Frequent Treatment Modality Research Articles

In vitro elution of amikacin, cefazolin, gentamicin, ampicillin/sulbactam, and meropenem from a commercially available calcium sulfate delivery kit.

The use of implantable antibiotic beads has become a frequent treatment modality for the management of surgical site infections in human and veterinary medicine. The objective of this study is to describe the elution kinetics of five antibiotics from a commercially available calcium sulfate antibiotic delivery kit. A secondary goal was to compare elution concentrations with minimal inhibitory concentrations (MIC) for commonly encountered bacteria from the University of Florida's veterinary microbiology laboratory database. Calcium sulfate powder was combined with amikacin, cefazolin, gentamicin, ampicillin/sulbactam, and meropenem. Triplicates of three antibiotic-loaded beads were immersed in 5 mL of phosphate-buffered saline (PBS) and kept at 37°C under constant agitation. Antibiotic-conditioned PBS was sampled at 14 time points from 1-h to 30 days and analyzed by liquid chromatography to determine the antibiotic concentration. All beads eluted concentrations of antibiotics for the 30-day sampling period, except for ampicillin/sulbactam, with the most antibiotics being eluted within the first week. The concentration of antibiotics within the eluent within the first 3-9 days (3- and 5-mm beads, respectively) was greater than the MIC of common isolates. The 5 mm bead samples were superior in maintaining higher concentrations for a longer period, compared to the 3-mm beads. CSH beads eluted antibiotics over the 30-day course of the study. Most of the antibiotic elution occurred within the first week and was maintained above the MIC of commonly encountered isolates. This information may be useful for clinical decision making for treatment of local infections encountered in practice.

Assessment of Plaque Characteristics by Contrast-Enhanced Ultrasound and Stent Restenosis following Carotid Artery Stenting: A Retrospective Study

Background and objective: carotid artery stenosis contributes significantly to ischemic strokes, with management options including carotid endarterectomy (CEA) and carotid artery stenting (CAS) ischemic stroke risk can be reduced. Controversies persist regarding their efficacy and factors influencing complications, and understanding the relationship between atherosclerotic plaque characteristics and stent restenosis after CAS is crucial. Methods: we conducted a retrospective study involving 221 patients who underwent CAS for symptomatic or asymptomatic carotid artery stenosis. Comprehensive assessments of plaque morphology were performed using contrast-enhanced ultrasound (CEUS) before CAS. Patient demographics, including smoking status and diabetes, were also recorded. Stent restenosis was diagnosed using various imaging modalities, including ultrasound, angiography, and digital subtraction angiography (DSA). Results: plaque analysis using CEUS revealed a significant association between plaque grade and restenosis incidence (p < 0.001), particularly with grade 0 (11.1%) and grade 2 plaques (66.7%). Smoking was notably associated with plaque vascularization and restenosis (p < 0.001), while diabetes did not significantly impact plaque characteristics or restenosis risk (p > 0.05). The mean duration of restenosis was 17.67 months. Stenting was the most frequent treatment modality for restenosis (70.6%). However, no significant relationship was found between restenosis type and plaque morphology (p = 0.268). Furthermore, while no clear relationship was observed between plaque morphology and the type of restenosis, our findings underscored the importance of plaque characterization in predicting post-CAS outcomes. Conclusions: this study highlights the utility of CEUS in predicting stent restenosis following CAS. There was a significant association between stent restenosis within 12–24 months after the carotid stenting procedure and an elevated grade of plaque vascularization. Moreover, one of the main factors possibly determining the grade of plaque vascularization was smoking. Further research is warranted to elucidate the underlying mechanisms and refine risk stratification in this patient population.

