Favorable Long-term Outcome Research Articles

Long-term recurrence-free survival following second-generation cryoballoon ablation for persistent atrial fibrillation: role of the autonomic nervous system

Abstract Background The cardiac autonomic nervous system (ANS) plays a pivotal role in the regulation of atrial fibrillation (AF). Cryoballon (CB)-guided pulmonary vein isolation (PVI) is an established treatment for AF. Purpose In our present study we evaluated the impact of vagal reactions (VRs), as a surrogate parameter for ANS modulation, on the long-term outcome of CB-ablation in patients with persistent AF (PERS AF). Methods Data from consecutive PERS AF patients undergoing primary CB-guided PVI for symptomatic drug refractory AF between 2013-2023 were analysed. VRs were defined as bradycardia < 40 beats/min, asystole or higher-degree atrioventricular block. Long-term follow-up data were assessed. AF-recurrence was defined as AF lasting > 30 seconds beyond a 3-month blanking period. Results A total of 250 consecutive patients (mean age 63.9±10.0 years, 30% female) were included. VRs were recorded in 61 patients (24%, mean age 64.2±13.0 years, 30% female). The mean follow-up duration amounted to 84±14 months. Within this observation period 101 patients (40%) developed AF-recurrence. Re-ablation procedures were performed in 61 patients (60%). Patients with PVI-associated VRs presented with a significantly higher estimated AF-free survival rate (log-rank p-value < 0.001) (Figure 1) and a significantly longer median AF-free survival time (75 months, interquartile range (IR) 63-92 months) compared to those without (69 months, IR 13-79 months) (p=0.002). Beyond that Kaplan-Meier plot analyses revealed significant gender differences (Figure 1). Multivariate cox regression analyses confirmed VRs (Confidence interval (CI) 0.294-0.838, Hazard Ratio (HR) 0.497, p=0.009) and male gender (CI 0.352-0.781, HR, 524, p=0.001) as independent predictors (IPs) for AF-free-survival. Conclusion CB-ablation procedure associated VRs and male gender seem to be associated with a favorable long-term outcome in PERS AF. Further studies are warranted to verify our observations.Kaplan Meier plot on long-term AF-free s

Clinical and electrophysiological characteristics and long term outcomes of catheter ablation for right and left atrial tachycardias

Abstract Background Atrial tachycardias (AT) are complex supraventricular tachycardias which are refractory to antiarrhythmic drugs that require catheter ablation. Purpose In this trial, we aimed to evaulate the outcomes of catheter ablation in patients with symptomatic atrial tachycardia, define the acute procedural success and the recurrence rates in long-term follow-up and determine the clinical and electrophysiological features that affect these outcomes. Methods A total of 666 [mean age: 55 ±16, gender: 344 (51.7%) female] symptomatic patients with AT were enrolled. Prior catheter or surgical ablation history for ATa was present in 199 (29.9%) and 18 (2.7%) of these patients, respectively. Activation mapping was performed during tachycardia in all patients as well as entrainment mapping when needed. Voltage mapping were performed in sinus rhythm in both atriums, late potential mapping was also performed in some patients. Low voltage areas and signals with continuous-fragmented morphology were tagged. Results Macroreentry was the primary mechanism in right and left atrium (70.2% and 52.8%, respectively). Cavotricuspid isthmus (CTI) dependent macroreentry was the most frequent mechanism in right ATs and perimitral reentry and roof-dependent macroreentry were the most common mechanisms in left ATs. A total of 59 (7.5%) complications were observed in 780 procedures.(2.1% major and 5.5% minor) Acute procedural success was 95.9%. Freedom from ATa was 72.8 % during a mean follow-up of 39±23 months. Freedom from ATa after index procedure was 82.3% at 12 months and 75.9 % at 24 months. After multiple procedures, freedom from ATa was 90% at 12 months and 86% at 24 months during the follow-up. In multivariate Cox regression analysis, atrial fibrillation (AF) [(HR) 2.43, 95% c(CI) 1.78-3.30; p<0.001] , history of cardiac surgery [(HR) 1.68, 95% c(CI) 1.22-2.30; p=0.001] and moderate to severe tricuspid regurgitation [(HR) 1.47, 95% c(CI) 1.08-2.01; p=0.014] were significant predictors of ATa recurrence. Conclusion Our findings demonstrated that tailored catheter ablation of ATs especially guided by high density mapping has a high acute success rate and favourable long-term outcomes in patients with symptomatic AT episodes.

Management of systemic lupus erythematosus: a systematic literature review informing the 2023 update of the EULAR recommendations

ObjectivesTo analyse the new evidence (2018–2022) for the management of systemic lupus erythematosus (SLE) to inform the 2023 update of the European League Against Rheumatism (EULAR) recommendations.MethodsSystematic literature reviews were...

