Course Of Therapy Research Articles

Patient-reported outcomes during first-line palliative systemic therapy alternated with pressurized intraperitoneal aerosol chemotherapy for unresectable colorectal peritoneal metastases: a single-arm phase II trial (CRC-PIPAC-II)

BackgroundThe CRC-PIPAC-II study prospectively assessed bidirectional therapy (BT) consisting of first-line palliative systemic therapy and electrostatic precipitation oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy (ePIPAC-OX) in patients with unresectable colorectal peritoneal metastases (CPM). This study describes the exploration of patient-reported outcomes (PROs).MethodsIn this phase II trial, 20 patients with isolated CPM were treated with up to three cycles of BT, each cycle consisting of two to three courses of systemic therapy, followed by ePIPAC-OX (92 mg/m2). Patients were asked to complete the EuroQoL EQ-5D-5L, EORTC QLQ-C30, and EORTC QLQ-CR29 questionnaires at baseline, during the first cycle of BT, and one and four weeks after each consecutive BT cycle. PRO scores were calculated and compared between baseline and each subsequent time point using linear-mixed modeling (LMM). PROs were categorized into symptom scales and function scales. Symptom scales ranged from 0 to 100, with 100 representing the maximum symptom load. Function scales ranged from 0 to 100, with 100 representing optimal functioning.ResultsTwenty patients underwent a total of 52 cycles of bidirectional therapy. Most PROs (29 of 37, 78%) were not significantly affected during trial treatment. In total, only eight PROs (22%) were significantly affected during trial treatment: Six PROs (index value, global health status, emotional functioning, C30, appetite, and insomnia) showed transient improvement at different time points. Two PROs transiently deteriorated: pain initially improved during the first BT cycle [− 16, p < 0.001] yet worsened temporarily one week after the first two BT cycles (+ 20, p < 0.001; + 17, p = 0.004; respectively). Abdominal pain worsened temporarily one week after the first BT cycle (+ 16, p = 0.004), before improving again four weeks after treatment ended (− 10, p = 0.004). All significant effects on Pros were clinically significant and all deteriorations in PROs were of temporary nature.DiscussionPatients undergoing BT for unresectable CPM had significant, but reversible alterations in several PROs. Most affected PROs concerned improvements and only two PROs showed deteriorations. Both deteriorated PROs returned to baseline after trial treatment and were of a temporary nature. These outcomes help to design future studies on the role of ePIPAC in the palliative setting.

Beyond the screw: Exploring the recurrence of oral lesions

The integration of skeletal anchorage systems has revolutionized orthodontics, especially with the advent of mini-screws known for their ease of use and minimal invasiveness. The mandibular buccal shelf area, with its ample high-quality bone and low failure rates, has become a preferred extra-alveolar anchorage site. However, complications involving adjacent soft tissues are common with orthodontic bone screw placement. This case report describes the recurrence of reactive oral lesions following placement of orthodontic bone screws in the buccal shelf area. During the course of orthodontic therapy, the patient developed exophytic growths twice, at the same site, on the lower right back buccal mucosa. Diode laser was used in both instances for excision of the lesion and the specimen was sent for histo-pathological analysis. The first lesion was diagnosed as inflammatory fibrous hyperplasia, while the recurrent lesion was identified as pyogenic granuloma. At 12-months follow-up, no new lesions were detected. This report highlights the influence of lesion development time on its clinical and histological presentation. It is postulated that leaving the bone screw in place after initial biopsy could have contributed to its recurrence. Complete excision is the preferred treatment. Treatment options, including laser therapy, are available for such lesions.

A Revolutionary Approach for Combating Efflux Transporter-mediated Resistant Epilepsy: Advanced Drug Delivery Systems.

