Effect Of Treatment Type Research Articles

A - 141 The Relationship of Tumor Location and Treatment on Cognition in Long-Term IDH-Mutant Glioma Survivors

Abstract Objective Isocitrate dehydrogenase 1 mutation (IDH-M) denotes a distinct subtype of glioma which has a relatively favorable prognosis but nevertheless requires treatment including surgery, radiation and/or chemotherapy and the tumors inevitably recur. Factors influencing cognition in long-term survivors (LTS) of IDH-M have not been well characterized. We investigated factors affecting cognition in a cohort of well characterized of IDH-M LTS. Method Patients (N = 65; 98.5% Caucasian; 47.7% female; Mage = 47.51; Medu = 16.06) who were at least 3 years post-IDH-M diagnosis who completed neuropsychological assessment in the Neuro-oncology division at Massachusetts General Hospital were included. Tests of processing speed, working memory, episodic memory, and executive function were analyzed along with tumor, treatment, and individual difference factors relevant to cognition. Exploratory analyses were conducted to generate hypotheses regarding factors of interest. Results Tumor hemisphere affected delayed recall of word list learning Z-score (F = 4.00; p = 0.024; left = −1.41; right = −0.59). Tumor lobe affected visual learning (F = 3.11; p = 0.054; frontal = −0.594; temporal = −0.807; parietal = −1.983). There were no effects of treatment type (photon vs proton radiation; single vs multi-agent chemotherapy), presence of seizures, psychiatric diagnosis, tumor subtype (oligodendroglioma/astrocytoma), grade (2,3,4) or disease duration (Mean = 9.5y; min = 3y; max = 28.8y) on cognition. Conclusions In this heavily treated group of IDH-M glioma LTS referred for neuropsychological evaluation, typical lateralizing/localizing cognitive deficits were revealed. However, simple dichotomies may fail to capture relevant contributors to cognitive impairment. Integration with individual factors including premorbid cognition, radiation dosimetry and brain network connectivity may be necessary to predict cognitive trajectories and outcomes.

Application of principal component analysis (PCA) to the study of the influence of the thermochemical treatment process of tropical wood sawdust on the calorific, mechanical, physicochemical and combustion properties of the resulting fuel briquettes

Despite its potential for environmentally friendly energy production, lignocellulosic biomass has less advantageous physicochemical properties that limit its optimal industrial use. This study used principal component analysis (PCA) to evaluate the effects of two thermochemical processing methods (torrefaction and carbonization) on the calorific, physicochemical, mechanical and combustion properties of the resulting biofuels. Various types of tropical sawdust (Dabema, Dibetou, Fraké, Samba and Iroko) are subjected to these treatments, then densified and characterized for energy applications. Specific fuel consumption varies from Samba torrefied (Sam t: 0.69 kg/L) to Samba carbonized (Sam c: 1.48 kg/L). Higher heating values range from Samba torrefied (Sam t: 23983 kJ/kg) to Iroko torrefied (Iro t: 27,442 kJ/kg). Burning speed varies from Samba carbonized (Sam c: 3.07 g/min) to Iroko torrefied (Iro t: 4 g/min). The impact resistance index ranges from 187.5 to 500% for Dibetou torrefied (Dib t) and Samba carbonized (Sam c), respectively. Densities are between Samba carbonized (Sam c: 297.83 kg/m3) and Dibetou carbonized (Dib c: 393.69 kg/m3). The results indicate that these techniques are promising approaches for improving biomass properties. In sum, the PCA reveals that the effect of treatment type on fuel characteristics also depends on the properties of the initial biomass.

Abstract 3616: In vivo expansion patterns of anti-BCMA CAR T-cell in relapsed/refractory multiple myeloma: Comparative immunomonitoring of idecabtagene vicleucel and ciltacabtagene autoleucel