Arthroscopic debridement, synovectomy, and thermal shrinkage for basal joint arthritis.

Ligamentous laxity, cartilage wear, and diffuse synovitis are frequently seen in thumb basal joint arthritis. Although these degenerative changes may be mild for the majority, they have the potential to cause discomfort during movement and compromised hand function. This study assesses the long-term outcomes of arthroscopic debridement, synovectomy, and thermal shrinkage in managing early-stage basal joint arthritis. We retrospectively reviewed patients with basal joint arthritis who underwent arthroscopic debridement, synovectomy, and thermal shrinkage between November 2010 and January 2021 by a single surgeon at our medical institute. We assessed functional outcomes, thumb range of motion, perioperative nonsteroidal anti-inflammatory drug (NSAID) use, return to work and satisfaction level. A total of 12 patients (13 hands), with a mean follow-up of 72 months, were included in this study. Significant improvements were observed in pain scores and functional outcomes, along with a reduction in postoperative NSAID use. Patients also reported a relatively quick return to work and a high satisfaction level. The study highlights the benefits of arthroscopic intervention, providing a minimally invasive approach with favorable long-term outcomes for patients with symptomatic basal joint arthritis.

Long-term Outcomes of Ampullary Adenoma According to Resected Margin Status after Endoscopic Papillectomy.

: Endoscopic papillectomy (EP) is increasingly used as an alternative to surgery for managing benign ampullary neoplasms. However, post-EP resection margins are often positive or indeterminate, and there is no consensus on the management of ampullary adenomas with positive or indeterminate margins after EP. This study was designed to compare the long-term outcomes between resected margin-negative (RMN) and resected margin-positive/indeterminate (RMPI) groups and to identify factors associated with clinical outcomes. : This retrospective analysis included patients with ampullary adenoma without evidence of adenocarcinoma who underwent EP between 2004 and 2016. The RMN and RMPI groups were compared for recurrence rates and recurrence-free duration during a mean follow-up duration of 71.7±39.8 months. Factors related to clinical outcomes were identified using multivariate analysis. : Of the 129 patients who underwent EP, 82 were in the RMN group and 47 were in the RMPI group. The RMPI group exhibited a higher recurrence rate compared to the RMN group (14.6% vs 34.0%, p=0.019). However, the recurrence-free duration was not significantly different between the groups (34.7±32.6 months vs 36.2±27.4 months, p=0.900). Endoscopic treatment successfully managed recurrence in both groups (75% vs 75%). Submucosal injection was a significant risk factor for residual lesions (hazard ratio, 4.11; p=0.009) and recurrence (hazard ratio, 2.57; p=0.021). : Although ampullary adenomas with positive or indeterminate margins after EP showed a higher rate of recurrence at long-term follow-up, endoscopic treatment was effective with favorable long-term outcomes. Submucosal injection prior to resection was associated with increased risk of recurrence and residual lesions.

Twenty-year experience following aortic valve replacement in patients younger than 60 years of age

ObjectiveReports on long-term outcomes of surgical aortic valve replacement (AVR) for patients aged < 60 years are scarce in Japan. Hence, we aimed to evaluate these outcomes in patients aged < 60 years.MethodsBetween March 2000 and December 2020, 1477 patients underwent aortic valve replacement. In total, 170 patients aged < 60 years who underwent aortic valve replacement were recruited. Patients aged < 18 years were excluded. Patient data collected from the operative records and follow-up assessments were reviewed.ResultsThe mean age was 49 ± 9 years, and 64.1% of patients were male. One-hundred-and-fifty-two patients (89.4%) underwent aortic valve replacement with a mechanical valve and 18 (10.6%) with a bioprosthetic valve. The mean follow-up period was 8.1 ± 5.5 years. No operative mortality occurred, and in-hospital mortality occurred in one patient (0.6%). Ten late deaths occurred, with seven cardiac-related deaths. The overall survival rate was 95.4 ± 1.7%, 93.9 ± 2.3%, 90.6 ± 3.9%, and 73.2 ± 11.8% at 5, 10, 15, and 20 years, respectively. Freedom from major bleeding was 96.4 ± 1.6% at 5, 10, and 15 years, and 89.0 ± 7.3% at 20 years. Freedom from thromboembolic events was 98.7 ± 1.3%, 97.3 ± 1.9%, 90.5 ± 4.5%, and 79.0 ± 11.3% at 5, 10, 15, and 20 years, respectively. Freedom from valve-related reoperation was 99.4 ± 0.6% at 5 years, 97.8 ± 1.7% at 10 and 15 years, and 63.9 ± 14.5% at 20 years.ConclusionsPatients aged < 60 years undergoing aortic valve replacement with a high mechanical valve implantation rate had favorable long-term outcomes.