Epilepsy is a persistent neurological condition that affects 60 million individuals globally, with recurrent spontaneous seizures affecting 80% of patients. Antiepileptic drugs (AEDs) are the main course of therapy for approximately 65% of epileptic patients, and the remaining 35% develop resistance to medication, which leads to Drug-Resistant Epilepsy (DRE). DRE continues to be an important challenge in clinical epileptology. There are several theories that attempt to explain the neurological causes of pharmacoresistance in epilepsy. The theory that has been studied the most is the transporter hypothesis. Therefore, it is believed that upregulation of multidrug efflux transporters at the blood-brain barrier (BBB), such as P-glycoprotein (P-gp), which extrudes AEDs from their target location, is the major cause, leading to pharmacoresistance in epilepsy. The most effective strategies for managing this DRE are peripheral and central inhibition of P-gp and maintaining an effective concentration of the drug in the brain parenchyma. Presently, no medicinal product that inhibits P-gp is being used in clinical practice. In this review, several innovative and promising treatment methods, including gene therapy, intracranial injections, Pgp inhibitors, nanocarriers, and precision medicine, are discussed. The primary goal of this work is to review the P-gp transporter, its substrates, and the latest novel treatment methods for the management of DRE.

Significant drop in serum C-reactive protein in patients with solid neoplasia and bacterial infection is associated with a better prognosis and identifies candidates for short-course antibiotic therapy

IntroductionThe greater predisposition to infections, as well as the possibility of a worse response to treatment, can lead to the excessive use of antimicrobials among cancer patients. C-reactive protein (CRP) has gained prominence as a tool for monitoring therapeutic responses and reducing the duration of antibiotic therapy; however, few studies have analyzed this protein in cancer patient populations. We hypothesize that cancer patients with a good response to antibiotic therapy show a faster decline in serum CRP levels, which would allow us to identify candidates for short-course treatments.ObjectiveTo evaluate the behavior of serum CRP levels among adult cancer patients using antibiotic therapy, and its association with the duration of this treatment, therapeutic response, and clinical recurrence.MethodsThis work consisted of a retrospective study with cancer patients admitted to a university hospital between September 2018 and December 2019. Adults (age ≥ 18 years) who underwent at least one course of antibiotic therapy were included. CRP behavior over the first 7 days of treatment was classified as: i) good response: when the CRP value on the fifth day of therapy reached 50% or less of the peak value detected in the first 48 h of treatment, and ii) poor response: Maintenance, within the same interval, of a CRP value > 50% of the peak value in the first 48 h. The duration of antibiotic therapy was categorized as up to seven full days or more. Outcomes were assessed by events that occurred during the 30 days of hospitalization or until hospital discharge. Primary outcome: Clinical recurrence of the index infection. Secondary outcomes: i) Death from any cause; ii) microbiological recurrence; iii) therapeutic response; iv) colitis associated with Clostridioides difficile; and v) isolation of multi-resistant bacteria, whether in clinical or surveillance samples.ResultsThe final analysis consisted of 212 patients, with a median age (IQ) of 59.2 (48 – 67) years old and a predominance of females (65%), who were hypertensive (35%), smokers (21%), and diabetics (17.8%). There was no difference in clinical recurrence between the two groups (8.1% vs. 12.2%; p = 0.364), with a lower 30-day mortality in the good CRP response group (32.2% vs. 14.5%; p = 0.002). Despite the tendency towards a lower occurrence of other secondary outcomes in the good response group, these differences were not statistically significant. In the poor CRP response group, outcomes like clinical recurrence, mortality, and therapeutic response were significantly worse, regardless of the duration of antibiotic treatment.ConclusionIn this study, cancer patients with a good CRP response during antibiotic therapy presented lower mortality and a higher proportion of satisfactory therapeutic responses. CRP can be a useful tool when combined with other clinical information in optimizing the duration of antimicrobial treatment in a hospitalized cancer population.

Relieving effect of jiao-tune of 5-element music on negative emotions in patients with decompensated hepatitis B virus cirrhosis: A randomized and controlled experiment study.