Abstract Introduction: Chimeric antigen receptor (CAR) T cell (CAR-T) treatments have revolutionized the treatment of multiple myeloma (MM). Two CAR-T cell products targeting B cell maturation antigen (BCMA) have received approval for the treatment of MM: idecabtagene vicleucel (idecel) and ciltacabtagene autoleucel (ciltacel). A comparative analysis of in vivo CAR-T responses in patients receiving these novel cellular therapies has not been performed, especially not in the real-world setting. Methods: We prospectively enrolled 23 MM patients treated with idecel or ciltacel in our study GCCC2043. Blood samples were obtained at apheresis, pre-lymphodepleting (LD) chemotherapy, on days 0, +7, +14, +21, +28 and at +3 months post CAR-T. Samples were stained using BCMA or control CAR detection reagents, monoclonal antibodies against T cell surface antigens, and analyzed using flow cytometry. Results: Baseline clinical characteristics, pre-apheresis and pre-LD absolute lymphocyte counts were comparable between groups. There were no G3 cytokine release syndrome (CRS) events whereas G1/2 CRS and all-grade Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) events were not significantly different between cohorts. The global overall response rate (ORR) was 78.3% (n=18) and 60.9% (n=14) at days 30 and 90, respectively. At +1 month, 72.7% (8/11) of idecel and 83.3% (10/12) of ciltacel cohort had an objective response (p=0.625). There was no statistical ORR difference between idecel and ciltacel cohorts at 3, 6, and 9 months. Two-way ANOVA of CAR-T expansion studies revealed a trend towards an effect of treatment type (p=0.0595). Time to peak CAR-T numbers was significantly shorter for idecel (p=0.0127), however, ciltacel showed a significantly more pronounced CAR-T expansion (p=0.043) and longer persistence. Peak CAR-T expansion was associated with clinical responses across cohorts at +1 (p=0.034) and +3 months (p=0.050). Day +30 responses were indicative of Day +90 and Day +180 responses (p<0.001, p=0.011). There was no difference in CD8+ CAR T cell peak levels, however, CD4+ CAR T cell peak levels were much higher (p=0.019) for ciltacel vs. idecel. Similarly, there were significantly higher (p=0.002) CD4+/CD8+ double-positive CAR-T peak levels in ciltacel vs. idecel patients. There was no significant difference in the distribution of T cell memory subtypes at peak level. Conclusions: We demonstrate here for the first time significant differences in CAR T cell expansion and persistence patterns following infusion of either idacel or ciltacel. Studies are underway at our institution investigating anti-BCMA CAR T cell responses in more detail and larger numbers of patients. Such studies have the potential to identify predictive/prognostic biomarkers and/or lead to further optimization of myeloma-targeting CAR-T. Citation Format: Mehmet Kocoglu, Aaron P. Rapoport, Etse Gebru, Destiny Omili, Daniel Yamoah, Rediet Mulatu, Jean Yared, Nancy M. Hardy, Michael Kallen, Ashraf Z. Badros, Djordje Atanackovic. In vivo expansion patterns of anti-BCMA CAR T-cell in relapsed/refractory multiple myeloma: Comparative immunomonitoring of idecabtagene vicleucel and ciltacabtagene autoleucel [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 3616.

The Effect of Botulinum Toxin (Masport) Injection Following Internal Urethrotomy of Bulbar Urethral Stricture: A Pilot Study.

The application of Botulinum toxin (Masport) in urology has a long history. We aimed to assess the effect of local Masport on improvement in patients with urethral stricture by reducing the recurrence of urethral stricture. This pilot study conducted was a double-blind randomized clinical trial with code IRCT20191222045852N1 on patients suffering from urethral stricture. Finally, 28 patients were allocated to intervention and control groups. Twelve patients received intralesional injection with Masport in addition to internal urethrotomy, while 16 patients underwent internal urethrotomy with normal saline. The Cox regression hazard model was used to evaluate the effect of treatment status on recurrence time adjusted for the age, length, and location of the stenosis, cause of the stenosis, and history of previous operations. The effect of treatment type was significant at the .05 level. The past medical history and cause of urethral stricture had a significant impact on relapse-free survival. Also, the improvement in the mean score of the EuroQol Visual Analogue Scale (EQ-VAS), International Prostate Symptom Score (IPSS), and Q-max in the group with Masport was significantly different from the group with normal saline. The internal urethrotomy with intralesional injection of Masport has a better survival prognosis than internal urethrotomy with normal saline group. Therefore, the authors suggest that, given this successful initial clinical trial, consideration be given to future studies involving the use of botox in the management of urethral strictures in conjunction with internal urethrotomy.

A preliminary study on the effect of trauma-focused therapies on sexual dysfunctions in women with PTSD after childhood abuse