Final 5-year report of BIONYX comparing the thin-composite wire-strut zotarolimus-eluting stent versus ultrathin-strut sirolimus-eluting stent.

The BIONYX randomized trial is the first study to evaluate the Resolute Onyx durable polymer-coated zotarolimus-eluting stent (ZES) in all-comers. Furthermore, it is the first trial to assess safety and efficacy of this stent versus the Orsiro biodegradable-polymer sirolimus-eluting stent (SES) in all-comers, paying particular attention to patients with diabetes. It has previously shown promising results until 3 years of follow-up. We aimed to assess long-term clinical outcome after percutaneous coronary intervention (PCI) with Onyx ZES versus Orsiro SES at 5-year follow-up. The main composite endpoint was target vessel failure (TVF): cardiac death, target vessel myocardial infarction,or target vessel revascularization. Time to primary and secondary endpoints was assessed using Kaplan-Meier methods, applying the log-rank test for between-group comparison. Follow-up was available in 2414/2488 (97.0%) patients. After 5 years, TVF showed no significant difference between Onyx ZES and Orsiro SES (12.7% vs. 13.7%, hazard ratio [HR]0.94, 95%confidence interval [CI][0.75-1.17], plog-rank = 0.55). Landmark analysis between 3- and 5-year follow-up found a lower target lesion revascularization rate for Onyx ZES (1.1% vs. 2.4%, HR 0.47, 95%CI[0.24-0.93], plog-rank = 0.026). A prespecified subgroup analysis showed no significant between-stent difference in clinical outcome among patients with diabetes. After treatment with Onyx ZES, patients aged ≥75 years had significantly lower rates of TVF (13.8% vs. 21.9%, HR 0.60, 95%CI[0.39-0.93], plog-rank = 0.023). The final 5-year analysis of the randomized BIONYX trial showed favorable and similar long-term outcomes of safety and efficacy for Onyx ZES and Orsiro SES in both all-comers and patients with diabetes.

Abstract PO1-01-11: Development and Validation of a Breast Cancer Recurrence Model Demonstrates Accurate Identification of Patients with Favorable Long-Term Outcomes

Abstract Background: The Oncotype DX (ODX) test is a 21-gene expression assay widely used for the prediction of risk recurrence in early-stage breast cancer, but it may be possible to identify patients who can forgo testing using only clinicopathologic variables. In 2018, the National Cancer Database (NCDB) began reporting quantitative histologic parameters for estrogen receptor (ER), progesterone receptor (PR), and Ki-67 expression in breast cancer patients. Inclusion of these variables may improve the development of nationally applicable models to predict ODX results using clinicopathologic variables alone. Methods: Using a cohort of patients from the NCDB diagnosed from 2018–2020 with hormone receptor (HR)-positive, HER2-negative, Stage I-III breast cancer, we trained machine learning models to predict high-risk (26-100) ODX score. A subset comprising 80% of patients was used for model training, while the remaining data were set aside for internal validation. An external validation cohort was selected from the University of Chicago Medical Center (UCMC), including patients diagnosed from 2009–2021. Feature selection, model architecture selection, and hyperparameter tuning were performed using 10-fold cross-validation within the NCDB training set. We compared a model with quantitative ER, PR, and Ki-67; a model with only quantitative ER and PR, and a model without quantitative immunohistochemistry – to best reflect the likely data available in a variety of practice patterns. The primary endpoint was the area under the receiver operating characteristic curve (AUROC) for prediction of high-risk ODX results in the UCMC validation cohort. Models were also evaluated as rule-out tests to identify low-risk patients who did not require further ODX testing, using a high (90%) sensitivity threshold, fit in the NCDB training dataset. Results: We identified 53,346 patients from the NCDB cohort meeting the inclusion criteria; 7% had a high risk ODX score, with a median follow-up time of 28 months. The UCMC validation cohort included 896 patients, and was more diverse, with 30% non-Hispanic Black patients (versus 8% in NCDB), more high-risk patients (18% with high ODX), and a longer median follow-up time of 55 months. In the NCDB validation cohort, models incorporating quantitative ER/PR (AUROC 0.78, 95% CI 0.77–0.80) and quantitative ER/PR/Ki-67 (AUROC 0.81, 95% CI 0.80–0.83) both performed better than the non-quantitative model (AUROC 0.70, 95% CI 0.68–0.72). These results were preserved in the external UCMC cohort, where the ER/PR model (AUROC 0.86, 95% CI 0.80–0.92, p = 0.032) and the ER/PR/Ki-67 model (AUROC 0.87, 95% CI 0.81–0.93) outperformed the non-quantitative model (AUROC 0.80, 95% CI 0.73–0.87, p = 0.009). The high sensitivity rule-out threshold of the ER/PR model predicted that 30% of patients in the UCMC cohort would be low ODX, and the ER/PR/Ki-67 model predicted 44% as low risk – negative predictive value was over 96% for prediction of high ODX. Of the patients predicted to be low risk by the quantitative models, none had a documented high ODX score, and recurrence was &amp;lt; 3% at 5 years. The hazard ratio for recurrence free interval, adjusted for age and comorbidity score, of patients predicted to be high risk by this threshold was 2.96 (95% CI 1.02–8.58) for the ER/PR model and 3.84 (95% CI 1.48–9.97) for the ER/PR/Ki-67 model. Conclusions: We present externally validated and nationally applicable models that identify approximately half of HR-positive/HER2-negative breast cancer patients who are unlikely to have high ODX results using widely available quantitative clinicopathologic variables. Patients identified as low risk by these models have excellent long-term outcomes and may be able to forgo adjuvant chemotherapy without further genomic testing. Citation Format: Asim Dhungana, Augustin Vannier, Fangyuan Zhao, Jincong Freeman, Poornima Saha, Megan Sullivan, Katharine Yao, Elbio Flores, Olufunmilayo Olopade, Dezheng Huo, Alexander Pearson, Frederick Howard. Development and Validation of a Breast Cancer Recurrence Model Demonstrates Accurate Identification of Patients with Favorable Long-Term Outcomes [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-01-11.

