Efficacy Of Different Modalities Research Articles

Predictive value of contrast-enhanced ultrasonography and ultrasound elastography for management of BI-RADS category 4 nonpalpable breast masses

PurposeThe objective of this study was to investigate the independent risk factors and associated predictive values of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and strain elastography (SE) for high-risk lesions (HRL) and malignant tumors (MT) among nonpalpable breast masses classified as BI-RADS category 4 on conventional ultrasound. MethodsThis prospective study involved consecutively admitted patients with breast tumors from January 2018, aiming to explore the management of BI-RADS category 4 breast tumors using CEUS and elastography. We conducted a retrospective review of patient data, focusing on those with a history of a nonpalpable mass as the primary complaint. Pathologic findings after surgical resection served as the gold standard. The CEUS arterial-phase indices were analyzed using contrast agent arrival-time parametric imaging processing mode, while quantitative and qualitative indices were examined on ES images. Independent risk factors were identified through binary logistic regression multifactorial analysis. The predictive efficacy of different modalities was compared using a receiver operating characteristics curve. Subsequently, a nomogram for predicting the risk of HRL/MT was established based on a multifactorial logistic regression model. ResultsA total of 146 breast masses from 146 patients were included, comprising 80 benign tumors, 12 HRLs, and 54 MTs based on the final pathology. There was no significant difference in pathologic size between the benign and HRL/MT groups [8.00(6.25,10.00) vs. 9.00(6.00,10.00), P = 0.506]. The diagnostic efficacy of US plus CEUS exceeded that of US plus SWE/SE for BI-RADS 4 nonpalpable masses, with an AUC of 0.954 compared to 0.798/0.741 (P ＜ 0.001). Further stratified analysis revealed a more pronounced improvement for reclassification of BI-RADS 4a masses (AUC: 0.943 vs. 0.762/0.675, P ＜ 0.001) than BI-RADS 4b (AUC:0.950 vs. 0.885/0.796, P＞0.05) with the assistance of CEUS than SWE/SE. Employing downgrade CEUS strategies resulted in negative predictive values ranging from 95.2 % to 100.0 % for BI-RADS 4a and 4b masses. Conversely, using upgrade nomogram strategies, which included the independent predictive risk factors of irregular enhanced shape, poor defined enhanced margin, earlier enhanced time, increased surrounding vessels, and presence of contrast agent retention, the diagnostic performance achieved an AUC of 0.947 with good calibration. ConclusionAfter investigating the potential of CEUS and ES in improving risk assessment and diagnostic accuracy for nonpalpable BI-RADS category 4 breast masses, it is evident that CEUS has a more significant impact on enhancing classification compared to ES, particularly for BI-RADS 4a subgroup masses. This finding suggests that CEUS may offer greater benefits in improving risk assessment and diagnostic accuracy for this specific subgroup of breast masses.

P600 Efficacy of different modalities of faecal microbiota transplantation to induce clinical remission in patients with ulcerative colitis: a systematic review and network meta-analysis

Abstract Background We aimed to compare the efficacy of different modalities of faecal microbiota transplantation (FMT) to induce clinical remission in patients with ulcerative colitis (UC). Methods We performed a systematic review and network analysis (random effects model) of randomized controlled trials including at least one arm of FMT in adult patients with active UC. Primary endpoint, i.e. clinical remission (total Mayo score≤ 2 with Mayo endoscopic score≤ 1), was assessed between week 6 and 12. Results are expressed as relative risk with 95% confidence intervals, adjusted for bowel cleansing and pre-FMT antibiotics therapy. Ranking of FMT modalities for clinical remission was calculated as their surface under the cumulative ranking (SUCRA), which represents the percentage of efficacy achieved by an agent compared with an imaginary agent that is always the best without uncertainty. Heterogeneity among studies was evaluated by τ² (global statistical heterogeneity across all comparisons). Results Among the 12 selected studies, patients were exclusively bio-naïve in 4 studies (4/12), while between 9 and 32% had prior biologics exposure in the other trials. Risk of bias was low across all domains in 7 studies. Global heterogeneity was negligible (τ² = 0). After adjustment on bowel cleansing and pre-FMT antibiotics, oral capsule (RR=7.1[1.8-33.3]), lower GI FMT (RR=4.5[1.7-12.5] and combination of both (RR=12.5[2.1-100]) were more effective than placebo to induce clinical remission contrary to upper GI FMT (RR=1.1[0.2-7.7]) and autologous FMT (RR = 0.8[0.2-3.8](Table 1). The combination of lower GI FMT and oral capsule was significantly more effective than upper GI FMT to induce clinical remission (RR=10.7[1.1-104.2]). Combination of lower GI FMT and oral capsule ranked highest for the induction of clinical remission (SUCRA=0.93), followed by oral capsule (SUCRA=0.82) and lower GI FMT (SUCRA=0.72). Autologous FMT ranked lower than placebo (SUCRA=0.12vs0.22). We performed a sensitivity analysis distinguishing single donor FMT and multi-donor FMT (pooled samples from different donors). Combination of lower GI FMT and oral capsule ranked highest for the induction of clinical remission (SUCRA=0.89), followed by single donor lower GI FMT (SUCRA=0.70), multi-donor (pooled samples) lower GI FMT (SUCRA=0.65), multi-donor (pooled samples) oral capsule (SUCRA=0.61), single donor oral capsule (SUCRA=0.60). Conclusion In this network meta-analysis, we confirmed the efficacy of FMT to induce clinical remission in patients with UC. The combination of lower GI and oral capsule FMT seems to be the best modality of FMT for patients with UC while upper GI FMT is not suitable. In clinical trials, autologous FMT should be avoided due to a potential detrimental effect.