BackgroundPosttraumatic stress disorder (PTSD) is often associated with female sexual dysfunctions (FSD). However, little is known about the impact of therapies for PTSD on FSD according to DSM-5 criteria. Aim/objectiveTo examine if sexual functioning diagnosed according to DSM-5 criteria improves after treatment for PTSD in women with a PTSD diagnosis after interpersonal child abuse. MethodFSD according to DSM-5 criteria were assessed with the structured clinical interview SISEX in N = 152 female participants (mean age = 36.5 years) of a large randomized controlled trial three months into treatment and after 15 months of receiving either dialectical behavior therapy for PTSD or cognitive processing therapy.Number of fulfilled FSD criteria and diagnostic status were compared from pre-to post-treatment using Poisson and negative binomial regression analyses and the McNemar test. The effect of treatment type on reduction of FSD symptoms and the association between reduction in PTSD symptoms and reduction in FSD symptoms were assessed. ResultsFrom pre-to post-treatment, the number of fulfilled criteria for each FSD decreased (Incident rate ratios between 0.60 and 0.71, p between <. 001 and <0 .05). Less women met criteria for genito-pelvic pain/penetration disorder at post-treatment compared to pre-treatment (11.8 % vs. 6.6 %, p < .05). No difference was found between treatments in reduction of FSD symptoms. Reduction of PTSD symptoms was associated with greater decrease in FSD symptoms. ConclusionsOur results suggest a positive association between effective PTSD treatments and improvements in sexual functioning of women with PTSD after child abuse.

Influence of green pepper extract on the physicochemical, antioxidant, and sensory properties of stirred yogurt

The green pepper has garnered interest in different societies as a functional food and food additive. Numerous studies have indicated that the phytochemicals found in pepper possess antioxidant, anti-cancer, anti-inflammatory, anti-obesity, and anti-arteriosclerotic properties. In this study, green pepper extract was used in yogurt to increase the acceptability of consumption and improve its health properties. For this purpose, green pepper extract was added in concentrations 100, 200, and 300 ppm in the preparation of yogurt. And pH, acidity, total content of phenolic compounds, DPPH inhibition percentage, viscosity, syneresis, and sensory properties were evaluated in 1, 7, 14, and 21 days after production. The results showed that by increasing the amount of extract, the percentage of antioxidant activity and phenolic compounds increased significantly. The effect of storage time on these indicators was also significant (p < 0.05). in such a way that over time, there was a decrease in antioxidant activity. But, there was a slight increase in antioxidant activity on the 14th day of storage. Also, the effect of treatment type on some physicochemical characteristics of yogurt containing green pepper extract including pH, acidity, viscosity, and syneresis was significant (p < 0.05). During storage, acidity, syneresis, and viscosity increased and pH decreased significantly in all yogurt samples. Regarding the tested sensory attributes, the 200 ppm sample received the highest score among the evaluators, and in terms of overall acceptance, the samples containing the extract were more favorable than the control sample.

In Vivo Anti-BCMA CAR T-Cell Expansion Kinetics Correlate with Early IMWG Response in RRMM: A Single Institution Study with Comparative Analysis of Idecabtagene Vicleucel and Ciltacabtagene Autoleucel