Depression and anxiety are common in patients with decompensated hepatitis B virus (HBV) cirrhosis. This study aimed to evaluate the relieving effects of the jiao-tune of 5-element music on negative emotions in patients with decompensated HBV cirrhosis. The patients were randomly allocated into the control group (standard nursing care) and the jiao-tune group (standard nursing care plus a 2-month course of music therapy with the jiao-tune of 5-element music). The negative emotions of patients were assessed before intervention treatment and at the end of the 2-month follow-up using the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). The analysis included 209 patients, with 102 in the control group and 107 in the jiao-tune group, all of whom returned their completed questionnaires. Baseline clinical characteristics and length of hospital stay were comparable between 2 groups. Before intervention treatment, there were no significant differences in SAS score (55.78 ± 5.64 vs 56.47 ± 3.28) and SDS score (65.13 ± 3.12 vs 64.48 ± 4.47) between the jiao-tune group and control group. After 2-month follow-up, the jiao-tune group had a significantly lower SAS score (53.17 ± 5.61) and SDS score (61.28 ± 1.52) compared with the control group (55.49 ± 3.37 and 63.08 ± 2.76), there were significant differences between 2 groups (P < .001). The jiao-tune of 5-element music can relieve the negative emotions in patients with decompensated HBV cirrhosis.

PD-related peritonitis from Psathyrella candolleana caused by poor PD catheter belt hygiene.

Peritoneal dialysis (PD)-associated fungal peritonitis, although rare, presents significant challenges in diagnosis and management. Here, we present the first case of PD-related peritonitis attributed to Psathyrella candolleana and highlight a potential route of infection through contamination from the PD catheter belt. A 37-year-old female, with a history of heart and lung transplantation and undergoing continuous ambulatory PD, presented with acute abdominal pain and cloudy PD effluent (PDE). Genetic analysis of PDE and PD catheter tip confirmed diagnosis of P. candolleana. Treatment was successful without any relapses with timely PD catheter removal and an extended course of antifungal therapy. The root cause analysis suspected the dirt-stained PD catheter belt as the origin of contamination. In conclusion, this is the first case of P. candolleana infection in PD-related peritonitis. Preventive strategies should prioritize hygiene practices, including the PD belt to mitigate the risk of contamination and subsequent infections of such pathogens.

EP118 - Chronic Vesicouterine Fistula (Youssef's syndrome) Complete Opening of Anterior Uterine Wall in the Urinary Bladder: A- very rare case

Abstract Background Vesicouterine fistula is an uncommon urogenital condition typically following Caesarean sections (C/S). Youssef syndrome, characterized by haematuria, amenorrhea, and urinary incontinence, poses a diagnostic challenge and demands comprehensive assessment. Case report We present a case of a 40-year-old woman with persistent urine incontinence and haematuria for three years post her fourth C/S. Clinical evaluation revealed periodic lower abdominal pain, haematuria, amenorrhea, and urine incontinence. sonography was normally reported, while cystoscopy revealed a complete 5x2 cm opening between the anterior uterine wall and the posterior bladder wall, confirming Youssef syndrome. After a course of antibiotic therapy, surgical intervention was planned. Transabdominal total hysterectomy, partial cystectomy, and repair were performed following meticulous anatomical delineation using cystoscopy. The procedure involved dissecting the vesicouterine attachment, performing partial cystectomy, and eventually total hysterectomy. Closure of the urinary bladder defect with absorbable sutures and a negative leak test concluded the surgery. The patient showed no postoperative complications, with follow-ups at 6 and 12 months indicating complete recovery without complaints.

Significance of correcting magnesium deficiency in different groups of women in surgical menopause