Alternative Medical Therapy.

Complementary/alternative medicine" (CAM) is defined as a diverse range of medical treatments, largely non-allopathic, mostly traditional, and not integrated into the authoritarian healthcare system. Interestingly for some schools, allopathy is alternative/complementary therapy. Osteoporosis is an ever-known disease treated before the era of allopathic medicine. Even though the customary medical system of India is among the most well-known in the world, every continent has its own alternative therapies for various chronic diseases. This review of the scientific information is to help the readers understand how crucial the conceptual underpinnings of alternative medical therapy systems are to the advancement of conventional allopathic practices. Many older and recent articles about alternative medical therapy in the management of osteoporosis published in scientific journals are reviewed. Relevant information from cross-references on methods of evaluating the efficacy of different modalities and their scientific pathways is included. An effort has been made to summarise the treatment of osteoporosis by these systems. Opinions, impressions, and inferences are added while describing various aspects of these modalities. The National Library of Medicine has played an active role in publishing studies of the management of osteoporosis by alternative therapies. Many issues of management of osteoporosis still lack reliable treatment. However, good information is now available about choosing alternate medical therapy that has been studied scientifically and has shown promising results. Medicinal plants and certain natural treatments can treat osteoporosis and its problems. The use of alternate medical therapy has been proven recently by clinical practice and conventional wisdom. This sharing may help the medical practitioner to understand and judiciously allow complementary therapy while treating osteoporosis.

Use of Social Media for Patient Education in Dermatology: Narrative Review.

Social media has rapidly become one of the main avenues for news and communication among those with access to technology. Nearly 60% or 4.7 billion people worldwide use social media. Different social media networks provide users with a barrage of posts, opinions, and transformations. With this noticeable uptick in physician and patient education usage of social media, exploration of the impacts of social media on patient education in dermatology is crucial. The goal of this narrative review was to evaluate existing peer-reviewed literature examining the use of social media for patient education in dermatology and to establish trends and implications. Additional attention was given to different social media sites, and potential differences in modalities of posts such as short-form videos on TikTok and Instagram Reels, long-form videos on YouTube, and infographics on Twitter, Instagram, and Facebook. PubMed, Access DermatologyDxRx, and Scopus searches of peer-reviewed publications were performed to discover articles with social media and patient education keywords in combination with other health care-relevant or dermatology-relevant keywords. Subsequently, the screening of these studies was performed by the author who has experience with education and research experience in health care, dermatology, social media, and telehealth. Ultimately, the selected articles were summarized through qualitative analysis of key points and presented for further discussion. Through this narrative review, the researcher was able to identify several publications focusing on dermatology and social media. Some common subject areas included the use of social media for the promotion of private dermatology practices, residency programs, and research journals. So long as providers, such as dermatologists, take ethical considerations into account, these platforms can provide patients with curated educational content. In addition, several publications emphasized the use of social media as a form of patient education on dermatologic conditions but also as a source of misinformation. This narrative review illuminated the use of social media as a form of patient education for dermatology, with its applications addressed across many demographics and situations. As social media platforms continue to update their algorithms, content filters, and posts, social media may become a reputable form of patient education in dermatology. Future studies and innovations should continue to explore innovations in this space, the efficacy of different modalities of posts, and longitudinal differences in patient outcomes and health literacy.

