Clinical Comparison Research Articles

Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Background and objectiveCryoablation is a traditional antitumor therapy with good prospects for development. The efficacy of endoscopic management as a kidney-sparing surgery for high-risk upper tract urothelial carcinoma (UTUC) remains controversial. Our aim was to evaluate the impact of endoscopic cryoablation (ECA) versus radical nephroureterectomy (RNU) on survival outcomes, renal function, and complications. MethodsWe retrospectively analyzed data for 116 patients with newly diagnosed high-risk UTUC who underwent either ECA (n = 13) or RNU (n = 103) from March 25, 2019 to December 8, 2021. Propensity score matching (1:4) using the nearest neighbor method was performed before analysis. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), intravesical recurrence-free survival (RFS), the change in renal function, and treatment-emergent adverse events (TEAEs). Key findings and limitationsAt median follow-up of 28.2 mo for the ECA group and 27.6 mo for the RNU group, 2-yr OS (82% vs 84%), PFS (73% vs 71%), and intravesical RFS (81% vs 83%) rates after matching did not significantly differ. A decline in renal function was observed after RNU, but not after ECA. Five (41.7%) patients in the ECA group reported six TEAEs, and 17 patients (35.4%) in the RNU group reported 20 TEAEs. Conclusions and clinical implicationsIn comparison to RNU, ECA for UTUC resulted in noninferior oncological outcomes and superior preservation of renal function. Patient summaryOur study suggests that a treatment called endoscopic cryoablation for high-risk cancer in the upper urinary tract can help in preserving kidney function, with similar survival outcomes to those after more extensive surgery. This option can be considered for selected patients with a strong preference for kidney preservation.

Minimally invasive extractions with physics forceps - clinical evaluation and comparison.

Tooth extraction is still one of the most common dental procedures, routinely performed for a variety of reasons. Tooth extraction forceps and elevators are well-known extraction instruments which have been the standard in tooth extraction procedures for well over a hundred years. Physics forceps are one possible alternative, aiming to perform less traumatic and more predictable extractions.

A Clinical Comparison of Dental impression accuracy between One-step and Two-step Dual phase impression technique by using Polyvinyl Siloxane Impression Material.

Objective:: The objective was to assess the number of visible defects within impression made by two different techniques.  Methodology: This was comparative cross-sectional study was conducted between June 2019 to December 2019 at out patient department of Institue of dentistry, LUMHS Jamshoro. Two impressions were made from 53 crown preparation by using one step and two step dual phase impression techniques. Totaling to 106 impressions. Polyvinyl Siloxane impression material was used with each technique. Evaluation of impressions were made for tears, voids and bubbles and impression were compute as acceptable (A or B) and unacceptable (C or D). Result: There was no significant difference seen in proportion of overall evaluation of two impression technique, as compared by using “Chi-square test”. Conclusion: Insignificant difference was seen b/w one step and two step dual phase impression techniques.   Keywords: One step impression technique, two step dual phase impression technique, dimensional accuracy.  

Clinical comparison of acute stroke cases with and without COVID-19

Background We aimed to assess acute stroke cases with and without coronavirus disease 2019 (COVID-19) positivity concerning clinical features and the number of hospitalizations acute stroke cases compared to the previous year. Methods Acute stroke patients with and without COVID-19 positivity, including those who were hospitalized in the neurology service and intensive care unit of tertiary healthcare center between 17 December 2020 and 31 January 2021 due to acute stroke, were included in this cross-sectional study. Results Mortality (p=0.042) and mechanical ventilation use (p=0.041) were more frequent in COVID-19-positive stroke patients compared to those without COVID-19. The most common type of stroke in COVID-19-positive acute stroke patients was ischemic stroke (69.23%). Additionally, stroke patients with COVID-19 had a significantly higher percentage of kidney disease compared to those without COVID-19 (p=0.009). We also observed that the number of acute stroke cases hospitalized in our hospital during the pandemic decreased significantly compared to the previous year (p=0.036). Conclusion Since the majority of our patients were diagnosed with COVID-19 after admission to the hospital due to stroke, it should be kept in mind that patients who apply to the hospital with stroke symptoms may also have COVID-19, even if they are asymptomatic.