Background. In the 21st century, there is a clear trend towards an increase in the proportion of women with climacteric syndrome (CS) and surgical menopause. Medical care for such patients usually includes menopausal hormone therapy (MHT), which often causes changes in magnesium and pyridoxine metabolism and their deficiency, leading to the development of adverse reactions. Therefore, it is necessary to improve rehabilitation programs designed to increаse the quality of life (QoL) for this category of gynecological patients.Objective: to assess the profile of women with CS and surgical menopause receiving and not receiving MHT and to identify the significance of magnesium deficiency (MD) effect on the recovery process.Material and methods. The observational non-interventional study included a total of 9168 women, of which 1528 patiеnts with CS and surgical menopause were taking MHT (Group 1), and 1528 patients with CS and surgical menopause were not taking MHT (Group 2). The Magnesium Deficiency Questionnaire (MDQ) was used to determine the number of participants with MD. A biochemical blood test was also performed, including determination of plasma magnesium concentration. The patients’ profile was analyzed for general somatic pathologies, obstetric and gynecological history, complaints, and MD symptoms using visual analogue scale. To assess QoL before the start of 4-week MD replenishing course and at the end of therapy, the World Health Organization Quality of Life Questionnaire (WHOQL-26) was applied.Results. The MDQ data showed that the prevalence of DM in Group 1 was higher compared to Group 2. In both groups, women with hypomagnesemia had a higher incidence of viral infections, vegetative-vascular dystonia, osteochondrosis and arterial hypertension, more pronounced sleep disorders, irritability, back pain, rapid fatigue, and higher MDQ scores. After completion of the course of therapy with magnesium citrate and pyridoxine combination, the MDQ scores in patients with DM decreased along with an increase in plasma magnesium concentration. Besides, women's satisfaction with their physical, psychological, social wellbeing and microsocial support increased, and self-perception improved. A decrease in the severity of DM and a significant improvement in QoL according to WHOQOL-26 were demonstrated in patients with CS and surgical menopause after therapy.Conclusion. The profile of patients with CS and surgical menopause, regardless of MHT, is often characterized by DM and decreased QoL. It seems reasonable to include blood magnesium level monitoring and DM correction in the comprehensive rehabilitation program for such patients.

Experience with the use of hyaluronic acid solution (Diart) in the treatment of patients with degenerative-dystrophic diseases of the hip joint

Background. Degenerative-dystrophic diseases of the joints are chronic progressive pathological conditions, accompanied by such features as presence of pain syndrome, impaired functional capacity, muscle weakness, deformation and instability of the joints. The high prevalence of degenerative-dystrophic diseases of the hip joint necessitates the search for optimal non-invasive treatment methods. Objectives. This study aims to analyze the clinical results of intra-articular injections of hyaluronic acid solution (Diart) in the treatment of patients with II–III stages of degenerative-dystrophic diseases of the hip joint. Materials and methods. The clinical results of 30 patients with II–III stages of degenerative-dystrophic diseases of the hip joint were analyzed. The group included 11 (36.67%) males and 19 (63.33%) females. The mean age of group was 61.43±7.98 years. All patients underwent a course of drug therapy using hyaluronic acid solution (Diart), which included 3 intra-articular injections of the drug, which were performed with the 7-day interval. Clinical results were evaluated at the initial visit, at 7, 14, 30 and 90 days after the first injection of Diart by objective examination of patients and analysis of subjective data using the WOMAC questionnaire. Statistical analysis was performed using Statistica 13 software package. Results. The high effectiveness of intra-articular injections of hyaluronic acid (Diart) in the treatment of patients with II-III stages of degenerative-dystrophic diseases of the hip joint and the absence of complications associated with intra-articular injection of the drug have been established. Signs of post-injection sy- novitis, discomfort, swelling or other unpleasant sensations weren’t observed in any of the examined patients. Comparing the results established during remote period, on the 90th day of observation, and indicators determined at the initial visit, we proved a decrease in the intensity of the pain syndrome in the hip joint by 30.35%, in stiffness — by 29.57%, an improvement in the indicators characterizing the functional capacity by 21.34 % and the total values of the WOMAC index — by 27.37%, after a treatment course using Diart. Conclusion. The high efficiency of using intra-articular injections of hyaluronic acid solution (Diart) in the treatment of patients with II–III stages of degen- erative-dystrophic diseases of the hip joint has been proven.