Abstract PO3-17-05: Clinical Characteristics and Outcomes of Patients Receiving Adjuvant Paclitaxel and Trastuzumab (APT regimen) for HER2-Positive Early-Stage Breast Cancer in Brazil: A Real-World Evidence

Abstract Introduction: The APT trial established adjuvant paclitaxel and trastuzumab (TH) as the standard of care for HER2-positive early-stage breast cancer with tumor size ≤ 3 cm and no more than one lymph-node micrometastasis. This single-arm phase II trial demonstrated favorable long-term outcomes, with a 3-year invasive disease-free survival (IDFS) rate of 98.7% (95% CI 97.6 – 99.8%). In an updated follow-up analysis, the 10-year IDFS and overall survival (OS) rates were 91.3% (95% CI 88.3 – 94.4%) and 94.3% (95% CI 91.8 – 98.3%), respectively. Nevertheless, outcomes observed in real-world scenarios have frequently been less favorable than those observed in clinical trials. We aimed to characterize the population receiving the APT regimen in clinical practice and evaluate if real-world outcomes align with those observed in the pivotal clinical trial. Methods: This retrospective cohort study included patients with HER2-positive early-stage breast cancer treated between 2015 and 2023 at four Brazilian cancer institutions, including public and private hospitals. Clinical and demographic data, treatment details, and outcomes were collected from electronic records. The primary endpoints were the 3-year and 7-year invasive disease-free survival (IDFS) rates. Secondary endpoints included overall survival (OS) and factors associated with IDFS. Survival analysis employed the Kaplan-Meier method, and Cox regression assessed prognostic factors. Results: A total of 133 patients treated with the APT regimen were evaluated, with a median age of 56 years (range 20–83). The majority had no special type breast carcinoma (92.4%), grade 2 (63.4%) or grade 3 (34.3%) tumors, no angiolymphatic invasion (76.3%), positive estrogen receptor (69.9%), positive progesterone receptor (55.6%), and node-negative disease (94.7%). Tumor staging distribution was as follows: T1a (12%), T1b (23.3%), T1c (49.6%), and T2 (13.5%). Most patients (95.4%) received the APT regimen as per guideline recommendations, while 3.8% received it due to contraindication to other therapies. With a median follow-up of 45.8 months, 8 patients (5.8%) experienced an invasive disease event or death from any cause: 5 (3.8%) had distant recurrence, 1 (0.8%) had local recurrence, and 2 (1.5%) died without recurrence. Notably, these events occurred in patients receiving the APT regimen according to standard indications, except for one patient with N+ disease and a contraindication to another regimen. The recurrence rate according to the T stage is presented in the Table. The 3-year IDFS rate was 100% (95% CI not applicable). All events occurred after the 3-year time point, resulting in a 7-year DFS rate of 80.8% (95% CI 62.7–90.7%). No prognostic factors related to IDFS were identified. Four patients died during the study period, yielding a 7-year OS rate of 88.0% (95% CI 61.6–96.6%). Conclusion: While the baseline characteristics of this cohort resembled those of the APT trial, the long-term outcomes observed in the real-world setting were less favorable. Further investigation is required to determine the reasons for this discrepancy, underscoring the necessity for larger real-world data studies to validate these findings. Recurrence rate according to T stage XX XX Citation Format: Giselle Carvalho, Renata Colombo Bonadio, Pedro Bergmann, Marina Nishimuni, André Rossi, Cristiano Souza, Gabriel Guimarães, Laura Testa, José Bines. Clinical Characteristics and Outcomes of Patients Receiving Adjuvant Paclitaxel and Trastuzumab (APT regimen) for HER2-Positive Early-Stage Breast Cancer in Brazil: A Real-World Evidence [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-17-05.