Danish Nationwide Study on Surgical Treatment of Infective Native Abdominal Aortic Aneurysms

This study aimed to describe surgical trends, survival, and infection related complications (IRC) in a Danish cohort of patients with infective native aortic aneurysms (INAAs). A retrospective nationwide cohort study including all patients in Denmark who were surgically treated for abdominal INAA 2000 - 2020 was conducted. Patients were identified through the Danish vascular registry, Karbase, which is a database registering all patients treated with vascular surgery in Denmark. Subsequent data on clinical presentation, treatment, all-cause mortality, and complications were obtained from the electronic patient charts. Seventy-five patients were included in the study, of which 60 (80%) were male, with a median age of 69 (IQR 64, 75) years. Open surgical repair (OSR) was performed in 54 (72%) patients and endovascular aortic repair (EVAR) in 21 (28%) patients. Median follow up was 52 (IQR 32, 103) months. Open repair was consistently the most frequent treatment modality throughout the study period, but EVAR became more frequent over time. The 30 day survival of the total cohort was 97% (94 - 100%). Kaplan-Meier survival estimates for the cohort were 92% (95% CI 85 - 98%), 80% (95% CI 71 - 91%), 63% (95% CI 52 - 78%), and 48% (95% CI 35 - 66%) at 1, 3, 5 and 10 years, respectively. Patients treated with EVAR had comparable long term survival to patients treated with OSR, with a hazard ratio of 0.35 (95% CI 0.10 - 1.22), but was associated with better short term survival up to 5 years. The most common cause of death was sepsis. Five (9%) OSR patients had IRC compared with one (5%) EVAR patient. In this nationwide study of patients treated for abdominal INAA, an increasing number of patients were surgically treated during the study period. Patients treated with EVAR demonstrated long term survival comparable with OSR. The incidence of post-operative IRC was low. These results should be interpreted with caution and prospective registers are desired.

Improved overall survival for Stage III NSCLC patients treated with curative-intended therapy from 2010 to 2018–a cohort study in Denmark

Background Despite advances in treatment strategies and improved clinical outcomes, an unmet need remains for NSCLC patients. With an increased real-world knowledge of NSCLC, clinicians could offer patients optimal tailored treatment and disease management. In this retrospective cohort study, we describe patient characteristics, treatment patterns and modality, and survival in NSCLC patients diagnosed and treated at Aarhus University Hospital, Denmark. Methods Data on Stage III NSCLC patients aged ≥18 years diagnosed 2010-2018 were obtained from a regional cancer database and linked to national registries for information on socioeconomic and vital status. Patients were stratified by planned treatment intention at diagnosis (curative/palliative). Treatment patterns and overall survival (OS) were estimated using time-to-event methods. Results Broad patient and diseases characteristics and multiple treatment options demonstrated the heterogeneity of this patient cohort. Of 851 Stage III NSCLC patients, 599 (70%) and 252 (30%) were offered curative- and palliative-intended treatment, respectively, upon evaluation by a multidisciplinary team (MDT). The most frequent treatment modalities were CRT (n = 328; 55%) and RT (n = 97; 38%) in the curative and palliative setting, respectively. Age, disease stage, performance status and comorbidity were associated with curative-intended treatment initiation. Curative-intended treatment was associated with an improved OS of 14.6 months (median OS 24.4 months, 95% CI 21.1-27.6). Being offered curative-intended treatment and/or being diagnosed in the more contemporary study period (2016-2018) were significantly correlated with better OS (p < 0.001). Conclusion Stage III NSCLC is a heterogeneous disease as regards patient and clinical characteristics, multiple treatment options, and outcomes. Age, disease staging, performance status, and comorbidity, as well as MDT evaluation and matching treatment intent, are important determinants of curative-intended treatment. Notably, an NSCLC diagnosis in the more contemporary study period was statistically significantly associated with better OS.