Introduction: The most recent breakthrough in the treatment of relapsed/refractory MM (RRMM) is chimeric antigen receptor (CAR) T-cell (CAR T) therapy which led to high overall response rates with acceptable toxicity. Here we present our single-institution experience with MM-specific CAR T performing a comparative analysis of clinical data and expansion kinetics after infusion of two commercially available myeloma CAR-T products. Methods: Out of 76 RRMM patients treated with CAR T, 23 patients provided consent, enrolled, apheresed and treated with commercial CAR-T between 6/20/2022 and 4/24/2023. Majority of patients had relapsed and multi-refractory MM. 11 patients received idecabtagene (idecel) and 12 received ciltacabtagene (ciltacel). Manufacturing slot availability was the primary deterministic factor for CAR T-type assignment. Study was IRB approved and informed consent was obtained to collect blood and clinical data. Blood samples were obtained at apheresis, pre-lymphodepleting (LD) chemotherapy, and on days 0, +7, +14, +21, +28 and +3 months post CAR T-cell infusion. PBMCs were generated from whole blood using density gradient centrifugation and were stained using BCMA or control CAR detection reagents and monoclonal antibodies against T-cell surface antigens. Samples were analyzed using MacsQuant-10 flow cytometer, gating on CD3+ and CAR+ cells. Fisher's Exact Test and Pearson Chi-Square tests were used for assessment of categorical variables whereas Independent-Samples Median Test was employed for non-categorical variables. Mann-Whitney U test was used for CAR T cell expansion analyses at individual timepoints. Results: As of July 10, 2023, 23 commercial patients were enrolled. Baseline clinical characteristics were comparable between the idecel and ciltacel cohorts with regard to age (median 66, p=0.827), prior lines of treatment, ASCT history (Table 1). Two patients in each cohort were penta-refractory. Three patients in each cohort had EMD (27.3%). There was balanced distribution of del 17p and t(4;14) across cohorts (p=1.000, p=0.175). Each cohort had 1 RISS-3 patient (p=0.476). Seven patients (30.4%) were previously treated with belantamab. Pre-apheresis and pre-LD absolute lymphocyte count (ALC) were comparable across cohorts. (Table 1). There were no G3 CRS events whereas G1/2 CRS events were not statistically significant between cohorts (p=0.256). Three G3 ICANS were observed, 2 in idecel and 1 in ciltacel cohorts (18.2% and 8.3%). Distribution of all-grade ICANS across cohorts were not statistically significant (p=0.676). Post-CAR T ferritin max correlated with the baseline b2m (p&amp;lt;0.001) and tocilizumab dose number (p=0.009) but none correlated with peak CAR T expansion (p=0.315). Responses were assessed by IMWG criteria at months 1,3,6,9 for efficacy-evaluable patients at that timepoint (n=19,14,8 and 2 in grand cohort (82.6%, 60.9%, 34.8% and 8.7%)). Global cohort ORR was 78.3% (n=18) and 60.9% (n=14) at days 30 and 90 respectively. +1 month IMWG responses were comparable with 72.7% (8/11) in idecel and 83.3% (10/12) in ciltacel cohort (p=0.625). Similarly, there was no statistically significant ORR difference between cohorts at 3, 6, and 9 months. Two-way ANOVA revealed a trend towards an effect of treatment type on CAR-T expansion (p=0.0595) (Figure 1A). Time-to-peak analysis reached statistical significance (p=0.0127) between two products (Figure 1B). Despite its delayed peak, ciltacel had significantly higher magnitude of expansion (p=0.043) (Figure 1C). Peak CAR-T expansion was associated with clinical responses across cohorts at +1 (p=0.034) and +3 months (p=0.050) but not at +6 months (p=0.449). Day +30 responses were indicative of Day +90 and Day +180 responses (p&amp;lt;0.001, p=0.011). Conclusions: In our single-center study of comparative analysis of commercial BCMA targeting CAR T-cell treatments, peak CAR T-cell expansion showed a positive correlation with +1 and +3 month post-CAR-T clinical responses. Despite the delayed peak expansion with ciltacel, the expansion was more robust with a higher level of circulating CAR T-cells. Baseline ALC or fludarabine dose reduction did not have an impact on overall CAR T expansion in combined cohort. Studies are underway at our institution investigating anti-BCMA CAR T cell responses in more detail and larger numbers of patients and functional studies will be further presented.

Failure to control conventional cardiovascular risk factors in women with type 2 diabetes might explain worse mortality.

The standardised mortality rate (SMR) for people with diabetes in England is 1.5-1.7, with differences in outcomes between sexes. There has been little work examining the factors that could have an impact on this or on what may determine sex differences in outcome. Data were extracted for patients with type 2 diabetes (T2D) in Salford (England) in 2010 for the years up to 2020, including any deaths recorded. Expected deaths were calculated from annual Office of National Statistics mortality rate and life expectancy by age and gender, adjusted for the local Index of Multiple Deprivation (IMD). This provided the SMR deprivation (SMRd), and life expectancy years lost per death (LEYLD). The effects of treatment type, and clinical features on SMRd relative to sex were examined by univariable and multivariable analysis. Data from n=11,806 (F=5184; M=6622) patients were included. Of these, n=5540 were newly diagnosed and n=3921 died (F=1841; M=2080). In total, n=78,930 patient years. The expected deaths numbered n=2596 (adjusted for age, sex, and IMD). Excess deaths were n=1325 (F=689; M=636). Life expectancy years lost (LEYL) 18,989 (F=9714; M=9275). SMRd 1.51 (F=1.60; M=1.44) and LEYLD 4.84years (F=5.28; M=4.46). The impact of risk factors was not different by sex. However, women had higher prevalence of % diagnosed >65years of age; % last eGFR <60mLs/min/1.73m2 , and lower prevalence of % prescribed ACE-inhibitor/ARB, DPP4-inhibitor and SGLT2-inhibitor. Applying the male prevalence rate to the female population and expected mortality suggested n=437 (55%) of excess T2D female deaths were attributed to sex difference in the prevalence of these risk and protective factors. Outcomes in women with T2DM are worse than in men, contributed to by greater prevalence of adverse factors and less prescribing of cardioprotective medication.

Overall survival associated with CDK4/6 inhibitors in patients with HR+/HER2- metastatic breast cancer in the United States: A SEER-Medicare population-based study.