Corneal ocular surface squamous neoplasia: Case series and review of literature.

The authors present a retrospective analysis of three cases of isolated corneal ocular surface squamous neoplasia (C-OSSN) without limbal or conjunctival involvement and review the clinical and anterior segment optical coherence tomography (AS-OCT) features, along with treatment outcomes. The mean age at presentation was 51 years (range: 32-64 years). The mean tumor diameter was 5 mm (range: 3-6.5 mm). All lesions were placoid with <1 mm thickness. One case had surface keratin. AS-OCT revealed hyperreflective epithelium with abrupt transition in all cases, with mean thickness of 118 μm (range: 60-162 μm). One patient underwent alcohol-assisted keratoepitheliectomy (AKE) and two patients received topical Interferon alpha-2B followed by AKE. Histopathology revealed mild squamous dysplasia in all. No tumor residue or recurrence was noted at a mean follow-up period of 2 years (range: 1-4 years). Isolated C-OSSN is rare. AS-OCT serves as a useful noninvasive tool for supporting the diagnosis of AKE yielding long-term favorable outcomes.

Low-Profile Visualized Intraluminal Support Device for Y-Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms: A Single-Center Experience

BackgroundThe Low-Profile Visualized Intraluminal Support (LVIS) device has been frequently used as intracranial stent for treating intracranial aneurysms. However, the feasibility and efficacy of LVIS devices in Y-stent-assisted coiling (Y-SAC) have remained contentious. This study aimed to evaluate long-term angiographic and clinical outcomes of Y-SAC using LVIS devices. MethodsWe retrospectively reviewed the clinical presentation and angiography data of patients treated with Y-SAC using LVIS stents. The vascular angle geometry between the parent and the two branch vessels, before and after stent deployment and after coiling were analyzed. Based on Raymond-Roy Occlusion Classification (RROC), aneurysm occlusion status was classified. Clinical outcomes were assessed using the modified Rankin Scale (MRS). ResultsForty patients with 40 aneurysms were included in this study. Immediate postprocedural angiograms revealed complete/near-complete occlusion (RROC 1 and 2) in 31 aneurysms (77.5%). The long-term follow-up angiographic studies were available in 32 patients revealing RROC class 1 and 2 in 93.8% of patients. Y-SAC with LVIS devices significantly decreased the angle between the bifurcation branches from 171.90 ° ± 48.0° (SD) to 130.21° ± 46.3° (SD) (p<0.0001). Periprocedural complications occurred in five patients (12.5%) including four in-stent thrombosis (10.5%). Thirty-six patients (90.0%) had favorable clinical outcomes at the final follow-up. Univariate analysis depicted that WFNS of 3-5, thick of subarachnoid hemorrhage on head CT scan, intraprocedural complications, and in-stent thrombosis were predictors of poor outcome. ConclusionY-SAC using LVIS device for intracranial bifurcation aneurysms is a feasible and relatively safe procedure with favorable long-term angiographic and clinical outcomes.

Hydrophilic Coating Microstructure Mediates Acute Drug Transfer in Drug-Coated Balloon Therapy.

Drug-coated balloon (DCB) therapy is a promising endovascular treatment for obstructive arterial disease. The goal of DCB therapy is restoration of lumen patency in a stenotic vessel, whereby balloon deployment both mechanically compresses the offending lesion and locally delivers an antiproliferative drug, most commonly paclitaxel (PTX) or derivative compounds, to the arterial wall. Favorable long-term outcomes of DCB therapy thus require predictable and adequate PTX delivery, a process facilitated by coating excipients that promotes rapid drug transfer during the inflation period. While a variety of excipients have been considered in DCB design, there is a lack of understanding about the coating-specific biophysical determinants of essential device function, namely, acute drug transfer. We consider two hydrophilic excipients for PTX delivery, urea (UR) and poly(ethylene glycol) (PEG), and examine how compositional and preparational variables in the balloon surface spray-coating process impact resultant coating microstructure and in turn acute PTX transfer to the arterial wall. Specifically, we use scanning electron image analyses to quantify how coating microstructure is altered by excipient solid content and balloon-to-nozzle spray distance during the coating procedure and correlate obtained microstructural descriptors of coating aggregation to the efficiency of acute PTX transfer in a one-dimensional ex vivo model of DCB deployment. Experimental results suggest that despite the qualitatively different coating surface microstructures and apparent PTX transfer mechanisms exhibited with these excipients, the drug delivery efficiency is generally enhanced by coating aggregation on the balloon surface. We illustrate this microstructure-function relation with a finite element-based computational model of DCB deployment, which along with our experimental findings suggests a general design principle to increase drug delivery efficiency across a broad range of DCB designs.