The Relationship between CT Angiography Collateral Score and Biochemical Parameters during Acute Ischemic Stroke Caused by Middle Cerebral Artery Infarct.

Background/Objectives: Collateral development after AIS is important for prognosis and treatment. In this study, we aimed to investigate the relationship and correlation between biochemical parameters and CT angiography collateral score within the first 9 h and its effect on the neurological outcomes of patients with AIS due to MCA infarction. Methods: A total of 98 patients with MCA infarction were hospitalized for diagnosis and treatment after undergoing CT angiography within 9 h of suffering a stroke. Demographic data, admission biochemical parameters, hospitalization data, and discharge NIHSS scores were recorded. Souza's scoring system for collateral distribution was used to evaluate collaterals. Souza CS system and clinical disability comparison outcomes identified. Results: According to the Souza CS system, 13 patients were in the malignant profile category, and 85 patients were in the good profile category. The NIHSS value of patients with a malignant profile was 27, while the mean NIHSS value of patients with a good profile was 9. There was a statistically significant difference in uric acid, total cholesterol, triglyceride, HDL cholesterol, CRP, hsCRP, D-Dimer, troponin I, vitamin B12, fibrinogen, NSE, homocysteine, aPTT, and INR levels according to collateral distribution. Conclusions: This study demonstrates that biochemical parameters can influence the distribution of malignant and benign collaterals in AIS independent of age and gender.

Encephalitis in the Immunocompromised: Clinical Presentation, Diagnostic Findings, Treatment, and Comparison of Infectious and Autoimmune Etiologies (S4.009)

Encephalitis in the Immunocompromised: Clinical Presentation, Diagnostic Findings, Treatment, and Comparison of Infectious and Autoimmune Etiologies (S4.009)

Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison.

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2-C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2-C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2-C7 SVA and ARA C2-C7 were measured. A linear-regression R2 value to assess the correlation between the CVA, C2-C7 SVA, and ARA C2-C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman's r = 0.549; R2 = 0.30, p < 0.001) between the CVA and C2-C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2-C7 and the CVA: Spearman's r = 0.524; R2 = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2-C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2-C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions.

Clinical and experimental parallels in the assessment of microcirculatory dysfunctions of the lungs in thoracic radiology

Introduction. Chronic obstructive disease (COPD) and thromboembolism of the branches of the pulmonary artery or pulmonary embolism (PE) remain the most common and socially significant lung diseases. Circulatory disorders in these pathologies play a critical role in the development of the disease. Radiation techniques, such as computed tomography/angiography and single-photon emission computed tomography (SPECT), are the leading ones in recognizing changes in the lung parenchyma and vessels. Many questions can be successfully solved experimentally. The main radiation techniques used to study the vascular bed when modeling lung diseases in experimental animals are microangiography and perfusion scintigraphy. Purpose. To show the capabilities of radiation diagnostic methods for identifying vascular disorders in COPD and PE in experiments and clinical manifestations. Material and methods. A clinical and experimental comparison of pulmonary circulation changes during COPD and PE was carried out based on the results of perfusion scintigraphy/SPECT in 55 rats with simulated COPD- like condition and 622 patients with COPD of varying severity, as well as 58 rats with simulated PE and 180 patients with PE. Results. When modelling lung diseases (PE and COPD), the results similar to blood circulation and structural changes in the lung parenchyma in patients with these nosologies were obtained. In COPD, changes in the lung parenchyma correlated with disturbances in functional indicators (microcirculation, PaO2, PaCO2, DSLzd, DLco/VA, SDPA) and increased levels of endothelin-1 (r=0.72) and endothelial growth factor (VEGF-A) (r=0.79). Analysis of experimental and clinical data on PE showed the importance of identifying minor forms of thromboembolism. Conclusion. 1. Persistent microcirculatory dysfunctions in the pulmonary circulation play an important role in the pathogenesis of chronic broncho-obstructive pathology. After just 7 days, initial signs of emphysema can be detected in the ischemic area of the lung tissue, and by the 60th day typical bullous cavities can be detected. 2. In the chronic course of minor forms of thromboembolism of small branches of the pulmonary artery, local emphysema is formed. 3. At the early stages of COPD formation, regional zones of emphysematous restructuring of the lung tissue with a predominance of ventilation dysfunctions and zones of «compressive ischemia» with prevailing vascular disorders are formed. As the pathological process progresses, the ischemia factor acquires independent significance in the pathogenesis of the disease.