Exploring the effects of short-course antibiotics on children’s gut microbiota by using 16S rRNA gene sequencing: a case-control study

BackgroundWith the widespread use of antibiotics, more attention has been paid to their side effects. We paid extra attention to the impact of antibiotics on children’s bodies. Therefore, we analyzed the characteristic changes in the gut microbiota of children after antibiotic treatment to explore the pathogenesis of antibiotic-associated diseases in more depth and to provide a basis for diagnosis and treatment.MethodsWe recruited 28 children with bronchopneumonia in the western district of Zhuhai, China, and divided them into three treatment groups based on antibiotic type. We took stool samples from children before and 3–5 days after antibiotic treatment. 16S rRNA gene sequencing was used to analyze the effects of antibiotic therapy on the gut microbiota of children. Continuous nonparametric data are represented as median values and analyzed using the Wilcoxon rank-sum test.ResultsWhile alpha diversity analysis found no significant changes in the mean abundance of the gut microbiota of children after a short course of antibiotic treatment, beta diversity analysis demonstrated significant changes in the composition and diversity of the gut microbiota of children even after a short course of antibiotic therapy. We also found that meloxicillin sulbactam can inhibit the growth of Proteobacteria, Bacteroidetes, and Verrucomicrobia, ceftriaxone inhibits Verrucomicrobia and Bacteroides, and azithromycin inhibits Fusobacteria, Actinobacteria, Proteobacteria, and Verrucomicrobia. We further performed a comparative analysis at the genus level and found significantly different clusters in each group. Finally, we found that azithromycin had the greatest effect on the metabolic function of intestinal microbiota, followed by ceftriaxone, and no significant change in the metabolic process of intestinal microbiota after meloxicillin sulbactam treatment.ConclusionsAntibiotic treatment significantly affects the diversity of intestinal microbiota in children, even after a short course of antibiotic treatment. Different classes of antibiotics affect diverse microbiota primarily, leading to varying alterations in metabolic function. Meanwhile, we identified a series of intestinal microbiota that differed significantly after antibiotic treatment. These groups of microbiota could be used as biomarkers to provide an additional basis for diagnosing and treating antibiotic-associated diseases.

Ретроспективный сравнительный анализ эффективности хондропротективной терапии пациентов с хронической болью в нижней части спины

INTRODUCTION. The choice of optimal therapy for chronic lower back pain includes: influence on all links of the pain vicious circle, has analgesic and anti-inflammatory effects, chondroprotective effect. AIM. A retrospective comparative analysis of outpatient records of patients with chronic lower back pain with a course of therapy with drugs containing chondroitin sulfate – Chondroguard, and bioactive concentrate of small marine fish – Alflutop. MATERIAL AND METHODS. Outpatient records of patients who took Chondroguard and Alflutop in the period from January 2022 to April 2024 were included. Data from 60 patients (medium age 51.5±9.7 years). Patients were retrospectively divided into two groups depending on the strategy of pain management. The main group (n=30; medium age 51.0±9.8 years), who received Chondroguard intramuscularly (I/ m) every other day No. 25 according to the scheme: the first 3 injections (1st, 3rd, 5th day) - 1 ml (100 mg), with good tolerability from the 4th injection (7 day) – 2 ml (200 mg); and the Comparison group (n=30; medium age 49.3±9.9 years), received Alflutop 2 ml, 1 time a day, every other day, a short course of 10 days. The dynamics of the condition was assessed on days 10, 20, 50. RESULTS AND DISCUSSION. By day 50 in the Main group, there was a decrease in pain by an average of 86.6% according to the numerical rating scale and an improvement in the functional status according to the Oswestry scale of 95.5%, in the comparison group there was a decrease in pain by an average of 77.2%, an improvement in the functional status according to Oswestry scale of 86.7%. By day 50, the severity of pain syndrome in the Main group decreased by 91.2%, in the Comparison group – by 33.9%; indicators of the functional status of Oswestry scale in the Main group improved by 97.3%, in the Comparison group – by 84.8%. In the Main group, the need for multiple nonsteroidal anti-inflammatory drugs on the 10th day of therapy decreased to 1 tablet per day in 76.7%, in the Comparison group – in 16.7%. In the main group, after a course of therapy for 21.3±2.2 months. they did not consult a doctor in the comparison group after 5.3±1.1 months. A second course of therapy was conducted. CONCLUSION. In the Main group, the effects of therapy can be regarded as long-term, since the effects of highly purified chondroitin sulfate on the pathogenetic mechanisms of the formation of chronic lower back pain remain. KEYWORDS: pain syndrome, lower back pain, chondroitin sulfate, Chondroguard

Application of seven tools for evaluation of greenness of chromatographic methods for Remdesivir analysis

Green analytical chemistry is concerned with making analytical techniques more secure and environmentally friendly. A crucial aspect of this approach is the assessment of the greenness of analytical methods. Remdesivir, a SARS-CoV-2 nucleotide analog RNA polymerase inhibitor, has been authorized by USFDA as the initial course of therapy for hospitalized COVID-19 patients. The proposed study evaluates greenness of several reported chromatographic methods for estimation of Remdesivir using seven different tools namely ComplexGAPI, BAGI, AGREE, AGREEprep, AMGS, ChlorTox and RGBfast.