Training gynecologists in the management of HIV pre-exposure prophylaxis: a 2-year experience

We aimed to evaluate the efficacy of different modalities of PrEP training sessions for OB/GYN providers given the disproportionate under-utilization of PrEP among women. Three separate training sessions were held for providers in the OB/GYN department at an academic medical center in New York City: 1) in-person resident didactics, 2) virtual resident didactics, 3) virtual departmental grand rounds. The participants were surveyed after the training on PrEP awareness, knowledge, and management. Two-sample t-test was used to compare difference in proportions of binomial variables and difference in means of likert-scored answers.

Efficacy of Different Modalities and Frequencies of Physical Exercise on Glucose Control in People with Prediabetes (GLYCEX Randomised Trial).

To assess the efficacy of different modalities and frequencies of physical exercise on glycaemic control in adults with prediabetes. A two-phase, parallel, randomised, controlled clinical trial will be carried out, in 210 participants. In phase 1, 120 participants will be randomized into four arms: (1) aerobic exercise, (2) aerobic exercise combined with resistance, (3) high-intensity intervallic exercise and (4) control group. In phase 2, 90 new participants will be randomized into three arms, using the exercise modality that showed the best glycaemic control in phase 1 in the following manner: (1) frequency of 5 days/week, (2) frequency of 3 days/week and (3) frequency of 2 days/week. The control group (n = 30) will be included in phase 1 to evaluate the effect of any type of intervention versus no intervention. Data collection will be performed at baseline and after 15 weeks of follow up. Sociodemographic data, medication, comorbidity, blood biochemical parameters, blood pressure, anthropometric measurements, body composition, physical activity, sedentary lifestyle, diet, smoking, alcohol consumption, quality of life and sleep questionnaires will be collected. Physical activity, sedentary behaviour and sleep will be further determined with an accelerometer, and continuous glycaemia will be determined with a glycaemic monitor, both during seven days, at two time points. The main dependent variable will be the reduction in the mean amplitude of glycaemic excursions. The impact of these interventions on health will also be evaluated through gene expression analysis in peripheral blood cells. The results of this study will contribute to a better understanding of the mechanisms behind the glucose response to physical exercise in a population with prediabetes as well as improve physical exercise prescriptions for diabetes prevention. Increasing glycaemic control in people with prediabetes through physical exercise offers an opportunity to prevent diabetes and reduce associated comorbidities and health costs.

Prognostic Value of the Serum HER2 Extracellular Domain Level in Breast Cancer: A Systematic Review and Meta-Analysis.

Simple SummaryWe performed a systematic review and meta-analysis evaluating the predictive value of the serum HER2 extracellular domain (sHER2 ECD) for breast cancer prognosis. Our review investigated 40 studies (12,229 patients) that assessed the impact of the sHER2 ECD levels on breast cancer prognosis and explored the clinical significance of sHER2 ECD levels in different treatment modalities. Our findings indicated that an elevated sHER2 was an unfavorable prognostic factor in breast cancer. More interestingly, sHER2 ECD was found to be a promising biomarker for predicting adverse clinical outcomes of trastuzumab-based treatment but did not affect the efficacy of tyrosine kinase inhibitors. In addition, the baseline cutoff value of sHER2 ECD in different treatment stages of breast cancer remains to be further explored. Overall, our study suggested that sHER2 ECD levels have important prognostic value in breast cancer and may be helpful for clinicians to select the appropriate anti-HER2 therapy for HER2-positive breast cancer, providing more evidence for guiding clinical practice.An elevated serum HER2 extracellular domain is associated with poor prognosis in breast cancer, but the relationship between sHER2 and the efficacy of different modalities remains controversial. Herein, we aimed to evaluate the prognostic value of serum HER2 extracellular domain (sHER2 ECD) in breast cancer and to identify its correlation with the efficacy of different treatment regimens. A systematic search of the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted to identify studies exploring the association between HER2 ECD level and clinical outcomes among patients with breast cancer. Using the random effects models, pooled hazard ratios (HRs), and odds ratios (ORs) with 95% confidence intervals (CI), were calculated for progression-free survival (PFS), overall survival (OS), disease-free survival (DFS), and the objective response rate (ORR). Heterogeneity was further evaluated by subgroup and sensitivity analysis. Overall, 40 studies comprising 12,229 patients were included in this systematic review and meta-analysis. Elevated HER2 ECD levels were associated with worse PFS (HR 1.74, 95% CI 1.40–2.17; p < 0.001), and this effect was observed in patients treated with chemotherapy (HR 1.81, 95% CI 1.37–2.39; p < 0.001), endocrine therapy (HR 1.91, 95% CI 1.57–2.32; p < 0.001), and trastuzumab (HR 1.74, 95% CI 1.31–2.30; p < 0.001). However, this association was not present in patients treated with tyrosine kinase inhibitors (TKIs) (HR 1.44, 95% CI 0.85–2.43, p = 0.17). The HRs/ORs for an elevated HER2 ECD level for DFS, OS, and ORR were 2.73 (95% CI 2.17–3.42; p < 0.001), 2.13 (95% CI 1.77–2.57; p < 0.001), and 0.80 (95% CI 0.49–1.31; p = 0.381), respectively. An elevated sHER2 ECD was an unfavorable prognostic factor in breast cancer but did not affect the efficacy of tyrosine kinase inhibitors such as lapatinib. Detection of sHER2 ECD may be helpful for clinicians selecting the appropriate anti-HER2 therapy for patients with HER2-positive breast cancer.