Observational cohort study of 100 patients presenting with functional visual loss: clinical characteristics and comparison with other functional neurologic disorders

ObjectiveRecent research has helped to develop a more detailed understanding of many functional neurologic disorders. The aim of this study was to increase our knowledge of functional visual loss and to compare the findings with those of other functional syndromes. DesignProspective and retrospective observational cohort study. MethodsThis study took place at neuro-ophthalmology clinics at 3 major hospitals in London, United Kingdom, over a 12-month period. The study population consisted of 157 participants, 100 with functional visual loss, 21 pathologic control subjects with organic visual loss, and 36 healthy nonpathologic control subjects. All participants had their diagnosis confirmed with a full neuro-ophthalmic examination, neuroimaging, and visual electrophysiology. A full assessment of all participants’ medical history was obtained from their general practitioner, and all participants completed a series of questionnaires assessing relevant associations. ResultsData were obtained on 157 participants, 100 with functional visual loss, 21 pathologic control subjects with organic visual loss, and 36 healthy nonpathologic control subjects. Participants with functional visual loss were typically female (74%) with a mean age at vision loss of 40.0 ± 16 years. Sixty-four percent of participants had bilateral vision loss; the remainder, unilateral loss. Twenty-six percent of the total cohort had organic visual loss with functional overlay. Fifty percent of participants with functional visual loss had a preexisting psychiatric diagnosis, the most common being a depressive disorder. Sixty-two percent of participants had an ocular history, and 87% had a previously diagnosed medical illness, most commonly neurologic (45%). Thirty-five percent of participants self-reported at least 1 additional functional symptom. ConclusionsOur population of functional visual loss subjects shares many similarities with the majority of patients with other functional neurologic disorders. They are generally young and female and have a greater than expected rate of psychiatric, medical, and coexisting ocular conditions. We found increased rates of precipitating stressors, clinical depression, and organic eye problems in subjects with functional visual loss.

Clinical and economic comparison of laparoscopic versus open hepatectomy for primary hepatolithiasis: a propensity score-matched cohort study.

It is unclear whether laparoscopic hepatectomy (LH) for hepatolithiasis confers better clinical benefit and lower hospital costs than open hepatectomy (OH). This study aim to evaluate the clinical and economic value of LH versus OH. Patients undergoing OH or LH for primary hepatolithiasis at Yijishan Hospital of Wannan Medical College between 2015 and 2022 were divided into OH group and LH group. Propensity score matching (PSM) was used to balance the baseline data. Deviation-based cost modelling and weighted average median cost (WAMC) were used to assess and compare the economic value. A total of 853 patients were identified. After exclusions, 403 patients with primary hepatolithiasis underwent anatomical hepatectomy (OH n=143; LH n=260). PSM resulted in 2 groups of 100 patients each. Although LH required a longer median operation duration compared with OH (285.0 versus 240.0min, respectively, P<0.001), LH patients had fewer wound infections, fewer pre-discharge overall complications (26 versus 43%, respectively, P=0.009), and shorter median postoperative hospital stays (8.0 versus 12.0days, respectively, P<0.001). No differences were found in blood loss, major complications, stone clearance, and mortality between the two matched groups. However, the median overall hospital cost of LH was significantly higher than that of OH (CNY¥52,196.1 versus 45,349.5, respectively, P=0.007). Although LH patients had shorter median postoperative hospital stays and fewer complications than OH patients, the WAMC was still higher for the LH group than for the OH group with an increase of CNY¥9,755.2 per patient undergoing LH. The overall clinical benefit of LH for hepatolithiasis is comparable or even superior to that of OH, but with an economic disadvantage. There is a need to effectively reduce the hospital costs of LH and the gap between costs and diagnosis-related group reimbursement to promote its adoption.