Dynamics of Daily Glioblastoma Evolution During Chemoradiation Therapy on the 0.35T Magnetic Resonance Imaging-Linear Accelerator

Glioblastoma changes during chemoradiation therapy are inferred from magnetic resonance imaging (MRI) before and after treatment but are rarely investigated due to logistics of frequent MRI. Using a combination MRI-linear accelerator (MRI-linac), we evaluated changes during daily chemoradiation therapy. Patients with glioblastoma were prospectively imaged daily during chemoradiation therapy on 0.35T MRI-linac and at 3 timepoints with and without contrast on standalone high-field MRI. Tumor or edema (lesion) and resection cavity dynamics throughout treatment were analyzed and compared with standalone T1 postcontrast (T1+C) and T2 volumes. Of 36 patients included in this analysis, 8 had cavity only, 12 had lesion only, and 16 had both cavity and lesion. Of these, 64% had lesion growth and 46% had cavity shrinkage during treatment on MRI-linac scans. The average MRI-linac migration distance was 1.3 cm (range, 0-4.1 cm) for lesion and 0.6 cm (range, 0.1-2.1 cm) for cavity. Standalone versus MRI-linac volumes correlated strongly with R2 values: 0.991 (T2 vs MRI-linac cavity), 0.972 (T1+C vs MRI-linac cavity), and 0.973 (T2 vs MRI-linac lesion). There was a moderate correlation between T1+C and MRI-linac lesion (R2 = 0.609), despite noncontrast MRI-linac inability to separate contrast enhancement from surrounding nonenhancing tumor and edema. From pretreatment to posttreatment in patients with all available scans (n = 35), T1+C and MRI-linac lesions changed together-shrank (n = 6), grew (n = 12), or unchanged (n = 8)-in 26 (74%) patients. Another 9 patients (26%) had growth on MRI-linac, although the T1+C component shrank. In no patient did T1+C lesion grow while MRI-linac lesion shrank. Anatomic changes are seen in patients with glioblastoma imaged daily on MRI-linac throughout the chemoradiation therapy course. As surgical resection cavities shrink, margins may be reduced to save normal brain. Patients with unresected or growing lesions may require margin expansions to cover changes. Limited volume glioblastoma boost trials could consider triggered gadolinium contrast administration for evaluation of adaptive radiation therapy when lesion growth is seen on noncontrast MRI-linac.

Reirradiation of Utracentrally Located Thoracic Tumors Using a 10-Fraction Hypofractionated Stereotactic Body Radiation Therapy Course: A Detailed Dosimetric Analysis