Evidence on overall survival (OS) with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors is generally limited to data from clinical trials or a few observational studies with limited generalizability to Medicare population. The aim of this study was to determine OS benefits associated with CDK4/6 inhibitors in older Medicare patients with hormone receptor (HR)-positive and human epidermal growth factor receptor-2 overexpressing (HER2-) metastatic breast cancer (MBC). In a retrospective cohort design, female patients aged ≥65years with diagnosis of HR+/HER2- MBC from 2015 to 2017 who initiated first-line systemic therapy within 12months of MBC diagnosis were selected from the Survey Epidemiology and End Results-Medicare database. The effect of treatment type (endocrine therapy [ET]+CDK4/6 inhibitor vs. ET alone) on OS was analyzed using Kaplan-Meier methods and multivariable Cox regression models. Adjusted hazard ratio (aHR) and 95% CIs were estimated. A total of 630 eligible patients were identified (169 patients treated with ET+CDK4/6 inhibitor and 461 patients treated with ET alone). In the Kaplan-Meier analysis, OS rate at 3years after first-line treatment initiation was 73.0% for ET+CDK4/6 inhibitor versus 49.1% for ET alone (log-rank p<.0001). In Cox regression analysis, first-line ET+CDK4/6 inhibitor therapy was associated with 41% lower rate of mortality versus ET alone (aHR, 0.590; 95% CI, 0.423-0.823). The findings of this real-world study demonstrate significant OS benefit associated with ET+CDK4/6 inhibitor therapy over ET alone in an older Medicare population of patients with HR+/HER2- MBC, largely consistent with the evidence from clinical trials.

Biomass, Phenolic Compounds, Essential Oil Content, and Antioxidant Properties of Hyssop (Hyssopus officinalis L.) Grown in Hydroponics as Affected by Treatment Type and Selenium Concentration

Hyssop (Hyssopus officinalis L.) is an aromatic plant that is rich in various biologically active compounds and is widely used as a natural preservative and flavoring agent in the food and cosmetic industry and as a folk medicine against certain respiratory diseases. Despite the fact that selenium is not an essential trace element for plants, in a certain range of concentrations it can not only improve plant growth, but also increase the content of nutrients and biologically active compounds in plants. In the present study, the effect of treatment type (in a nutrient solution (NS) or by foliar application (FA)) and selenium (Se) concentration (2.0, 5.0, 10.0, 20.0, 40.0 μM) on the biomass, phenolic compounds, essential oil content, and antioxidant properties of hyssop grown in hydroponics was studied. Neither a toxic nor a beneficial effect of Se addition on the plants was observed. Selenium treatment significantly increased Se concentration in hyssop up to 38.35 μg g−1 (NS) and 34.86 μg g−1 (FA). The effect of selenium on the content of phenolic compounds, essential oil, and the antioxidant activity of hyssop depended on the applied selenium concentration. Hyssop treated with 10 μM Se (NS) and with 20 μM Se (FA) had a higher total content of hydroxycinnamic acids and higher contents of rosmarinic and chlorogenic acids, as well as a higher total content of phenolic compounds, higher content of essential oil, and higher antioxidant activity compared to other experimental plants. The results confirm the feasibility of selenium treatment of hyssop without reducing its production in order to enhance its nutritional and pharmaceutical properties.

Proximal humeral bone loss in stemless shoulder arthroplasty: potential factors influencing bone loss and a new classification system.

Proximal humeral bone loss in total shoulder arthroplasty (TSA) is more frequent than in hemiarthroplasty. Factors such as age, gender, inclination angle, and radiolucent lines may also contribute. Additionally, current bone loss grading systems are often not sensitive enough to detect slight bone changes, especially at the medial calcar where bone loss is commonly observed. This study uses a new, more detailed bone loss grading system to evaluate factors that could influence bone loss at the proximal humerus. In this single-center prospective study, patients underwent hemiarthroplasty or TSA with an anatomic stemless prosthesis. Bone loss was measured at the proximal humerus using the new grading system. The effect of treatment type, age, gender, radiolucent lines, and inclination angle on bone loss was evaluated. The Constant-Murley score of patients was assessed and complications recorded. Ninety-one shoulders were available for the final follow-up examination at a median of 85.0months (range 82.6-121.1months). Bone loss was found at the proximal humerus in approximately one-third of shoulders, and significantly more shoulders had bone loss in TSA than in hemiarthroplasty (P = 0.03). However, this difference was no longer significant after stratifying by gender and age (P > 0.05). Bone loss significantly correlated with gender (P = 0.03) but not with treatment type, radiolucent lines, and the postoperative inclination angle (P > 0.05). Most Constant-Murley score components did not differ significantly between shoulders with and without bone loss (P > 0.05). Lastly, six complications and four revisions were reported. Results showed gender had the greatest influence on bone loss after stemless shoulder arthroplasty. Furthermore, both patients with or without bone loss can expect similar clinical outcomes with the stemless prosthesis used in this study. Lastly, the new grading system is simple and straightforward to use.