Subgroups of Clinical High Risk for Psychosis Based on Baseline Antipsychotic Exposure: Clinical and Outcome Comparisons Across a 2-Year Follow-up Period.

Antipsychotic (AP) prescription in clinical high risk for psychosis (CHR-P) subjects remains a divisive issue. Although official guidelines currently discourage AP treatment in CHR-P, it is common in clinical practice, especially for psychosis prevention. The aim of this study was to investigate whether baseline AP need (especially in high-dose) indexes a CHR-P subgroup with poorer prognosis and differs from AP-naïve subjects in terms of sociodemographic, clinical, and outcome parameters across a 2-year follow-up. CHR-P participants were treated within an "Early Intervention in Psychosis" program and completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale both at baseline and every 12 months. Individuals with baseline AP prescription were included in the high-dose or low-dose CHR-P-AP+ subgroup. The others were grouped as AP-naïve. Cox regression analyses and mixed-design ANOVA were performed. 180 CHR-P individuals were enrolled (32 high-dose, 60 low-dose, and 88 AP-naïve). Compared to AP-naive, CHR-P AP+ subgroups showed older age and more severe clinical presentation. High-dose subgroup also had grater functioning decline at entry and poorer functional recovery at follow-up. No inter-group differences in psychosis transition and symptomatic remission were found. Significant improvement in clinical outcomes were found over time in all subgroups. Baseline AP prescription was specifically associated with a more relevant improvement in PANSS total score, and in negative and disorganized symptoms. Our results suggest that baseline AP need is an important prognostic parameter in CHR-P and should be considered in risk/benefit calculators.

Sample Size Estimation and Statistical Analysis of Cholangiography Robots

In recent years, with the continuous innovation of medical devices encouraged by the government and the investment and attention of enterprises in research and development, coupled with the relevant requirements of the CDE (Center for Drug Evaluation) of the National Medical Products Administration, in order to improve the efficiency of trials and accelerate the launch of cholangiography robots, medical device research and development enterprises are increasingly focusing on the design of clinical trial plans, adopting more scientific, reliable, efficient and standardized statistical designs. Insufficient sample size may lead to issues with sample representativeness, while human centered trials are very expensive, and excessive sample size could increase the difficulty of clinical research. Therefore, this study used the "golden rule" of RCT (Randomized Controlled Trials), combined with the outcome indicators, test level, confidence, dropout rate, etc., to estimate the number of cases in the clinical efficacy comparison study of the cholangiography robot.

Abstract 4083: Pre-clinical development of IAMA-005, a long-acting cytokine fusion of modified IL-2 and IFN-α

Abstract In 1990s, both IL-2 and IFN-α were approved as the first two immunotherapies for metastatic melanoma and renal cell carcinoma; IFN-α was also approved for hairy cell leukemia. Although the response rates are relatively low, along ~25%, those who responded have long term survival benefits. However, the severe toxicity especially in high dose prohibited their broad use in oncology. Recently, there have been tremendous interests in modifying these two cytokines in the efforts to reduce the toxicity and enhance the activity. One such effort is to enhance the binding of IL-2 to the intermediate affinity β/γ receptors, which are expressed and function on CD8 T cells and NK cells. Another effort is to reduce the binding of IL-2 to high affinity α/β/γ receptors which mostly expressed on Treg and stimulate the growth of Treg cells, which suppress immune responses. Recently, whether it’s better to target intermediate affinity or high affinity for cancer therapy has become controversial with some studies showing that high affinity receptor engagements are required for robust anti-tumor activity while others favoring intermediate affinity receptor engagement for better efficacy; However, the clinical comparison is still lacking to be sure which approach is better. Here we have developed a long-acting novel IL-2-Fc-IFN-α fusion molecule termed IAMA-005 that has mutations to reduce the toxicity effects of IL-2 and IFN-α. We have characterized this molecule preclinically both in vitro and in vivo. IAMA-005 has demonstrated a potent tumor cell killing activities in numerous cancer cell lines including BT-474, SK-OV-3, NCI-N87, OE19, HCC-1954, MDA-MB-231, MDA-MB-468. When combined with IAMA-004 (a Her2-CD47-CD16 tri-specific antibody) in vitro, the tumor cell killing activities were dramatically increased. In addition, IAMA-005 was also tested in patient-derived Ex-Vivo fluids (one malignant pleural effusion and one malignant asities) and demonstrated excellent tumor cell killing efficacies. In addition, the killing activities of IAMA-005 could be attributed to the specific part of the fusion molecule because of the TME immune cell compositions. The in vivo assays to demonstrate efficacy and safety are ongoing and will be presented in the poster. These results suggest that this fusion cytokine molecule may be used in monotherapy in certain indications and an excellent complementary therapeutic to antibody targeted therapies or immunotherapies when used in combination. Citation Format: Liming Liu, Zhen Han, Yang Fan, Qi Pan. Pre-clinical development of IAMA-005, a long-acting cytokine fusion of modified IL-2 and IFN-α [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4083.