Endovascular Coiling of Ruptured Tiny Saccular Intracranial Aneurysms: A Systematic Review and Meta-Analysis

BackgroundThe safety and efficacy of endovascular coiling of ruptured tiny saccular intracranial aneurysms (IAs) (≤ 3mm) remains unknown. MethodsA comprehensive search of PubMed, Embase, Web of Science, and Scorpus databases up to November 15, 2023 was performed. Pooled prevalence was calculated for occlusion rates, recanalization, retreatment, long-term favorable outcome, and procedure-related complications and mortality. Pooled odds ratios were calculated to compare these outcomes between coiling and stent-assisted coiling (SAC). Results42 studies with 2,174 ruptured tiny saccular IAs treated with coiling were included. The follow-up complete aneurysm occlusion rate was 83.9% (95% CI: 77.2–88.9%). The rates of recanalization and retreatment were 7.7% (95% CI: 5.7–10.2%) and 5.8% (95% CI: 4.5–7.5%). The range of median Hunt and Hess grades was 1.4–2.9 and the favorable outcome rate was 85.6% (95% CI: 81.1–89.2%). The rates of thromboembolism, intraprocedural rupture, and mortality were 4.6% (95% CI: 3.6–5.8%), 5.4% (95% CI: 4.1–7.0%), and 5.6% (95% CI: 4.4–7.2%), respectively. Comparison of coiling and SAC revealed no significant difference, except for a higher likelihood of follow-up complete aneurysm occlusion in SAC (odds ratio [OR] 0.37, 95% CI: 0.17–0.80) and recanalization in the coiling (OR, 3.21 [95% CI, 1.37–7.51]). ConclusionsOur meta-analysis demonstrates that coiling for ruptured tiny saccular IA is a feasible, effective, and safe approach that is associated with favorable clinical outcomes in both the short and long term for patients with mild to moderate Hunt and Hess grades.

Longitudinal study of patients with anti-SAE antibody positive dermatomyositis: a multicenter cohort study in China.

To describe the longitudinal study and long-term prognosis of multicentre large inception cohort of patients with anti-SAE positive DM. We retrospectively recruited patients with anti-SAE+DM in four tertiary referral centers from China between March 2005 and December 2022. Long-term survival analysis was performed in the enrolled patients. The Myositis Damage Index (MDI) and Cutaneous Disease Area and Severity Index (CDASI) were used to evaluate the degree of different organ damage and the extent of skin rashes. Longitudinal computed tomographic (CT) patterns were analyzed. Phenotypes were characterized using unsupervised cluster analysis. All-cause death occurred in 10.5% (4/38) of all patients, in which three patients succumbed to malignancies at 13, 18, and 36 months. Most patients had favorable long-term outcomes, 35.3% of them were in drug-free remission. Skin rashes showed significant improvement evaluated by CDASI with time. However, damage to different systems was observed in 70.6% of the surviving patients using the MDI, which mainly consisted in skin damage, accounting for 47.1%. Nine patients with anti-SAE+DM associated interstitial lung disease (ILD) underwent repeat CT showed marked radiological improvement at 6 months or being stable after 12 months. In further, different characteristics and outcomes were also showed in three clusters identified by unsupervised analysis. Anti-SAE+DM is characterized with lower mortality rate and the development of malignancies being the primary cause of death. Patients who survived showed notable cutaneous damage, while the ILD tends to stabilize. Clusters identified with unsupervised analysis could assist physicians in identifying higher risk of mortality.

