and flexible wearable gadget is introduced for addressing such complexities; moreover, the gadget is fabricated by recycling waste material. Subsequently, it is interfaced with various deep/machine learning algorithms for classification/prediction of different hand poses; particularly unsupervised k‐means clustering is used for observing discrete classes, and different supervised algorithms such as k‐nearest neighbor, support vector machine, deep neural network (DNN), and pattern recognition that provide the high degree of prediction accuracy (up to ≈98%) for classification of different postures. Thus, artificial intelligence‐aided wearable gadget can not only offer an unique solution for autonomously tracking various body movements but also assist in reducing waste materials, which is otherwise a threat to the environment.

74MO Clinical outcomes for pelvic node-positive vulvar carcinoma in the PET and IMRT era: Reassessing the stage IVb designation

Pelvic node-positive (PNP) vulvar carcinoma has historically had poor outcomes; 2-year DFS was 27% in GOG 37. Studies in this cohort were performed prior to widespread PET staging and intensity modulated radiotherapy (IMRT). We assessed clinical outcomes and prognostic factors in FIGO IVb patients in the PET and IMRT era, hypothesizing that PET staging and IMRT treatment may improve outcomes. Following IRB approval, we reviewed all patients with PNP vulvar squamous cell carcinoma (SCC) who received IMRT from 2012-2022. Patients treated palliatively were excluded. Eligible patients met stage IVb criteria and received simultaneous integrated boost (SIB) to radiologically positive lymph nodes (LN). Tumor size, grade, PET primary and LN SUVmax, largest LN size, LN anatomic location, p16 status, chemotherapy (CHT), and RT completion were recorded, as were survival (OS), disease free survival (DFS), local (LRFS)/regional (RRFS) recurrence and distant metastasis (DMFS). Patterns of recurrence and survival were examined via Kaplan Meier, with univariate analysis (UVA) via log-rank t-test. Multivariate analysis (MVA) was performed via Cox regression. 198 patients received RT for vulvar SCC, and 31 met inclusion criteria. Median follow up was 26 months (IQR 9-49) for patients completing RT (n=25) and 3 months (IQR 1-9) for patients not completing RT (n=6). 93.5% (n=29) had PET staging, with avid LN at external iliac (74.2%, n=23), common iliac (16.1%, n=5) and para-aortic (9.7%, n=3) echelons. RT was majority definitive/neoadjuvant (83.9%, n=26); 93.5% (n=29) received concurrent CHT. 22.5% (n=7) underwent LN dissection, with median 3 LN resected and 2 LN positive. With RT completion, 3-year OS and DFS were 64.1% and 69.6%, with 82.6% LRFS, 83.1% RRFS, and 77.5% DMFS. On UVA, LN SUVmax correlated with worse DFS, RRFS, and DMFS, and p16- status with worse OS, RRFS, and DMFS (p<0.05). LN SUVmax retained significance for DFS (p=0.045) and DMFS (p=0.041) on MVA. Clinical outcomes for PNP vulvar SCC have substantially improved in the PET and IMRT era, challenging the FIGO IVb designation. PET LN SUVmax may help predict patients at higher risk of DM, and p16+ status those with more favorable outcomes.

Presenting Three Case Reports of Congenital Vaginal and Complete Uterine Septum with Double Cervix (U2bC2V1) with Different Reproductive Outcomes: Is There a Need for Surgical Treatment?

Congenital uterine anomalies (CUAs) consist of structural disorders of the female genital tract arising as a result of abnormal fusion or resorption of the Müllerian ducts. The prevalence of CUAs is 5.5% in the general population, 8.0% in infertile women, and 13.3% in women with a history of miscarriage. Here, we present three cases of women with complex genital tract anomalies, including cervical duplication and vaginal septum with different reproductive outcomes. A complete uterine septum with double functional cervix may have a wide spectrum of reproductive outcomes: from completely normal conception and pregnancy to infertility and recurrent pregnancy losses. In these cases, we advised patients to complete their evaluation by undergoing hysteroscopy, to provide reliable information for the anatomical status of the cervix, tubal ostia, and, especially, the uterine cavity. In cases of infertility or recurrent miscarriages, the dilemma is whether to proceed with the resection of the uterine septum in combination with the resection of vaginal one. We suggest that among women with this type of CUAs, surgical treatment should be offered. Further evidence from larger population studies is needed as the risks of surgical treatment cannot be disregarded.