Treatment approaches and outcomes of a head and neck lymphedema service at an Australian comprehensive cancer center

Patients treated for head and neck cancer are at high risk of developing head and neck lymphedema (HNL). We describe outcomes of HNL management at an Australian institution from 2018 to 2020. Electronic records from Chris O'Brien Lifehouse were retrospectively reviewed from January 1, 2018 to December 31, 2020. Objective changes in HNL were assessed using The M. D. Anderson Cancer Center (MDACC) HNL rating scale and Assessment of Lymphedema of the Head and Neck (ALOHA). Among the 100 patients referred for management of HNL, surgery was the most frequent treatment modality (80%; 70% with neck dissection) and 69% underwent radiotherapy. Manual lymphatic drainage (MLD) was most often prescribed (96%), followed by self-MLD (93%). Small but significant improvements in ALOHA measurements were observed for 50 patients (50%). Only 5/29 (17%) patients had post-treatment improvements on the MDACC scale. Standardized, prospective measurement of treatment approaches and outcomes is needed to further evaluate the service.

PREVALENCE OF MAXILLOFACIALFRACTURES REPORTEDAT ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL, MELMARUVATHUR, TAMILNADU, INDIA

Background: This retrospective study reviews the maxillofacial fractures over a 2 year period at Adhiparasakthi dental college and hospital Melmaruvathur, tamilnadu, India Introduction: To analyze the most frequent causes, sites, treatment modalities,age and gender wise distribution of maxillofacial fractures. Study design: Over a two-year period (from Jan2020 to Dec 2021), the medical records and radiographs (OPG, PA mandible, occipitomental and submentovertex view) of 223 patients treated for maxillofacial fractures at Adhiparasakthi dental college and Hospital were reviewed. A variety of parameters were assessed and recorded, including the patient's age, gender, race, occupation, and mechanism of injury, type of facial injuries, treatment modality, and postoperative complications. Results: Medical records of 223 patients with maxillofacial fractures were reviewed. Among them 184 (82.5%) had mandibular fractures whereas 39 (17.5%) had midface fractures. Most patients with mandibular fractures had fractures of the symphysis and parasymphysis 62(27.8%) while fractures of the zygomaticomaxillary complex (ZMC) were more common in the midface 15 (6.7%). Most patients were in the 21-30 year old age group, and the male: female ratio was 2.8:1. Road traffic collision was the most common cause that accounted for 127 (57%) of cases. Maxillomandibular fixation (MMF) was the most common type of treatment modality used, 129 (58%) cases were treated with this method and 42% were treated by ORIF+IMF. Conclusion: The most common etiology of maxillofacial injury was road traffic accidents (RTA) followed by falls and assaults, the sports injuries seem to be very less.The majority of victims of RTA were young adult males between the ages of 21 to 30 years.Mandible was the most common sites of fracture,followed by the maxilla. Majority of mandibular fracture occurred at symphsis and parasymphsis region,In Maxilla, majority of the fracture occurred at zygomatic complex region.Majority of cases were treated with maxillomandibular fixation (MMF). Open reduction and internal fixation were performed for indicated fracture patients.Clinical Significance: This research has essential significance in the specialty of maxillofacial surgery.It presents the occurrence of maxillofacial fractures in a particular population and also the ability of a dental surgeon in treating and restoring normal function in the maxillofacial region

MP35-18 MINI-PERCUTANEOUS NEPHROLITHOTOMY VERSUS STANDARD PERCUTANEOUS NEPHROLITHOTOMY FOR THE MANAGEMENT OF 20- TO 40-MM RENAL CALCULI : SAFETY AND EFFICACY