Abstract CT163: FIT-001: A phase 1 clinical trial of the farnesyl transferase inhibitor KO-2806 alone or as part of combination therapy for advanced solid tumors

Abstract Background: Farnesyl transferase inhibitors (FTIs) block post-translational modification of RAS and other farnesylated proteins. HRAS-driven tumors are highly sensitive to FTI treatment. Recent clinical trials (NCT03719690, NCT02383927) of the FTI, tipifarnib, in patients with HRAS-mutant (HRAS-m) head and neck squamous cell carcinoma harboring high variant allele frequency mutations (VAF ≥20%), showed objective response rates of up to 50% and favorable long-term outcomes. KO-2806 is a next-generation FTI that has increased potency and improved pharmacokinetic properties. In preclinical studies, KO-2806 has been shown to: (1) enhance tumor growth inhibition of tyrosine kinase inhibitors, including cabozantinib, in multiple clear cell renal cell carcinoma (ccRCC) cell line- and patient-derived xenograft models; and (2) enhance activity of KRAS inhibitors, including adagrasib, in KRAS mutant non-small cell lung cancer (NSCLC), colorectal cancer (CRC), and pancreatic ductal adenocarcinoma (PDAC) mouse models. These preclinical data support clinical investigation of KO-2806 alone and in combination therapy. Study Design: FIT-001 is a first-in-human, multicenter, open-label clinical trial that will evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics (Pd), and preliminary antitumor activity of KO-2806 as monotherapy or in combination therapy in advanced solid tumors (KO-2806-001; NCT06026410). Up to 270 patients will be enrolled in phase 1a and phase 1b combined across 50 sites. Phase 1a will have separate monotherapy and combination dose-escalation arms. As monotherapy, the study will enroll patients with N/K/HRAS alterations in specific solid tumor types, such as NSCLC, CRC, and PDAC, who are refractory to standard-of-care therapies. KO-2806 and cabozantinib will be combined in patients with advanced or metastatic ccRCC who progressed on ≥1 prior line of immunotherapy-based systemic therapy; KO-2806 and adagrasib will be combined in patients with KRAS-G12C mutant locally advanced or metastatic NSCLC who received ≥1 prior systemic therapy. On the basis of emerging data from phase 1a, two Pd cohorts (n≤12) with mandatory pre- and on-treatment tumor biopsies may be enrolled. In each Phase 1b dose expansion, patients will receive the recommended phase 2 dose [RP2D] of KO-2806 with cabozantinib (in ccRCC) or adagrasib (in NSCLC), or will be randomized by dose if 2 potential KO-2806 RP2Ds are identified for a combination. Other combination arms may also be considered. The study began accrual in October 2023. Citation Format: Glenn J. Hanna, Douglas R. Adkins, Jacob S. Thomas, Justine Y. Bruce, Manish R. Patel, Guru Sonpavde, Jason Henry, Nawal Bendris, Zijing Zhang, Amitava Mitra, Amaya Gascó, Andrew Saunders, Stephen Dale. FIT-001: A phase 1 clinical trial of the farnesyl transferase inhibitor KO-2806 alone or as part of combination therapy for advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT163.

Progress of artificial intelligence in anesthesia and perioperative medicine

Perioperative medicine is a series of medical activities throughout the perioperative period, including preoperative optimization, intraoperative safety, postoperative rehabilitation, and other activities. Anesthesia is closely integrated with perioperative medicine to guarantee smooth progress of operations, comfortable recovery, and favorable long-term outcome for patients. There are a huge number of clinical data in anesthesia and perioperative medicine, and artificial intelligence (AI) has a powerful ability to analyze and evaluate data; thus, applying AI is a significant advantage in analysis and prediction based on real clinical big data in anesthesia and perioperative medicine. AI has made some progress in the field of anesthesiology and perioperative medicine. This review introduces the most encountered computerized techniques of AI in anesthesiology, main clinical applications themes of AI in anesthesiology, as well as limitations and ethical implications involved in deployment of this technology.

A 21-bp deletion in the complement regulator CD55 promotor region is associated with multifocal motor neuropathy and its disease course.

To further substantiate the role of antibody-mediated complement activation in multifocal motor neuropathy (MMN) immunopathology, we investigated the distribution of promotor polymorphisms of genes encoding the membrane-bound complement regulators CD46, CD55, and CD59 in patients with MMN and controls, and evaluated their association with disease course. We used Sanger sequencing to genotype five common polymorphisms in the promotor regions of CD46, CD55, and CD59 in 133 patients with MMN and 380 controls. We correlated each polymorphism to clinical parameters. The genotype frequencies of rs28371582, a 21-bp deletion in the CD55 promotor region, were altered in patients with MMN as compared to controls (p .009; Del/Del genotype 16.8% vs. 7.7%, p .005, odds ratio: 2.43 [1.27-4.58]), and patients carrying this deletion had a more favorable disease course (mean difference 0.26 Medical Research Council [MRC] points/year; 95% confidence interval [CI]: 0.040-0.490, p .019). The presence of CD59 rs141385724 was associated with less severe pre-diagnostic disease course (mean difference 0.940 MRC point/year; 95% CI: 0.083-1.80, p .032). MMN susceptibility is associated with a 21-bp deletion in the CD55 promotor region (rs2871582), which is associated with lower CD55 expression. Patients carrying this deletion may have a more favorable long-term disease outcome. Taken together, these results point out the relevance of the pre-C5 level of the complement cascade in the inflammatory processes underlying MMN.