PurposeThere is very little information detailing outcomes and toxicity following re-irradiation for ultracentrally located thoracic tumors, and detailed dosimetric data is non-existent. This data is critical for the safe management of these extremely difficult cases. Materials and MethodsThe records of fifteen individuals undergoing 10-fraction hypofractionated stereotactic body radiotherapy (hfSBRT) for the management of ultracentrally located thoracic tumors between 2009 and 2020 at a single institution were retrospectively reviewed. Treatment outcomes and toxicity were analyzed. A detailed dosimetric analysis of treatment plans and centrally located organs at risk (OARs), from the initial, re-irradiation, and cumulative radiotherapy courses was presented. ResultsAt a median follow up of 10 months, one- and three-year overall survival (OS), progression free survival (PFS) and local control (LC) were 52% and 28%, 33% and 28%, and 76% and 61%, respectively. Treatment related adverse events were low with 5 individuals (33%) developing ≥ grade 2 pneumonitis (Grade 2 = 4, Grade 3 = 1). Dosimetric parameters were not associated with the development of clinically relevant pneumonitis. No adverse events involving central OARs (esophagus, great vessels, primary bronchial tree) were identified. Median cumulative mean lung dose (MLD) was 24 Gy (EQD2) (range: 10-33 Gy), with a V20 of 33% (range: 11-51%). Median esophageal, primary bronchial tree, and great vessel maximum doses (Dmax) were 93.2 Gy (EQD2) (range: 50-148 Gy), 163 Gy (range: 77-204 Gy), and 191 Gy (range: 129-262 Gy), respectively. ConclusionsThe current investigation is the first to provide detailed cumulative dosimetric data from a cohort of patients comprised entirely of ultracentrally located thoracic tumors. Despite unfavorable anatomic tumor location given an intimate association to critical OARs, delivering an ablative dose with a 10-fraction hfSBRT course can serve as a feasible option for these challenging cases.

ICG mapping of postoperative lymphatic leakage in the groin: a video article and literature review.

Inguinofemoral lymphoceles are a common postoperative complication after inguinofemoral lymphadenectomy (LNE) and a challenge for patients as well as physicians. We report here our preliminary experience in the surgical management of a recurrent lymphocele using indocyanine green (ICG) detection, followed by robotic-assisted closure of the lymphatic leaks. The aim of this article is to illustrate the surgical steps of ICG-assisted detection of inguinal lymphatic leaks and their surgical treatment by means of robot-assisted suturing. Furthermore, the feasibility of the approach will be evaluated. A 59-year-old woman with locally advanced squamous cell carcinoma of the vulva and previous conventional bilateral inguinofemoral LNE presented with symptomatic therapy-resistant lymphoceles in the groin. After a lengthy and frustrating course of standard therapy, she was offered the off-label option surgical treatment with ICG detection and subsequent robot-assisted ligation of the leaks, using the Da Vinci robotic system™. Perioperative data, specific aspects of the surgical approach specifics, objective and subjective outcomes of the new approach. The procedure was performed as planned, with no intraoperative complications or device-related issues. The postoperative course was uneventful, and the patient developed no further lymphoceles. Visualisation of the leakage by ICG combined with minimally invasive robotic-assisted laparoscopy is a promising therapy option. The pictures and videos demonstrate our experience in regard of the safety, feasibility, and usefulness of this procedure. Further studies will be needed, to prove the absolute efficacy of the technique and express a general recommendation in regard of this approach for the treatment of inguinofemoral lymphoceles.

863P Safety and efficacy of four courses of pembrolizumab combined with carboplatin and albumin-binding paclitaxel versus two courses of neoadjuvant therapy in patients with resectable head and neck squamous cell carcinoma: An optimal efficacy study (prospective, two-arm, phase II)

863P Safety and efficacy of four courses of pembrolizumab combined with carboplatin and albumin-binding paclitaxel versus two courses of neoadjuvant therapy in patients with resectable head and neck squamous cell carcinoma: An optimal efficacy study (prospective, two-arm, phase II)

Rationale for Hepatitis C Virus Treatment During Hematopoietic Stem Cell Transplant in the Era of Novel Direct-Acting Antivirals.

Untreated hepatitis C (HCV) infection in patients undergoing hematopoietic stem cell transplantation (HSCT) can lead to worse outcomes. Traditionally, HSCT patients infected with HCV would wait until after immune reconstitution to receive HCV therapy, as the oncologic urgency of transplant would not allow time for a full preceding treatment course of HCV therapy. However, in the era of newer direct-acting antivirals (DAAs), we propose that concomitant treatment of HCV while undergoing HSCT is safe and feasible, while keeping in mind potential drug-drug interactions. A literature review was performed to summarize the available data on the impact of HCV on patients undergoing HSCT. Drug-drug interactions for DAA's and pertinent HSCT drugs were evaluated using Lexicomp online® and http://hep-druginteractions.org . During HSCT, HCV appears to be a conditional risk factor for sinusoidal obstruction syndrome and a potential risk factor for graft versus host disease, both of which are associated with increased mortality. HCV reactivation and exacerbation may impact the use of chemotherapeutics, but available studies haven't shown impact specifically on HSCT. Limited case reports exist but demonstrate safe and effective use DAAs during HSCT. These, along with a drug-drug interaction review demonstrate agents such as sofosbuvir/velpatasvir and glecaprevir/pibrentasvir are promising DAAs for use in HSCT. HCV infection may worsen outcomes for patients undergoing HSCT. Concomitant treatment of HCV during HSCT using newer DAAs appears feasible and may improve patient morbidity and mortality, however large-scale studies are needed to further support this practice.