CRISP: An Inpatient Pediatric Curriculum for Family Medicine Residents Using Clinical Reasoning and Illness Scripts.

Clinical reasoning enables safe patient care and is an important competency in medical education but can be challenging to teach. Illness scripts facilitate clinical reasoning but have not been used to create pediatric curricula. We created CRISP (Clinical Reasoning with Illness Scripts in Pediatrics), a curriculum comprising four 1-hour learning sessions that deliberately incorporated clinical reasoning concepts and illness scripts to organize how four common chief complaints were taught to family medicine residents on inpatient pediatric rotations. We performed a multisite curriculum evaluation project over 6 months with family medicine residents at four institutions to assess whether the use of clinical reasoning concepts to structure CRISP was feasible and acceptable for learners and instructors and whether the use of illness scripts increased knowledge of four common pediatric chief complaints. For all learning sessions, family medicine residents and pediatric hospitalists agreed that CRISP's format was preferable to traditional didactic lectures. Pre-/posttest scores showed statistically significant increases in family medicine resident knowledge (respiratory distress [n = 42]: pretest, 72%, posttest, 92%; abdominal pain [n = 44]: pretest, 82%, posttest, 96%; acute febrile limp [n = 44]: pretest, 68%, posttest, 81%; well-appearing febrile infant [n = 42]: pretest, 58%, posttest, 73%; ps < .05). By using clinical reasoning concepts and illness script comparison to structure a pediatric curriculum, CRISP represents a novel instructional approach that can be used by pediatric hospitalists to increase family medicine resident knowledge about diagnoses associated with common pediatric chief complaints.

Abstract 1453: Development and evaluation of subcutaneous and orthotopic PC3M metastatic prostate cancer xenograft model in SRG rats for therapeutic assessment

Abstract Introduction: Prostate cancer is the most prevalent cause of cancer deaths in American males after lung cancer. The establishment of clinically relevant prostate cancer models is crucial for advancing our understanding of the disease and evaluating potential therapeutics. Oncology studies in rats provide a secondary species to mice with the advantage of extensive longitudinal blood sampling and tumor biopsies in pharmacodynamics analysis. This in vivo study evaluates the behavior of subcutaneous and orthotopic luciferase (luc) tagged metastatic PC3M-luc cells in immunodeficient SRG rats (Hera Biolabs) for tumor growth kinetics, metastasis, and response to paclitaxel and carboplatin alone and in combination. Methods: PC3M-luc cells were implanted subcutaneously into the right flank or orthotopically into the prostate of SRG rats. Subcutaneous tumor progression and treatment responses were monitored using calipers and bioluminescent imaging (BLI), with the capacity to detect developing metastases prior to necropsy. Orthotopic implants were monitored exclusively using BLI. Tolerability was evaluated based on biweekly changes in body weight, daily observations for signs of tumor- or treatment-related clinical signs, necropsy results, and complete blood count (CBC) and clinical chemistry marker comparisons with immunocompetent CD rats. Results: PC3M-luc prostate carcinoma was successfully established orthotopically and subcutaneously in SRG rats, with similar growth rates and the development of spontaneous metastases to distant organs, modeling metastases observed in prostate cancer patients. Paclitaxel treatment was less tolerated in SRG rats in comparison to nude rats, enhanced toxicity was observed when combined with carboplatin. Comparison of CBC and clinical chemistry blood markers in naïve immunocompetent CD and immunodeficient SRG rats differed mainly in White Blood Cell (WBC) counts that were significantly lower in SRG rats, as expected due to the lack of mature B, T, and NK cells in these animals. Conclusion: The development of orthotopic and subcutaneous PC3M-luc prostate cancer models in rats provides a valuable alternative platform for assessing the effectiveness of established and novel therapies. This rat-based models offers a secondary species for comparison of prostate cancer behavior in mice, successfully mimics the clinical development of metastases, and provides additional insights into disease progression and therapeutic strategies. Future studies will focus on the assessment of tolerability and combination therapy strategies for improved treatment outcomes. Citation Format: Kyle Draheim, Elizabeth Rainbolt, Bincy John, Cara Clouse, Karyn Shinn, Justin Avery, Koh Meng Aw Yong, Chassidy Hall, Patrick Fadden, Anya Avrutskaya. Development and evaluation of subcutaneous and orthotopic PC3M metastatic prostate cancer xenograft model in SRG rats for therapeutic assessment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1453.