Matched whole grain wheat and refined wheat milled products do not differ in glycemic response or gastric emptying in a randomized, crossover trial

Epidemiologic and some clinical studies support the view that whole grain foods have lower glycemic response than refined grain foods. However, from the perspective of food material properties, it is not clear why whole grain cereals containing mostly insoluble and nonviscous dietary fibers (e.g., wheat) would reduce postprandial glycemia. We hypothesized that glycemic response for whole grain wheat milled products would not differ from that of refined wheat when potentially confounding variables (wheat source, food form, particle size, viscosity) were matched. Our objective was to study the effect of whole grain wheat compared with refined wheat milled products on postprandial glycemia, gastric emptying, and subjective appetite. Using a randomized crossover design, healthy participants (n=16) consumed 6 different medium-viscosity porridges made from whole grain wheat or refined wheat milled products, all from the same grain source and mill: whole wheat flour, refined wheat flour, cracked wheat, semolina, reconstituted wheat flour with fine bran, and reconstituted wheat flour with coarse bran. Postprandial glycemia, gastric emptying, and appetitive response were measured using continuous glucose monitors, the 13C-octanoic acid (8:0) breath test, and visual analog scale (VAS) ratings. Bayes factors were implemented to draw inferences about null effects. Little-to-no differences were observed in glycemic responses, with lower incremental AUC between 0 and 120min glycemic responses only for semolina [mean difference (MD): -966mg min/dL; 95% CI: -1775, -156mg min/dL; P = 0.02) and cracked wheat (MD: -721mg min/dL; 95% CI: -1426, -16mg min/dL; P = 0.04) than for whole wheat flour porridge. Bayes factors suggested weak to strong evidence for a null effect (i.e., no effect of treatment type) in glycemic response, gastric emptying, and VAS ratings. Although whole grain wheat foods provide other health benefits, they did not in their natural composition confer lower postprandial glycemia or gastric emptying than their refined wheat counterparts.This trial was registered at clinicaltrials.gov as NCT03467659.

Physicochemical characteristics and antioxidant capacity of set yogurt fortified with dill (Anethume graveolens) extract

In the present study, dill extract was used in yogurt in order to increase its consumption acceptability and promote its functional properties. Milk fortified with 0, 5 and 10% (wt /vol) dill extract and its pH, acidity, total phenolic compounds, DPPH inhibitory percentage, viscosity, syneresis, water holding capacity, color and sensory properties were evaluated after 1, 7, 14 and 21 days of production. Investigation of the results showed that with the increase of the extract amount, inhibition percentage and total phenolic compounds increased, significantly (P < 0.01). The effect of storage time was also significant on the indexes, in a way that antioxidant properties and phenolic compounds increased in all treatments until 7 days and then it decreased. Also, the effect of treatment type was significant on some physicochemical characteristics (such as pH, acidity, viscosity, syneresis and water holding capability) of the fortified yogurt (P < 0.01). The results of the color evaluation indicated that the addition of dill extract reduced the red spectrum (a*) and lightness (L*) and increased the yellow spectrum (b*). In sensory evaluation, the highest score was given to the yogurt with 5% of dill extract.

Drug diffusion behaviours of biomaterials derived from tea fibre and chitosan

ABSTRACTThere is a strong linkage between the waste tea fibre and chitosan, because of being used as wound treating materials separately for years. The waste tea fibre and chitosan including biomaterials were developed due to being renewable sources, biodegradable, hygienic and harmless materials. Waste natural fibres were pre-treated with different chemicals in order to improve the compatibility of the fibre and the polymer. The effect of treatment type and additives were examined by using X-ray diffraction patterns and SEM images. Drug delivery behaviours were determined by calculating the diffusion coefficients of biomaterial-drug systems with a selected model drug, ciprofloxacin. The diffusion phenomenon was affected by both the treatment type and the additives. The findings of the structural and morphological examinations indicated that the association of the tea waste fibre and chitosan may be a promising biomaterial for wound dressing applications.