You have accessJournal of UrologyCME1 Apr 2023MP35-18 MINI-PERCUTANEOUS NEPHROLITHOTOMY VERSUS STANDARD PERCUTANEOUS NEPHROLITHOTOMY FOR THE MANAGEMENT OF 20- TO 40-MM RENAL CALCULI : SAFETY AND EFFICACY Aymen Sakly, Walid Zakhama, Nejm Jleli, Aymen Mnasser, and Yassine Binous Aymen SaklyAymen Sakly More articles by this author , Walid ZakhamaWalid Zakhama More articles by this author , Nejm JleliNejm Jleli More articles by this author , Aymen MnasserAymen Mnasser More articles by this author , and Yassine BinousYassine Binous More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of small and medium-sized stones is rising. A list of minimally invasive approaches is available and urologists must choose the best therapeutic option to ensure complete stone clearance with less morbidity. Initially, mini-percutaneous nephrolithotomy (mPCNL) was developed to manage renal stones in pediatric patients. Then, this approach has become a frequent treatment modality even in high stone burden. Although an increasing number of studies have been published on mPCNL, randomized clinical studies are rare. We conducted this study to assess the safety and the effectiveness of mPCNL versus sPCNL. METHODS: We conducted a prospective randomized study between September 2018 and April 2021 including all patients with a 20 to 40 mm kidney stone managed by percutaneous approach. Exclusion criteria were pediatric population, abnormal coagulopathy state, abnormal renal anatomy and multiple-tract percutaneous access. All procedures were performed by the same surgeon in the supine position. In all, 110 patients were randomized into two groups: Group A: 59 patients underwent sPCNL using a 24 Fr nephroscope through a 30 Fr sheath; and group B: 51 patients underwent mPCNL procedure using minimally invasive PCNL system: 12 Fr nephroscope with a 16,5/17,5 Fr sheath after a single-step dilatation. For both groups, demographic data, stone characteristics, operative data, and postoperative data were recorded prospectively. All patients were evaluated with a non-contrast spiral CT 1 month after the operation, to determine the final stone-free status. Statistic evaluation was performed using Student's t test. RESULTS: The mean age was 51.1±12.2 and 44.4±16.3 years for sPCNL group and mPCNL group, respectively. The median stone size was 33.1±9.8 mm for group A and 28.8±11.2 mm for group B. The operative time was higher in group B (135±57.8 min vs 110±41.1 min, p=0.033). According to Clavien–Dindo classification, no statistical difference was detected between the groups in terms of complication rates (p=0.09). However, the rates of hemoglobin drop and transfusion rates were significantly higher in sPCNL than mPCNL (1.53 g-dL vs. 0.73 g-dL, p<0.015). Only one patient required transfusion in group B compared with six patients in group A. The hospital stay was found to be significantly shorter in the mPCNL group (2.75±0.7 vs. 3.8±1.1 days, p=0.02). The success rate in the sPCNL group was higher than mPCNL group in terms of stone clearance after 1 month, but this difference was statistically insignificant (88.2 vs. 86%, p=0.59). CONCLUSIONS: Both standard and minimally invasive PCNL have shown good outcomes in the treatment of symptomatic renal stones between 20-40 mm. Although the success rates are similar for both techniques, hospitalisation time, bleeding and transfusion rates are in favor of mPCNL. With the availability of high energy Holmium lasers, even a high stone burden is amenable to mini-PCNL. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e477 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aymen Sakly More articles by this author Walid Zakhama More articles by this author Nejm Jleli More articles by this author Aymen Mnasser More articles by this author Yassine Binous More articles by this author Expand All Advertisement PDF downloadLoading ...

The dental triage method at Rothschild Hospital during the first lockdown due to the COVID-19 pandemic.

This study aims to (1) assess the efficacy of a face-to-face emergency protocol in children and adults and (2) measure the efficacies of prediagnosis at the triage level and clinical diagnosis at the emergency department level during the COVID-19 pandemic. A triage protocol was applied for patients at the entry of the Rothschild Hospital (AP-HP) between March 18th and May 11th, 2020. First, patients underwent a triage based on self-reported symptoms. If their condition was deemed urgent, they were oriented toward dental professionals, who performed an intraoral examination leading to a clinical diagnosis. Triage and diagnoses were categorized into four emergency groups: infectious, prosthetic, traumatic, and others. The agreement between triage and clinical diagnosis was tested (χ2 test). Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for each diagnostic category were assessed to evaluate the performance and efficacy of the triage. Out of 1562 dental visits, 1064 were included in this analysis. The most frequently reported symptoms by children at triage were pain (31.5%) and trauma (22%). Adults mainly complained of abscesses (45.1%) and pulpitis (20.5%). The most frequent clinical diagnoses were abscesses (29.2%) and pulpitis (20.5%) among children and adults, respectively. Tooth extraction was the most frequent treatment modality. Systemic antibiotics were prescribed for 49.2% of patients. Regardless of the age class, the PPV was high for groups 1 to 3, ranging from 78.9% to 100%. The NPV was high in all groups, ranging from 68.8% to 99.1%. This study demonstrates that the triage implanted during the first COVID-19 lockdown was effective and is an appropriate tool for the referral of adults and children before clinical examination.