The effect of percussion, diuresis and inversion therapy on RIRS success for lower renal pole stones.

Inversion of the patient, forced diuresis after hydration, and mechanical percussion technique was developed for lower renal pole (LRP) stones with extracorporeal shock wave (ESWL). In this study, we aimed to analyze the effect of percussion, diuresis and inversion (PDI) therapy on the success rates of retrograde intrarenal surgery (RIRS) for the LRP stones. 114 patients who underwent RIRS for LRP stones <2cm were included in this study. Patients' demographic, clinical, radiological and anatomical features and success status were recorded prospectively. The patients were divided into two groups. One group received RIRS procedure only (non-PDI group) and the other group received PDI therapy after the RIRS procedure (PDI group). PDI was performed to 60 (52.6%) patients, and not performed to 54 (47.4%) patients. The success rate (58.3%) for the PDI group was higher than the non-PDI group (25.9%), and this difference was statistically significant (p <0.001). In multivariate logistic regression analysis, stone size (OR = 1.306; 95% CI = 1.019-1.674; p <0.001), IU (OR = 1.702; 95% CI = 1.383-2.096; p <0.001) and not performing PDI therapy (p <0.001) OR = 9.455; 95% Cl = 2.426-10.853; p = 0.001) were revealed to be independent risk factors for failure. PDI therapy increases the success rates of RIRS performed for the LRP stones.

101. Effect of Human Papillomavirus Vaccine to Interrupt Recurrence of Vulvar and Anal Neoplasia (VIVA): A Randomized, Placebo-Controlled Trial

Abstract Background Anal and vulvar high-grade intraepithelial lesions (HSIL) often recur after primary treatment, with 30%-50% recurrence in the 5-years following treatment. Treatment for recurrent lesions can be uncomfortable, debilitating, and costly. The VIVA trial evaluated the effects of the nonavalent human papillomavirus (HPV) vaccine (9vHPV) on recurrent anal or vulvar HSIL. Methods We conducted a randomized, double-blinded, placebo-controlled trial of the 9vHPV in vaccine-naïve persons aged 27-69 years who were previously treated for anal or vulvar HSIL and HSIL-free at enrollment. Participants had high-resolution anoscopy or vulvoscopy at screening, month 18 and 36 visits. Eligible participants were randomly assigned (1:1) to receive 9vHPV or placebo on day 1, month 2 and 6. We hypothesized that 9vHPV leads to a 50% reduction of HSIL recurrence. The primary endpoint was anal or vulvar HSIL recurrence, which was assessed in the intent-to-treat (ITT) population. Results Between July 2017 and December 2021, 187participants (99 cis-men, 86 cis-women, 2 transgender persons) with a history of anal (104, 56%) or vulvar (83, 44%) HSIL enrolled in the trial. 181 (97%) participants were included in the ITT analysis. Median age was 55 years (IQR 48-63); 71 out of 181 participants (39%) had well-controlled HIV infection. The DSMB recommended stopping the study early because it met specified futility boundaries at interim analysis. Predictive power to show a significant difference in the primary endpoint was 6.4% should the study continue to accrue. With 46% of planned information accrued, the vaccine was not significantly more efficacious than the placebo in preventing recurrent HSIL, with 15 cases in the 9vHPV arm versus 18 cases in placebo (incidence 9.1 versus 10.0/100 person-years; p= 0.83 by log-rank test). We found no differences in HSIL recurrences among vaccine versus placebo recipients by anatomical site or HIV status. The 9vHPV was safe and well-tolerated. Kaplan-Meier Curve for overall high-grade squamous intra-epithelial neoplasia (HSIL) recurrences for nonavalent-HPV vaccine vs placebo recipients Conclusion We found no benefit of the 9vHPV vaccine for prevention of recurrent anal or vulvar HSIL. Our study underlines the importance of HPV prevention with prophylactic HPV vaccines and the need for novel therapeutic vaccines and antivirals to manage prevalent HSIL that have a high potential to recur. Disclosures Denise Galloway, PhD, Merck: Grant/Research Support Anna Wald, MD, MPH, Aicuris: Advisor/Consultant|Auritec: Advisor/Consultant|Crozet: Advisor/Consultant|DXNow: Advisor/Consultant|GSK: Grant/Research Support|Merck: Advisor/Consultant|sanofi: Grant/Research Support|VIR: Advisor/Consultant|X-Vax: Advisor/Consultant.