Mechanical Purification of Lipofilling: The Relationship Between Cell Yield, Cell Growth, and Fat Volume Maintenance.

The mechanical manipulations of fat tissue represented from centrifugation, filtration, washing, and fragmentation were considered the most effective strategies aiming to obtain purified lipofilling with different impacts both in terms of adipose-derived stem cells amount contained in stromal vascular fraction, and fat volume maintenance. The present work aimed to report results in fat volume maintenance obtained by lipofilling purification based on the combined use of washing and filtration, in a clinical study, and to deeply investigate the adipose-derived stem cells yield and growth capacity of the different stromal vascular fraction extraction techniques with an in vitro approach. A preliminary prospective, case-control study was conducted. 20 patients affected by face and breast soft tissue defects were treated with lipofilling and divided into two groups: n = 10 patients (study group) were treated with lipofilling obtained by washing and filtration procedures, while n = 10 (control group) were treated with lipofilling obtained by centrifugation according to the Coleman technique. 6 months after the lipofilling, the volume maintenance percentage was analyzed by clinical picture and magnetic resonance imaging comparisons. Additionally, extracted stromal vascular fraction cells were also in vitro analyzed in terms of adipose-derived stem cell yield and growth capacity. A 69% ± 5.0% maintenance of fat volume after 6 months was observed in the study group, compared with 44% ± 5.5% in the control group. Moreover, the cellular yield of the control group resulted in 267,000 ± 94,107 adipose-derived stem cells/mL, while the study group resulted in 528,895 ± 115,853 adipose-derived stem cells /mL, with a p-value = 0.1805. Interestingly, the study group showed a fold increase in cell growth of 6758 ± 0.7122, while the control group resulted in 3888 ± 0.3078, with a p < 0.05 (p = 0.0122). The comparison of both groups indicated that washing and filtration were a better efficient system in lipofilling preparation, compared to centrifugation, both in terms of volume maintenance and adipose-derived stem cell growth ability. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Congenital alveolar dysplasia and alveolar capillary dysplasia with misalignment of the pulmonary veins: clinical and anatomical comparisons

Congenital alveolar dysplasia (СAD) and alveolar capillary dysplasia with misalignment of the pulmonary veins (ACD/MPV) are rare genetically determined interstitial lung diseases in infants that manifest in the first hours to days after birth, have fatal outcome and are usually diagnosed at autopsy.The aim of this work was to consider the clinical manifestations and pathomorphologic picture of CAD and ACD/MPV based on clinical observations of newborns who were on a ventilator, received therapy for high pulmonary hypertension and extracorporeal membrane oxygenation (ECMO). The clinical characteristics and medical history of the patients are described. The results of lifetime imaging methods, autopsy examinations with light microscopy and the use of routine staining methods of micro-preparations as well as immunohistochemical methods are considered. Morphologic changes in the lungs characteristic of CAD and ACD/MPV are described in detail in the analysis of histologic examination data.Conclusion. The pathoanatomical examination data are of crucial importance for the diagnosis of CAD and ACD/MPV, which must be suspected in newborns with respiratory insufficiency and severe pulmonary hypertension when ventilation, inhalation of nitric oxide and ECMO are ineffective.