TU8.6 Pharmacological management of post-operative pain following appendicectomy: a meta-analysis

Abstract Introduction Appendicectomy is an increasingly common procedure internationally, and is the most frequent emergency surgery performed in the UK. Post-operative pain is common after surgery, if poorly controlled it can cause many negative outcomes for patients. Despite the large number of patients that undergo appendicectomy and the potentially severe outcomes of post-operative pain, there is no clear guidance on how best to control pain following appendicectomy. The aim of this meta-analysis is to compare the efficacy of different modalities of analgesics following appendicectomy, to identify which is best at controlling post-operative pain Methods A literature search was conducted across online libraries for trials assessing pain scores after appendicectomy with different analgesics administered. These were grouped based off modality. Using the data in these trials a forest plot was created for each modality with an effect estimate and confidence intervals calculated for each trial Results 6 studies investigated nerve-blocks; an estimated effect of -1.01 with CIs of -1.39 to -0.4 was calculated. 3 studies investigated NSAIDs; an estimated effect of -0.46 with CIs of -0.70 to -0.23 was calculated. 3 studies investigated local anaesthetics; an estimated effect of -0.83 with CIs of -1.91 to 0.26 was calculated. 1 study investigated opiates with an estimated effect of -0.82 with CIs of -1.47 to -0.17 was calculated Conclusion Nerve-blocks were the most effective modality of analgesic followed by NSAIDs. No clinically significant effect was proved for local anaesthetics as the CIs crossed the null hypothesis. Opiates were not compared due to insufficient data

The acupuncture-related therapy for stable chronic obstructive pulmonary disease: A protocol for systematic review and network meta-analysis.

Background:Chronic obstructive pulmonary disease (COPD) has become a huge economic burden. Increasing randomized clinical trials have favored the efficacy of a specified kind of acupuncture-related therapies (ATs) for treating stable COPD. Nonetheless, comparative efficacy of different ATs for stable COPD remains unknown. Thus, the purpose of this network meta-analysis protocol aims to determine the optimal modality of ATs for treating stable COPD.Methods:Six Chinese and English mainstream databases, including PubMed, Cochrane Library, Embase, China Biomedical Literature Database, Chinese National Knowledge Infrastructure, and Wanfang Database, will be systematically retrieved. The time range of the literature search is from the establishment date of each database to July, 2021. The primary outcome measures will be pulmonary function and incidence of acute exacerbations. The secondary outcome measures will consist of 6-minute walking distance, St George's Respiratory Questionnaire, and COPD assessment test. The methodological quality of included studies will be evaluated by Cochrane risk-of-bias tool and the quality of evidence will evaluated through Grading of Recommendations Assessment, Development, and Evaluation instrument. Network meta-analysis will be completed using STATA software.Results:A synthesis of current evidence of ATs for stable COPD will be provided in this study.Conclusion:This study will contribute to synthesizing the evidence regarding the comparative efficacy of different modalities of ATs for stable COPD. Therefore, it will yield decision-making reference to further assist clinicians in determining the optimal modality of ATs in the treatment of stable COPD.Study Registration:This protocol was registered in the international prospective register of systematic reviews (PROSPERO) with the registration number CRD42020166649.