Investigation of Anxiety and Health Locus of Control in Patients Undergoing Hemodialysis.

Hemodialysis is the most frequent treatment modality for End-Stage Renal Disease (ESRD). However, a number of limitations and modifications accompany this treatment, affecting people's physical and psychological well-being and increasing anxiety symptoms. The aim of this study was to investigate the level of anxiety and health locus of control among dialysis patients. One hundred and five patients on hemodialysis treatment completed a questionnaire with demographic characteristics, the State-Trait Anxiety Inventory and the Multidisciplinary Health Locus of Control Scale. Women had significantly higher levels of state anxiety than men (p=0.019). Similarly, patients with primary school education had significantly higher trait and total anxiety levels than those with technological education (p=0.002 and p=0.033, respectively). Widowed patients exhibited significantly higher state, trait, and total anxiety levels than married (p=0.032, p=0.012, and p=0.012, respectively). Participants who did not do any kind of exercise had significantly higher level of state, trait, and total anxiety than those who did (p=0.011, p=0.015, and p=0.006, respectively). Respondents who did not have any self-care skills had significantly higher level of state, trait, and total anxiety than those who had (p=0.011, p=0.015, and p=0.006, respectively). State, trait, and total anxiety levels were significantly (p≤0.05) correlated negatively with internal locus of control and positively with "chance" locus of control scale. Hemodialysis patients had increased anxiety symptoms and believed that others had control over their health to a greater extent. Renal professionals need to apply effective interventions to dialysis patients in order to help them gain a better sense of control over their health and reduce anxiety symptoms.

SYSTEMIC EPSTEIN-BARR VIRUS-RELATED T-CELL LYMPHOPROLIFERATIVE DISORDER: A RARE CAUSE OF DYSPNEA AND PULMONARY INFILTRATES IN AN IMMUNOCOMPETENT ADULT

SYSTEMIC EPSTEIN-BARR VIRUS-RELATED T-CELL LYMPHOPROLIFERATIVE DISORDER: A RARE CAUSE OF DYSPNEA AND PULMONARY INFILTRATES IN AN IMMUNOCOMPETENT ADULT

Real-world Treatment Patterns and Outcomes in Stage III Non-small Cell Lung Cancer: Middle East and Africa – KINDLE Study

IntroductionThe Middle East and Africa (MEA)-KINDLE, as part of a real-world global study, evaluated treatment patterns and survival outcomes in stage III non-small cell lung cancer (NSCLC) in the MEA. Materials and MethodsRetrospective data were analyzed from 33 centers for patients diagnosed between January 01, 2013, and December 31, 2017. Descriptive analyses included clinical-demographics and treatment patterns; inferential statistics evaluated an association of first-line treatment with progression-free survival (PFS) and overall survival (OS). ResultsOf 1,046 patients enrolled, the median (range) age was 61.0 years (24.0-89.0); 83.2% were men, 80.8% were current or past smokers, 58.9% had stage IIIA disease, 47.8% had adenocarcinoma and 20.0% of tested (35/175) had epidermal growth factor receptor mutations. Of 86.0% of patients receiving an initial therapy, about 16% underwent surgical resection. Concurrent chemoradiotherapy (cCRT) (32.3%) was the most frequent treatment modality followed by chemotherapy (CT) alone (19.6%) and sequential CRT (12.1%). Median PFS and OS (months, 95% CI) were 11.8 (10.6, 12.4) and 22.9 (21.2, 26.3), respectively for the overall MEA subset. OS (months) was highest with surgery-based therapies for stage IIIA (IIIA: 37.3, IIIB: 24.1) followed by cCRT (IIIA: 28.9, IIIB: 24.4). Female gender, adenocarcinoma, and cCRT or Sx+CRT in first-line were associated with higher OS (P < .05). ConclusionsThe data reveal an unmet need in stage III NSCLC with worse PFS and OS in the MEA subset than in the global cohort. Better access to newer therapies and quality care will be crucial in improving patient outcomes in the MEA.