Endovascular Approach in Treating Vertebrobasilar Insufficiency: A Systematic Review.

Vertebrobasilar insufficiency (VBI) is a significant medical condition that results from a lack of adequate blood flow to the posterior circulation of the brain. The first-line treatment involves the use of antiplatelet therapy, but in cases where patients are not responsive to drug therapy, surgical management is the next viable option. In the past, open endarterectomy was the preferred surgical approach for treating critical VBI patients. However, due to its high mortality rates and severe peri-procedural complications, its usage has decreased. Instead, the endovascular approach has emerged as an alternative surgical option for resolving VBI. This review explores the current literature to assess the effectiveness of endovascular interventions in treating VBI patients. It also highlights potential complications and adverse effects associated with these treatments while identifying gaps in the current research that warrant further investigation. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to extensively search relevant literature on endovascular approaches for treating VBI patients on PubMed, BioMed Central, and ClinicalTrials.gov. The findings suggest that endovascular treatments have demonstrated significant technical success in treating VBI, with low mortality rates and minor adverse effects, such as intracranial hemorrhage and restenosis. The overall incidence of these complications is relatively low. Combining medical therapies with endovascular interventions has improved outcomes and reduced restenosis rates. However, there are methodological limitations and inconsistencies in the current literature that necessitate further investigation. Future research should focus on larger, randomized clinical trials and direct comparisons with other treatment options to obtain more conclusive evidence.

O140: How clinically relevant are prostate cancer cell lines? A comprehensive multiomics analysis.

Abstract Introduction Cell lines remain a heavily used resource in cancer research despite their questionable clinical relevance, mainly due to their feasibility and affordability. A range of in silico, in vivo and ex vivo approaches are gaining popularity to potentially replace cell lines, however, we cannot ignore the plethora of historical data from cell lines, nor write off their future use. Therefore, we question if and how cell lines hold clinical relevance. Methods The clinical characteristics of 45 PCa cell lines were compared against worldwide data and the biological features of seven cell lines were compared to over 10,000 well-characterised cases from 23 studies in eight countries. Clinical comparisons included age, race, Gleason grade, cancer type and multiomics variables included mutations, copy number alterations, structural variants, microsatellite instability, mRNA and protein expression, and tumour mutational burden. Using this, cell-line-like patients were identified and characterised. Results The most used cell lines were derived from metastases over 40 years ago and accurately represented very few patients. The most common alterations in clinical datasets were not necessarily altered in cell lines and 24% of key PCa gene alterations were not altered in any cell line. From the seven cell lines analysed, the greatest number of patients were found to be biologically similar to VCaP. Conclusion Cell lines are valuable in cancer research, but they must hold biological and clinical relevance. PCa cell lines should either be applicable to typical PCa patients or representative of specific cancer subtypes to increase the relevance of translational research.

Borderline personality disorder vs. schizophrenia spectrum disorders in young people recruited within an "Early Intervention in Psychosis" service: clinical and outcome comparisons.

Borderline Personality Disorder (BPD) is under-recognized in First-Episode Psychosis (FEP) and its psychotic manifestations are difficult to differentiate from Schizophrenia Spectrum Disorders (SSD). The aim of this investigation was to compare clinical, sociodemographic, and outcome characteristics between FEP patients with BPD vs. FEP subjects with SSD both at baseline and across a 2-year follow-up period. Participants completed the Health of the Nation Outcome Scale (HoNOS), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale both at entry and every 12months during the follow-up. A mixed-design ANOVA model was conducted to investigate the temporal stability of clinical scores within and between the two subgroups. Among 356 FEP participants, 49 had a BPD diagnosis. Compared to FEP/SSD (n = 307), FEP/BPD patients showed higher prevalence of employment, current substance use, and past attempted suicide. They had a lower equivalent dose of antipsychotic medication at entry and lower levels of negative symptoms. Finally, they had a higher 2-year drop-out rate and a significant improvement in psychopathological scores limited to the first year of treatment. BPD as categorical entity represents a FEP subgroup with specific clinical challenges. Appropriate treatment guidelines for this FEP subgroup are thus needed.