Exploring parenthood in first episode of psychosis: the potential role of the offspring in the outcome of women.

The study aimed to explore the role of parenthood at first episode of psychosis (FEP) on recovery, with a focus on potential sex differences. Sociodemographic, clinical, and neurocognitive information was considered on 610 FEP patients form the PAFIP cohort (Spain). Baseline and three-year follow-up comparisons were carried out. Chi-square tests and ANCOVA analysis were performed controlling for the effect of age and years of education. Men comprised 57.54% of the sample, with only 5.41% having offspring when compared to 36.29% of women. Parenthood was related to shorter duration of untreated illness (DUI) in women with children (12.08months mothers vs. 27.61months no mothers), showing mothers better premorbid adjustment as well. Childless men presented the worst premorbid adjustment and the highest cannabis and tobacco consumption rates. Mothers presented better global cognitive function, particularly in attention, motor dexterity and executive function at three-year follow-up. Diminished parental rates among FEP men could be suggested as a consequence of a younger age of illness onset. Sex roles in caregiving may explain the potential role of parenthood on premorbid phase, with a better and heathier profile, and a more favorable long-term outcome in women. These characteristics may be relevant when adjusting treatment specific needs in men and women with and without offspring.

Exploring the fear of missing out (FOMO) and customer bonds in service relationships

PurposeMost research has investigated the fear of missing out (FOMO) in the context of online activities, often associated with negative personal outcomes such as fatigue and stress. However, given the increased desire to be informed and included associated with FOMO, organizations that can effectively meet these needs may develop or strengthen social and structural bonds, thereby turning short-term customers with FOMO into lifelong patrons. This study aims to examine the relationship between FOMO and favorable organizational outcomes as mediated by several constructs associated with the desire for information and inclusion.Design/methodology/approachThis research was conducted within the higher education sector of the service industry. FOMO served as the IV. The mediators represented context-specific aspects of campus involvement and inclusion. Organizational outcomes related to the long-term services relationship served as the DVs. The sample consisted of 435 students recruited from research pools at two southern universities in the USA. Exploratory factor analysis, OLS regression and the Hayes–Macro were used to examine the data.FindingsThe results demonstrate that FOMO is positively associated with students’ desires for information and inclusion (informal peer interaction, campus involvement, informal faculty interaction, campus information media use and a preference for in-person course scheduling), which are associated with the desirable university outcomes of satisfaction, connection and alumni donation/activity intentions.Practical implicationsIf a university fosters unstructured time spent with faculty and peers, and promotes campus information media involvement, students with higher levels of FOMO are more likely to be satisfied, feel connected to the university and report intentions to donate time and money as alumni.Originality/valuePrior research on FOMO is generally focused on internet and social media use; this study takes a broader perspective and identifies the effect of FOMO on a desire for information and inclusion within a novel context (a service environment). It also associates FOMO with favorable long-term service relationship outcomes that fortify social and structural bonds.

Long- term outcomes of congenital tracheal stenosis after slide tracheoplasty.

Long-term outcomes of slide tracheoplasty in patients with congenital tracheal stenosis (CTS) have rarely been reported. This study aimed to clarify the long-term outcomes of CTS after slide tracheoplasty. The medical records of 33 patients who underwent slide tracheoplasty for CTS at our institution between January 2005 and July 2018, with a follow-up duration > 5 years, were retrospectively reviewed. Patients' characteristics, perioperative condition, operative management, postoperative course, tracheal stenosis rates and growth data, were collected from medical records. The median operative age, minimum tracheal diameter, length of stenosis, duration of hospital stays, and follow-up duration were 8 months, 2.4mm, 35mm, 39 days, and 90 months, respectively. One patient died of bleeding in the right lung at 126 months postoperatively. Among the 10 patients requiring postoperative tracheostomy, seven were successfully decannulated at a median of 65 months postoperatively. Tracheal stenosis rates improved postoperatively and were subsequently maintained. Growth impairment and psychomotor delay were observed in 9 and 16 patients, respectively with significant differences found only in cases with genetic abnormalities and not in tracheal stenosis severity. Slide tracheoplasty for CTS leads to favorable long-term outcomes. However, various associated anomalies may influence growth and psychomotor development, emphasizing the importance of adequate support.