Does Surgical Placement of Syndesmosis Screws Affect Breakage Rate? A Retrospective Comparative Study

Category:AnkleIntroduction/Purpose:Fixation of syndesmosis disruption with metal screws remains a frequent and efficacious treatment modality. Screw breakage remains a complication seen in many patients following metal fixation. Overtime physiologic rotation or the tibia and fibula can lead to bone erosion and pain in patients with screw breakage. The purpose of this study is to compare patients with syndesmosis screw breakage and patients with intact screws based surgically controlled variables.Methods:A retrospective analysis of patients who underwent syndesmotic screw fixation from 2008 - 2020 was performed. Ninety-seven patients were found to have syndesmosis screw breakage, of which 88 met inclusion criteria. A control group of patients without syndesmosis screw breakage was selected at random and analyzed until 88 patients met inclusion criteria. The number of screws used, width, length, fracture type and number of cortices were all collected. Further analysis included radiographic measurement syndesmosis screw angle and height of placement above the tibial plafond. A regression analysis was performed to compare to the two groups, including a separate analysis comparing unbroken screws within syndesmosis screw breakage cohort versus their broken screws, as this provided an absolute control group. A stratified analysis of screw placement and angle was also performed based on standard deviation.Results:The average screw width in the breakage group was 3.67 (SD =.38) and 4.06 (SD =0.04) in the intact group (P =<.001). Average screw angle was 94.82 (SD = 12.75) in the breakage group and 94.67 (SD 12.31) in the intact group (based on 90 degrees relative to tibial plafond). Screw placement of the tibial plafond was 20.39 (SD =10.389) in the breakage group and 16. 75 (SD = 9.28) in the intact group. 70.3% of broken screws were placed > 20mm above the tibial plafond, compared to 64.0% in the control group. Most screws were placed at angle > 82 degrees relative to the tibial plafond; 76% (n =92) of broken screws and 81.2% (n=211) of intact screws). Decreased screw width (P =<.001) and screw placement > 20mm above the tibial plafond (P =<.001) were all associated with an increased risk of screw breakage.Conclusion:Metal screw fixation remains an efficacious treatment method of syndesmotic disruption. Despite extensive research the cause of syndesmosis screw breakage and the necessity of screw removal remains without consensus. The is study aims to analyze surgical variables in attempt to find correlation with screw breakage. An increased BMI was seen to predispose to screw breakage. Placement of the syndesmosis screw <20 mm above the tibial plafond and increased screw width provide protection against syndesmosis breakage. No significant differences were found between groups based on screw angle, number of cortices, screw length, or number of screws used.

Clinical study of liver abscess

Background: Liver abscesses, both amoebic and pyogenic, is an important cause of morbidity and mortality in tropical countries. However, liver abscess have been managed by conservative, percutaneous needle aspiration, surgical drainage and endoscopic drainage. The aim of our study was to study the etiological, predisposing factors, signs and symptoms and various modalities of treatment of liver abscess.Methods: In this study 30 cases of liver abscess, required data was collected and was compared statistically. All cases were studied upto discharge regarding presenting signs and symptoms and treatment modalities.Results: Liver abscesses were more common in males. History of alcoholism was present in 60% of cases. The common clinical features were rt hypochondriac tenderness 100%, tender hepatomegaly 90%, fever 97%, anorexia 77%, weight loss 40%, jaundice 13%. Elevated leukocytes was seen in 72%, elevated serum bilirubin in 17%, serum alkaline phosphatase in 50 % and serum transaminase in 17% of cases. Right lobe of liver was involved in 87%, left lobe in 13%, both lobes in 0%. 23% of cases were treated conservatively, 50% by aspiration, 27% by surgical open method drainage, complications were secondary infection in 8%, rupture into peritoneal cavity 13% and pleural effusion 17%. Mortality was nil.Conclusions: The modern day ultrasound and other non-invasive imaging techniques had greatly revolutionized the diagnosis and management of the liver abscess. Conservative management with IV antibiotics and USG guided percutaneous aspiration of liver abscess are most frequent treatment modalities used now, with fewer complications.