Age-related changes in protective arm reaction kinematics, kinetics, and neuromuscular activation during evoked forward falls.

Fall related injuries in older adults are a major healthcare concern. During a fall, the hands and arms play an important role in minimizing trauma from ground impact. Although older adults are able to orient the hands and arms into a protective orientation after falling and prior to ground impact, an inability to avoid increased body impact occurs with age. Previous investigations have generally studied rapid arm movements in the pre-impact phase or absorbing energy in the post-impact phase. There are no known studies that have directly examined both the pre-impact and post-impact phase in sequence in a forward fall. The aim of this study was to identify age-related biomechanical and neuromuscular changes in evoked arm reactions in response to forward falls that may increase fall injury risk. Fourteen younger and 15 older adults participated. Falls were simulated while standing with torso and legs restrained via a moving pendulum system from 4 different initial lean angles. While there was not a significant age-related difference in the amount of energy absorbed post-impact (p=0.68), older adults exhibited an 11% smaller maximum vertical ground reaction force when normalized to body weight (p=0.031), and 8 degrees less elbow extension at impact (p=0.045). A significant interaction between age and initial lean angle (p=0.024), indicated that older adults required 54%, 54%, 41%, and 57% greater elbow angular displacement after impact at the low, medium, medium-high, and high initial lean angles compared to younger adults. These results suggested older adults may be at greater risk of increased body impact due to increased elbow flexion angular displacement after impact when the hands and arms are able to contact the ground first. Both groups exhibited robust modulation to the initial lean angle with no observed age-related differences in the initial onset timing or amplitude of muscle activation levels. There were no significant age-related differences in the EMG timing, amplitude or co-activation of muscle activation preceding impact or following impact indicating comparable neuromotor response patterns between older and younger adults. These results suggest that aging changes in muscular elements may be more implicated in the observed differences than changes in neuromuscular capacity. Future work is needed to test the efficacy of different modalities (e.g. instruction, strength, power, perturbation training, fall landing techniques) aimed at reducing fall injury risk.

Efficacy of Different Modalities in Treatment of Different Types of Fungal Sinusitis

Efficacy of Different Modalities in Treatment of Different Types of Fungal Sinusitis

Efficacy of Different Modalities of Treatment in Management of Different Types of Fungal Sinusits

Abstract Background Fungal sinusitis is generally classified into invasive and non invasive fungal sinusitis based on histological features, invasive fungal sinusitis divided into acute, chronic and chronic granulomatous invasive fungal sinusitis. While non invasive fungal sinusitis include saprophytic fungal infestation, fungal ball, and fungus-related eosinophilic. Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each. AIM A systemic review of effective and safe method in management of different types of fungal sinusitis either by medical or surgical approaches or even combined. Be up to date with the different upcoming new modalities. Methodology A meta-analysis study is done to evaluate the medical and surgical outcomes of patients with invasive and noninvasive Fungal Sinusits. Results Finally, forty-five studies were included in the present systematic review and metaanalysis. Fifteen included studies (No = 539 patients) assessed different modalities for management of fungal ball, via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach for FB of the maxillary sinus. The results showed that functional endoscopic sinus surgery has led to success rate of 98.1%. Twenty included studies (No = 806 patients) have assessed the efficacy and safety of different modalities for the management of allergic fungal sinusitis via,Endoscopic Sinus Surgery, Post-ESS Systemic steroids, Antifungals and immunotherapy. The results showed that ESS represents the firstline management strategy of AFRS, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten studies (No = 327 patients) for Invasive Fungal Sinusitis.the results showed that combination of systematic antifungal therapy and aggressive surgical debridement are the treatment of choice. Conclusion FESS is the treatment of choice of fungal ball via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach. AFS treatment consists of surgical extirpation of the allergic mucin and polyps with maintenance of adequate sinus drainage followed by medical therapy consists of topical steroids, anti fungal therapy, Immunotherapy, and systemic corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.

Effect of Training on Patient Self-Assessment of Joint Counts in Rheumatoid Arthritis: A Systematic Review.