Functional Neuroimaging Guided Active Rehabilitation for PCS: A Retrospective Comparative Study of an NVC-Targeting Therapeutic Approach

Background: Recent work has demonstrated several advancements in therapeutic options for patients with postconcussion syndrome (PCS). Specifically, active rehabilitation has emerged as a promising direction for the best treatment outcomes. Enhanced Performance in Cognition (EPIC) is one form of active rehabilitation for PCS that uses a multi-disciplinary clinical approach focusing on two primary aims: the objective diagnosis of PCS using a quantitative, biomarker-based form of fMRI, and targeted neurorehabilitation. The targeting and rehabilitation of the neurovascular coupling (NVC) unit is an essential and novel component of this approach. This study seeks to contribute to the current field of active PCS therapy by demonstrating the usefulness of targeting NVC dysfunction. Further, we compare the EPIC protocol to treatment as usual using a retrospective comparative study design. Methods: The principal cohort was designated as all patients who received EPIC treatment from the time original pilot data was published to the time of retrospective data analysis and chart review (June 2016-October 2017) (N=375). Pre- and post-EPIC post-concussion symptom scales (PCSS) and severity index scores (SIS) were measured and compared. Then, based on pre-specified inclusion criteria for chart review, two patient cohorts were retrospectively assigned to treatment order 1 (TO1: N=15) and treatment order 2 (TO2: N=28). SIS was measured at pre-/post-EPIC and pre-/post-treatment as usual (TAU) functional neurocognitive imaging scans. SIS results from the treatment periods were compared and reported. Results: For the principal cohort (N=375), there was a statistically significant reduction in post-EPIC SIS and PCSS. Concerning the treatment cohorts, there was a highly significant (p<0.0001) overall effect of treatment type on SIS but no such effect of treatment order. However, analysis of TO2 alone revealed a significant effect on SIS reduction (p<0.001) if TAU occurs after EPIC therapy. Conclusion: The findings in this study appear to agree with the current body of research that demonstrates the effectiveness of active rehabilitation strategies compared to standard symptom-modulating and rest-based PCS therapies. Further, EPIC-style therapies contribute to the field of active PCS treatment by addressing NVC disruption in addition to the autoregulatory/vasoreactive aspects of PCS pathophysiology.

F1. The Effect of Treatment Type on Improvement of Subjective Sleep Quality in Complicated Grief

F1. The Effect of Treatment Type on Improvement of Subjective Sleep Quality in Complicated Grief

Locoregional treatments before liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry.

Locoregional treatment while on the waiting list for liver transplantation (Ltx) for hepatocellular carcinoma (HCC) has been shown to improve survival. However, the effect of treatment type has not been investigated. We investigate the effect of locoregional treatment type on survival after Ltx for HCC. We investigated patients registered in the European Liver Transplant Registry database using multivariate Cox regression survival analysis. Information on locoregional therapy was registered for 4978 of 23 124 patients and was associated with improved overall survival [hazard ratio (HR) 0.84 (0.73-0.96)] and HCC-specific survival [HR 0.76 (0.59-0.98)]. Radiofrequency ablation (RFA) was the one monotherapy associated with improved overall survival [HR 0.51 (0.40-0.65)]. In addition, the combination of RFA and transarterial chemoembolization also improved survival [HR 0.74 (0.55-0.99)]. Adjusting for factors related to prognosis, disease severity, and tumor aggressiveness, RFA was highly beneficial for overall and HCC-specific survival. The effect may represent a selection of patients with favorable tumor biology; however, the treatment may be effective per se by halting tumor progression. Clinicaltrials.gov number: NCT02995096.

T1N0 Esophageal Cancer: A Patterns of Care and Survival Analysis

Recent data show that overall survival after endoscopic mucosal resection (EMR) is similar to esophagectomy, however, limited data exists regarding the comparative efficacy of definitive radiotherapy (RT) for the treatment of T1N0 esophageal cancer. We sought to investigate the patterns of practice for the treatment of T1N0 esophageal cancer in the United States as well as to evaluate the comparative efficacy of esophagectomy vs EMR vs RT. Patients with clinical T1N0 esophageal carcinoma who underwent esophagectomy, EMR or RT (45 – 70 Gy) were identified from the National Cancer Database (NCDB) from 2004 to 2013. Univariate (UVA) and multivariable (MVA) effects of treatment type on survival were assessed using Cox proportional hazards regression. Overall survival (OS) was compared using Kaplan-Meier analysis and the log-rank test. Variables with p<0.001 were included in the MVA for OS. 6,262 met criteria for inclusion in this study: 2,995 (48%) underwent esophagectomy, 2,130 (34%) underwent EMR and 1,137 (18%) underwent RT. Only 3 patients underwent esophageal brachytherapy. Median age was 68 years, and patients undergoing RT were older (72 y) compared to those undergoing esophagectomy (65 y) or EMR (70 y) (p<0.0001). In the esophagectomy, EMR and RT groups, 70%, 75% and 72% of patients had a Charlson score of 0, respectively. Median follow-up was 34 months. Median RT dose was 50.4 Gy and 78% underwent concurrent chemotherapy. 30 day mortality was 3.1% for esophagectomy and 0.6% for EMR. In recent years, EMR was more frequently utilized, rising from 23% to 43% whereas esophagectomy and RT were less frequently utilized in the same time period (p<0.0001). RT was more frequently utilized at non-academic centers than academic centers, 30.3% vs 9.3%, p<0.0001. Of the patients who underwent esophagectomy, 614 (21%) were upstaged. On MVA, patients with Charlson/Deyo score ≥1 (HR 1.2, p=0.0003), older age (HR 1.03, p<0.001), Medicaid or no insurance (HR 1.5, p=0.003), treatment at non-academic centers (HR 1.1, p=0.009) and squamous histology (HR 1.3, p<0.001) were predictors of worse OS. There was no difference in OS between patients undergoing esophagectomy or EMR (p=0.4) and this finding persisted when analysis was limited to T1a patients (p=0.69). Patients requiring post-operative chemotherapy had a worse OS (HR 1.3, p<0.001). Patients who received definitive RT had a worse OS compared to patients who underwent esophagectomy or EMR (HR 1.8, p<0.001). EMR is increasingly utilized compared to esophagectomy and definitive RT for early esophageal cancer, whereas the utilization of esophageal brachytherapy was rare. Adoption of EMR in lieu of esophagectomy has not compromised survival. Patients undergoing esophagectomy and EMR had a superior OS compared to those who underwent definitive RT. Patients undergoing definitive RT appear to have unfavorable features likely affecting OS.