P–239 In vitro maturation of human oocytes: a systematic review and data analysis

Abstract Study question Based on published studies, how effective is in vitro maturation (IVM) in different patient groups, and how does the maturation rate correlate with culture conditions? Summary answer Clinical IVM is most effective when patients receive only hCG trigger prior to oocyte collection. Multiple additional parameters influencing the outcome were identified. What is known already Despite being used for more than fifty years, the overall efficacy of human IVM has not yet been determined, and results are often conflicting. Indeed, IVM is still perceived skeptically by many embryologists and doctors and not widely used in clinical practice. This review aims to collect all available data in the literature regarding the efficacy of IVM analyzing characteristics of patients, treatment, or laboratory conditions that may influence the MII-rate (MR). Study design, size, duration: A systematic search was performed in the PubMed database following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was limited to studies in the English language published before October 2020 using the following keyword: “oocyte in vitro maturation». Participants/materials, setting, methods Inclusion criteria for studies were: reporting data obtained on immature human oocytes, which transitioned to the MII stage after IVM. The requirement was that the numbers of cultured and matured oocytes were reported. If available, additional data were collected including patients’ characteristics (for example PCOS), hormonal stimulation prior to the procedure (administration of some FSH or hCG trigger or both), oocyte freezing before or after IVM, type of culture medium and supplements, etc. Main results and the role of chance A total of 350 publications were selected from 6866 search results, 436 abstracts, and 422 full read articles. Selected studies cover 21153 patients and 157420 immature oocytes cultured. It has been demonstrated that oocytes collected in vivo from adult, non-PCOS patients, who received only hCG trigger prior to the procedure had a statistically higher MII rate (66%) than oocytes from patients who received no gonadotropins or some FSH, or a combination of some FSH and hCG trigger (59%, 60% and 58% respectively). The same was valid for PCOS patients: MR in the trigger only cohort (66%) was significantly different from other cohorts. MR for in vivo collected oocytes (61%) from adult non-PCOS patients was significantly different from ex vivo collected oocytes (33%). MI stage oocytes at the moment of collection matured with a statistically higher rate (N = 4322, 73%), than GV oocytes (N = 3328, 54%). When in vitro matured oocytes were vitrified, their average survival rate was 81% (data from 50 studies on 1701 oocytes). Additionally, immature oocytes survived vitrification with a 75% rate (data from 30 studies on 4457 oocytes). Overall, ICSI fertilization rate for IVM oocytes was 69% (N = 59914). A total of 747 babies born from IVM were reported. Limitations, reasons for caution Among selected publications only 2 were randomized controlled trials and therefore the main challenge of this review is striking differences in setups among included studies. However, despite not being a meta-analysis, this study calculated MR for the most frequent treatment modalities and additional individual factors, which might influence MR. Wider implications of the findings: This review provides data regarding IVM efficiency in different cohorts of patients, performed under different culture conditions. Additional laboratory parameters influencing MR have been identified. Based on this new data, target groups benefiting the most were identified, and prognosis regarding the success of their treatment with IVM might be estimated. Trial registration number n/a

PROSTHETIC REHABILITATION OF A MAXILLECTOMY PATIENT WITH A TITANIUM CLOSED HOLLOW BULB OBTURATOR USING LOST WAX BOLUS TECHNIQUE - A CASE REPORT

Maxillary intraoral defects due to surgical resection create an open link between the oral and nasal cavities causing difficulty in deglutition, speech, and an unaesthetic appearance . Maxillary obturator prosthesis is a more frequent treatment modality than surgical reconstruction for maxillectomy in patients suffering from oral cancer. The obturators often become heavy and hence are hollowed out in the defect portion to reduce its weight as a standard practice. This case report describes the prosthetic rehabilitation of a maxillectomy patient with a titanium cast hollow obturator using lost wax bolus technique.