Assessment of the efficacy and safety of auricular keloids excision followed by 5-aminolevulinic acid photodynamic therapy

Background: Auricular keloids are a significant clinical challenge, which adversely affect the life of the patient at the level of aesthetic and psychological well-being. Despite various treatment modalities, a universally effective therapy has yet to be established. Photodynamic therapy (PDT) offers a promising approach by inhibiting the abnormal proliferation of fibroblasts while minimizing damage to surrounding healthy cells and tissues. This study evaluates the clinical outcomes of auricular keloid patients treated with excision followed by 5-aminolevulinic acid photodynamic therapy (ALA-PDT). Methods: This study included 8 patients diagnosed with auricular keloids based on pathological examination and clinical presentation. Following surgical excision of the auricular keloids, topical 5-ALA solution was applied for 4 hours. Then each lesion was irradiated with 120 J/cm² using a red LED (635-nm laser) for 20 minutes. Patients received 3-5 courses of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) during and after the surgery. Results: Among the 8 patients treated, auricular keloids were completely controlled with the combination therapy. During a follow-up period of 2.7 years (range: 1.8-4.1 years), all patients exhibited excellent outcomes with no recurrence of keloids. Conclusions: The combination of surgical excision and 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is an effective and safe treatment for auricular keloids. This combined approach shows promise as an alternative clinical treatment for managing auricular keloids.

Immune checkpoint inhibitor-associated sick sinus syndrome and cardiogenic shock.

Immune checkpoint inhibitors (ICI) represent a major advance in the treatment of cancer. Most studies of ICI have underestimated their cardiotoxicity; however, an increasing number of cases of cardiotoxicity are being reported. Herein we discussed a 67-year-old, male, Japanese patient who presented with cardiogenic shock accompanied by sick sinus syndrome 4days into his second course of ipilimumab plus nivolumab combination therapy. A temporary transvenous pacemaker was subsequently placed, and a permanent pacemaker was implanted for persistent, symptomatic, intermittent bradycardia. The permanent implantation of the pacemaker improved his symptoms and allowed him to continue his ICI therapy.

A small secret of big rheumatology

Current recommendations for RA treatment determine the need to reduce the dose and duration of glucocorticoid(GC) use. This is due to the wide spectrum and high frequency (up to 100%) of serious adverse events (AE) during GC treatment. However, in real practice GCs in RA are used very often (in Russia, Western Europe and the USA they are used in about 50% of patients), and often in long-term courses. This is explained by the fact that the combination of disease-modifying antirheumatic drugs (DMARDs), including biologics (bDMARDs) and Janus kinase inhibitors (JAK), with GCs allows to achieve faster improvement of patients’ condition and therefore is very “convenient” for many patients and physicians.However, it is very difficult to ensure dose reduction and (especially!) complete discontinuation of GC administration afterwards. Clinical and observational studies show that 30–40% of patients manage to discontinue the use of GCs during treatment with bDMARDs and JAK. In addition, discontinuation of GCs may significantly increase the risk of RA flare, even with complex pathogenetic therapy.Nevertheless, prolonged use of GCs, including low doses (less than 7.5 mg/day of prednisolone) should be considered as an indicator of the severity of the disease course and inadequacy of the current therapy. Therefore, we should strive for personalization of RA therapy, selection of DMARDs based on the assessment of the disease phenotype and predictors of response to treatment with different drugs, achieving the main goal of therapy – remission/low disease activity and achievement of acceptable quality of life, without the use of GCs.