ObjectivePatient self‐assessed joint counts, if accurate and reliable, could potentially serve as a useful clinical assessment tool in rheumatoid arthritis (RA). This systematic review examines the effect of patient training on the inter‐rater reliability of joint counts between patients and clinicians.MethodsThe review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A search was performed in PubMed, Embase, Cochrane Library, and CINAHL for articles that incorporated patient training and measured the reliability of patient self‐assessed joint counts in RA. Articles were included if they reported on the inter‐rater reliability between patient and clinician joint counts in both trained and untrained patients with RA. Data were extracted on characteristics of patients, structure and components of the training interventions, joint count reliability of patients with and without training, and patient feedback on training interventions. The relevant data were summarized and described.ResultsMultiple training methods have been studied (n = 5), including in‐person sessions run by rheumatologists and instructional videos on the joint examination. Overall, training improved the reliability of patient self–joint counts, with more marked improvement in reliability of swollen joint counts than tender joint counts. Patients had positive feedback when surveyed on their experiences with training.ConclusionVarious training modalities (in‐person and video‐based) may be effective at improving reliability of patient self–joint counts. More research is needed on this topic, with potential areas for future research including 1) comparison between the efficacy of different modalities of training, and 2) impact of patient factors (education level and disease severity) on the efficacy of training.

Combining mTOR Inhibitors and T Cell-Based Immunotherapies in Cancer Treatment.

Simple SummarySeveral clinical protocols are exploring the anticancer effect of immunotherapy combined to targeted therapy. Indeed, emerging evidence demonstrates that small-molecule targeted inhibitors promote the antitumor immune response. In the case of mechanistic target of rapamycin (mTOR) inhibitors, such approach appears initially counterintuitive due to their immunosuppressive properties. Nevertheless, recent studies have highlighted the complex role played by mTOR in immune cell biology and have demonstrated that mTOR inhibitors can promote or repress the immune response in a context-dependent manner. Accordingly, pre-clinical studies have shown that mTOR inhibitors have the potential to increase the antitumor efficacy of immunotherapies. Here, we therefore review the different inhibitors of mTOR and their effects on adaptive immunity related to current immunotherapies. We further discuss the therapeutic opportunities of combining mTOR inhibitors with immunotherapies in cancer treatment.mTOR regulates several processes that control tumor development, including cancer cell growth, angiogenesis and the immune response to tumor. Accordingly, mTOR inhibitors have been thoroughly explored in cancer therapy but have failed to provide long-lasting anticancer benefits. Several resistance mechanisms that counteract the antitumor effect of mTOR inhibitors have been identified and have highlighted the need to use mTOR inhibitors in combination therapies. In this context, emerging evidence has demonstrated that mTOR inhibitors, despite their immunosuppressive properties, provide anticancer benefits to immunotherapies. In fact, mTOR inhibitors also display immunostimulatory effects, in particular by promoting memory CD8+ T cell generation. Hence, mTOR inhibitors represent a therapeutic opportunity to promote antitumor CD8 responses and to boost the efficacy of different modalities of cancer immunotherapy. In this context, strategies to reduce the immunosuppressive activity of mTOR inhibitors and therefore to shift the immune response toward antitumor immunity will be useful. In this review, we present the different classes of mTOR inhibitors and discuss their effect on immune cells by focusing mainly on CD8+ T cells. We further provide an overview of the different preclinical studies that investigated the anticancer effects of mTOR inhibitors combined to immunotherapies.

Nonalcoholic fatty liver disease: New epidemic

The global obesity epidemic has dramatically increased the prevalence of nonalcoholic fatty liver disease (NAFLD), such that it is the most common cause of chronic liver disease in Western nations. NAFLD is an important cause of liver disease in India also. The prevalence of NAFLD in India is around 9%-32% of general population with higher prevalence in those with overweight or obesity and those with diabetes or prediabetes. NAFLD is an important cause of unexplained rise in hepatic transaminases, cirrhosis, and hepatocellular carcinoma. The spectrum of abnormalities which the term NAFLD encompasses is isolated fatty liver, nonalcoholic steatohepatitis (NASH), and cirrhosis. The pathogenesis of NAFLD/NASH is complex and includes the development of insulin resistance, accumulation of excess lipids in the liver, mitochondrial dysfunction, and cell damage, and development of necroinflammation. Diagnosis is usually incidental during the evaluation for unrelated abdominal symptoms, elevated transaminases without any other explanation. Imaging modalities such as ultrasound are useful to diagnose the presence of excessive fat deposition in the liver but are not useful in differentiating simple steatosis from NASH. Liver biopsy may be useful in making this distinction, especially in those with risk factors for significant liver disease. Treatment modalities include weight reduction and exercise, metformin, Vitamin E, pentoxifylline, and saroglitazar and are effective in normalizing transaminases or in improving hepatic steatosis and inflammation in Indian patients with NAFLD. Randomized controlled treatment trials involving large number of patients with histological end point are required to assess the efficacy of different modalities.