Occurrence of Selected Metals in Wastewater Effluent and Surface Water in Ireland

ABSTRACTMetals occur naturally in the environment and as constituents of the Earth’s crust. They have many uses, and metals such as iron, copper, and zinc are widely used in industries. Elevated levels of metals in the environment also occur as a result of human activities (municipal, residential, and traffic–related activities). A list of 15 metals chosen for this study included priority substances and those listed in the European Union Water Framework Directive 2000/60/EC. The concentrations of heavy metals in the environment are affected by several factors that must be taken into account when monitoring heavy metals released into the environment through wastewater treatment plants (WWPTs). This work examines the concentrations of metals found in WWPTs and the effects of treatment type on dissolved metal concentrations. Effluent samples were collected from the outflow of nine WWPTs in Dublin and Cork, Ireland from July 2009 to June 2011. All samples were found to contain priority metals that exceeded environmental quality standards in several cases. We present the frequency of occurrence and concentrations of metals in effluents of studied WWPTs and discuss relationships between the occurrence of heavy metals, the influence of factors such as industrial inputs, levels of treatment at WWPTs, and percentage urban area in an agglomeration. The results of this study are an indication that WWPTs may be contributing to the high levels of heavy metals found at discharge points back into river systems.

Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency.

BackgroundThe study compared downstream coronary and conduit disease progression in the left anterior descending coronary artery treated with coronary artery bypass grafting using the left internal mammary artery (LIMA) versus percutaneous coronary intervention with bare metal stent (BMS) or drug eluting stent (DES).Methods and ResultsA total of 12 301 consecutive patients underwent isolated primary coronary revascularization, of which 2386 met our inclusion criteria (Percutaneous coronary intervention, n=1450; coronary artery bypass grafting, n=936). Propensity score analysis matched 628 patients, of which 468 were treated to the left anterior descending with coronary artery bypass grafting with LIMA (n=314), percutaneous coronary intervention with BMS (n=94), and DES (n=60). Coronary angiograms were analyzed by quantitative coronary angiography (QCA; n=433). Cumulative downstream coronary and conduit disease progression were estimated by Kaplan–Meier method and effect of treatment type by Cox proportional hazard models. Patients treated with LIMA had significantly lower risk of downstream coronary disease progression at follow‐up angiogram compared with BMS and DES (hazard ratio [HR] [95% CI], 0.34; [0.20–0.59]; P=0.0002; and HR [95% CI], 0.39; [0.20–0.79]; P=0.01, respectively). LIMA was associated with a lower risk of conduit disease progression compared to BMS and DES (HR [95% CI], 0.18; [0.12–0.28]; P<0.001; and HR [95% CI], 0.27; [0.16–0.46]; P<0.001, respectively). BMS was associated with higher HR for downstream coronary and conduit disease progression compared with DES, but the difference did not reach statistical significance (HR [95% CI], 1.13; [0.57–2.36]; P=0.73; and HR [95% CI], 1.46; [0.88–2.50]; P=0.14, respectively).Conclusions LIMA grafting to left anterior descending is associated with significantly lower risk of downstream coronary and conduit disease progression compared to percutaneous coronary intervention with BMS and DES.