Anatomical and Functional Outcome of Retinal Detachment Surgery

Objective: To study the anatomical status and functional outcome of Pars Plana Vitrectomy surgery in rhegmatogenous retinal detachment (RRD) at a tertiary eye care center in India.&#x0D; Material, Patients and Method: This is a prospective, noncomparative, consecutive, interventional study of rhegmatogenous retinal detachment managed with Pars Plana Vitrectomy surgery performed in the Regional Institute of Ophthalmology, Prayagraj, India. 40 patients of 40 eyes (26 phakic 65%, 14 pseudophakic 35%) with retinal detachment were treated by primary pars plana vitrectomy with 6 months of follow-up.&#x0D; Result: A total of 40 patients (40 eyes) were operated, 18 males and 2 females, with age, ranges from 17 years to 90 years. After surgery, anatomically retinal reattachment was achieved in 40 (100%). Improved best-corrected visual acuity (BCVA) was seen in 38 (90%) patients, whereas in 2 (5%) patient BCVA was not improving and deteriorated from pre-operative in another 2 (5%) patient. There was no significant difference was found in the pseudophakic and phakic eye in functional outcome.&#x0D; Conclusion: Rhegmatogenous retinal detachment is one of the common causes of visual impairment and blindness. Timely surgical management with Pars Plana Vitrectomy surgery can give good anatomical and visual outcome.

Facial Nerve Exploration for Known or Suspected Transection: The Massachusetts Eye and Ear Experience.

Background: There is no ideal test to determine likelihood of spontaneous recovery after post-traumatic and postsurgical facial palsy (FP). Objective: Among patients with unexpected FP undergoing facial nerve (FN) exploration for suspected discontinuity, we endeavored to discern whether intraoperative findings, repair type, and time to exploration impact FN recovery, as measured by electronic Facial Clinimetric Evaluation (eFACE) and FaCE scales. Methods: Retrospective cohort study of 42 adult patients who underwent FN exploration. Results: FN injury resulted from either surgery (n = 29) or trauma (n = 13). Average time to repair was 68.4 (standard deviation 79.6) days. Postoperative improvements were observed in total eFACE (73.3-86.5; p < 0.0001) and FaCE (21.5-38.1; p = 0.0214) scores. Distal FN injuries were most common (n = 29) and had best recovery (percentage change in eFACE 57.2% vs. 34.3% main trunk, p = 0.0306). Discontinuity injuries (n = 33) repaired with primary coaptation (n = 18) had noninferior outcomes compared with cable graft repair (n = 16; percentage change in eFACE 49.6% vs. 39.2%, p = 0.3470). Denervation times <3 months yielded better recovery using percentage change in eFACE score (56.9% vs. 33.1%, p = 0.0270). Conclusions: Surgical exploration for unexpected FP allows for direct visualization of anatomical nerve status and timely repair.

How Could Medical and Surgical Treatment Affect the Quality of Life in Glaucoma Patients? A Cross-Sectional Study.

To evaluate and compare the visual function and the quality of life (QoL) in glaucomatous patients treated with topical medical therapy (TMT) alone, canaloplasty (CP), or trabeculectomy (TB). A total of 291 eyes of 167 patients with primary open-angle glaucoma or secondary pseudoexfoliative glaucoma in TMT or surgically treated with CP or TB were included. Eligibility criteria for surgical patients included not needing TMT after surgery. Each patient underwent a visual field assessment and peripapillary retinal nerve fiber layer (pRNFL) optical coherence tomography and filled out the Glaucoma Symptoms Scale (GSS) questionnaire and the 25-Item National Eye Institute Visual Functioning Questionnaire (25-NEI-VFQ). Comparison between the QoL level of the three groups and its correlation with optic nerve's anatomical and functional status was the primary outcome. CP patients reported the best general vision (p = 0.01), a lower incidence of eye burning (p = 0.03), and the lowest annoyance level of non-visual symptoms (p = 0.006). QoL positively correlated with pRNFL thickness, whereas no correlation was found with visual field damage. CP provides a better QoL when compared both to TB and TMT, regardless of glaucoma stage. pRNFL seems to provide additional information for predicting change in QoL.