Combined chemo-magnetic\xa0field-photothermal breast cancer therapy based on porous magnetite nanospheres

The efficacy of different modalities of treating breast cancer is inhibited by several limitations such as off-targeted drug distribution, rapid drug clearance, and drug resistance. To overcome these limitations, we developed Lf-Doxo-PMNSs for combined chemo-MF-PTT. The PMNSs were synthesized by hydrothermal method and their physicochemical properties were examined by FE-SEM, TEM, DLS, TGA, XRD investigations. The cytotoxicity of as-synthesized NPs against 4T1 cells was carried out by MTT and flow cytometry assays. Afterwards, the anti-cancer activities of as-synthesized Lf-Doxo-PMNSs on the tumor status, drug distribution and apoptosis mechanism were evaluated. The anti-cancer assays showed that Lf-Doxo-PMNSs significantly suppressed the cancer cell proliferation and tumor weight by prolonging drug availability and potential drug loading in tumor cells; whereas they showed a minimum cytotoxicity against non-cancerous cells. Likewise, combined chemo-MF-PTT using Lf-Doxo-PMNSs displayed the highest anti-cancer activity followed by combined chemo-PTT and combined chemo-MF therapy based on altering the apoptosis mechanism. Therefore, these results showed that combined chemo-MF-PTT based on Lf-Doxo-PMNSs can be used as a promising therapeutic platform with potential targeted drug delivery and high loading capacity features as well as reducing cancer drug resistance.

Renal replacement therapy for patients suffering from multiple Asian giant hornet stings: A retrospective study.

From June 2013 to June 2018, patients suffering from Asian giant hornet stings were treated with renal replacement therapy (RRT) in our hospital. We analysed the efficacy of different modalities of RRT in these patients. A comprehensive clinical history was recorded and a complete physical examination was done for each patient. Three different treatment plans were used in these patients according to the acute physiology and chronic health evaluation (APACHE) II score. These were: (i) haemoperfusion (HP) and intermittent haemodialysis (IHD); (ii) HP and continuous veno-venous haemofiltration (CVVH); and (iii) HP, CVVH and plasma exchange (PE). The average time of RRT was shorter in HP and CVVH or HP, CVVH and PE groups than in the HP and IHD group, and the patients who received HP and CVVH or HP, CVVH and PE had lower levels of blood urea nitrogen and serum creatinine after RRT for 7 days. Our study suggests that HP and CVVH or HP, CVVH and PE are effective treatments for patients suffering from Asian giant hornet stings, who require RRT.

AN UNCOMMON PRESENTATION OF THROMBUS-IN-TRANSIT AND MASSIVE ACUTE PULMONARY EMBOLISM

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Thrombus-in-transit is a rare presentation of venous thromboembolism, characterized by the presence of a floating clot traveling from the right heart into the pulmonary arterial vasculature. We present a case associated with massive pulmonary embolism (PE) in a patient with a contraindication to thrombolysis successfully treated with surgical thrombectomy. CASE PRESENTATION: A 50-year-old female with the diagnosis of Crohn’s disease presented with a one-week history of shortness of breath. On admission the patient was tachycardic, hypotensive and hypoxemic. The patient received intravenous fluids (IVF) and supplemental oxygen resulting in a transient stabilization of vital signs. Electrocardiogram showed ST depressions and T wave inversions in anteroseptal leads, Troponin- I was negative and D-dimer was elevated at 0.275 ug/mL. A chest computed tomography angiography revealed bilateral main pulmonary artery large filling defects, extending into segmental and sub-segmental arteries. Anticoagulation was started and the patient was admitted to the Medical Intensive Care Unit for close hemodynamic monitoring. A later transthoracic echocardiography showed a large hyperechoic, highly mobile mass in the right atrium, consistent with a thrombus-in-transit. The patient remained symptomatic and persistently hypotensive despite IVF. Thrombolysis was considered, but patient developed episodes of lower gastrointestinal bleeding due to Crohn’s disease flare. Cardiothoracic Surgery Service was consulted and patient underwent surgical bilateral pulmonary artery thrombectomy and removal of the right atrial thrombus. The patient was subsequently restarted on anticoagulation and discharged on day 19th post-surgery with excellent recovery. DISCUSSION: PE with thrombus-in-transit is a medical emergency that entails a high morbidity and mortality. Mortality rates can be as high as 50% in contrast to less than 10% in PE without a clot in transit. Early detection and intervention may decrease the risk of a catastrophic pulmonary embolism that can result in a poor outcome. Current therapeutic options include anticoagulation alone, medical thrombolysis and surgical thrombectomy. Although no randomized controlled trials have directly compared these treatment options, a systematic review article published in 2010 described a trend toward improved survival in surgical thrombectomy compared to thrombolysis and anticoagulation alone. On the other hand, a large study published in 2015, showed lower mortality rates with medical thrombolysis compared to surgical thrombectomy or anticoagulation alone (13.7%, 18.3% vs. 37.1%). CONCLUSIONS: PE with thrombus-in-transit is a life-threating condition that requires urgent intervention. Although no guideline recommendations have been established, surgical thrombectomy has shown high success rates and should be consider especially if contraindications to thrombolysis are present. Reference #1: Athappan G, Sengodan P, Chacko P, Gandhi S. Comparative efficacy of different modalities for treatment of heart thrombi in transit: a pooled analysis. Vasc Med. 2015;20(2):131-8. Reference #2: Myers PO, Bounameaux H, Panos A, Lerch R, Kalangos A. Impending paradoxical embolism: systemic review of prognostic factors and treatment. Chest.2010;137(1):164-70. Reference #3: Torbicki A, Galié N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll.2003; 18:41(12):2245-51. DISCLOSURES: No relevant relationships by Renaud Gueret, source=Web Response No relevant relationships by VICTOR PRADO, source=Web Response No relevant relationships by MARTIN WATANABE, source=Web Response No relevant relationships by Luis Watanabe-Tejada, source=Web Response

Radiological Intervention and Imaging Procedures in Management of Patients with Malignant Obstructive Jaundice

AbstractBackground: Malignant biliary obstruction has a bad prognosis and adverse effect on the quality of life, with most of those patients are inoperable at time of diagnosis. Patients who underwent whipple operation may develop anastomotic site (choledocho-jujenostomy) stenosis with subsequent ele-vated bilirubin level and related complications.Aim of Study: This prospective study will be conducted to evaluate the efficacy of different modalities of interventional radiological and imaging procedures as Percutaneous Trans hepatic Cholangiography (PTC), Percutaneous Trans hepatic Drainage (PTD) and biliary stenting in management of patients with malignant obstructive jaundice.Patients and Methods: This study was conducted on 30 patients (19 males and 11 females) with mean age of 56 years, 28 of 30 patients (93.3%) are non operable and the other 2 of 30 patients (6.7%) operated patients for choledocho-jujenostomy stenosis were subjected to intervention techniques. 10 of 30 patients (33.3%) underwent percutaneous external biliary drainage, 15 of 30 patients (50%) underwent percuta-neous stent insertion (8 of 30 patients (26.7%) with metallic stents & 7 of 30 patients (23.3%) with plastic stents), 3 of 30 patients (10%) underwent internal external drainage and 2 of 30 patients (6.66%) underwent biliary drainage through combined (randez-voux) technique.Results: High success rate (86.6%) with reduction of total bilirubin level was observed in metallic stenting group of patients.Conclusion: Biliary intervention procedures help to reduce high bilirubin level, bypass obstruction level and help in dilatation of post-operative stenosis site.

Acute post-operative edema. A major morbidity after hair transplant.

Objectives: To evaluate the efficacy of different modalities for the prevention of post-operative edema in patients undergoing hair transplant. Study Design: Prospective study. Place and Duration of Study: Department of Plastic Surgery, Bashir Hospital (private), Sialkot from March 2016 to April 2018. Patients and Methods: Male patients with typical male baldness patterns were serially included in the study. Informed consent was taken both for the surgery and purpose of research. Patients were followed up daily for one week to assess the post-operative edema. However patients were also called for follow up after three months to see the late complications. Patients not giving consent for the study were excluded from the data. Data was entered and analysis done by SPSS v 22. Results: Total 97 patients were operated. Two groups A&amp;B each of 45 and 57 patients were selected randomly. Group A which was administered tumescent solution including steroid showed maximum prevention of edema, success rate (93.3%). Group B having oral steroid course postoperatively for 5 days showed less promising results with success rate of (57.8%). Conclusion: The results of this study revealed that addition of steroid (Triamcinolone) to the tumescent solution had more promising results regarding the prevention of post-operative edema.