Plasma cell vulvitis: A systematic review.

BackgroundPlasma cell vulvitis (PCV) is an inflammatory vulvar dermatosis that is not well characterized. Diagnosis is often delayed, and the condition can be refractory to treatment. To date, there are no systematic reviews on this topic.ObjectiveThis study aimed to provide a systematic review of PCV, including epidemiologic, clinical, and histopathologic findings, as well as associated comorbidities and treatment options.MethodsA primary literature search was conducted using the PubMed, Ovid Medline, Cochrane, and CINAHL databases.ResultsFifty-three publications with 196 patients (mean age: 55.3 ± 14.5 years) were included. The majority of studies were case reports and case series. Common symptoms included burning/stinging (52%), dyspareunia (44%), and pruritus (41%). Common findings included erythema (84%), glistening/shiny appearance (29%), well-demarcated lesions (25%), and erosions (22%). Common anatomic sites were the labia minora (45%), introitus (31%), and periurethral (19%). Fifty-three percent of patients had a solitary lesion. Common histologic findings were a predominant plasma cell infiltrate (88%), presence of other inflammatory cells (55%), hemosiderin/siderophages (46%), and epidermal atrophy (43%). Topical corticosteroids (64%) and tacrolimus ointment (13%) were the most frequent treatment modalities. In most reports, previous treatments were tried, and there was a diagnostic delay.ConclusionPCV is likely underrecognized and should be considered in patients with erythema of the mucous and modified mucous membranes, symptoms of burning or stinging, and a predominant plasma cell infiltrate on histopathology. First-line therapy should begin with high-potency topical corticosteroids, with the most evidence for clobetasol 0.05% or tacrolimus 0.1% ointment. Prospective studies are needed to further characterize this condition and to develop treatment guidelines.

Patient assessment of 5-fluorouracil and imiquimod for the treatment of actinic keratoses: a retrospective study of real-world effectiveness

Background Despite the superior efficacy of topical therapies for the treatment of actinic keratoses in clinical trials, cryosurgery remains a frequent treatment modality in clinical practice. Little is known about patients’ experience of real-world use of topical therapy. Objective To determine the real-world effectiveness and tolerability of 5-fluorouracil and imiquimod in the treatment of actinic keratoses. Methods A phone survey and chart review was conducted among 51 patients prescribed 5-fluorouracil (N = 27) or imiquimod (N = 24) for actinic keratoses. Results Six patients (22%) in the 5-fluorouracil group and five patients (21%) in the imiquimod group reported severe local skin reactions, and three patients in both groups (11% and 13%, respectively) were unwilling to use the respective topical therapies again. Patients in the 5-fluorouracil group had, on average, 3.3 fewer cryosurgery spot treatments following topical treatment. Patients in the imiquimod group averaged 2.0 fewer spot treatments. Limitations While this study provides information on real-world experiences, patients’ responses were limited by the ability to recall treatment and potential adverse effects. Conclusion High rates of skin reactions, prolonged discomfort, and the continued need for procedural treatments may make patients less willing to use topical 5-fluorouracil or imiquimod for actinic keratoses.

Retrospective Analysis of Treatment Modalities and Survival of Patients with Cervical Cancer in Ain Shams University Maternity Hospital from 2012 to 2017

Abstract Background cervical carcinoma is considered the second most common cause of gynecological malignancy death following ovarian carcinoma. The incidence of invasive cervical cancer is higher in low-income countries due to lack of screening programs. There are many treatments for cervical carcinoma, namely surgery, chemotherapy and radiotherapy with different morbidity and survival rates (also according to the stage of the disease). Aim of the Work The aim of this work is to review the cervical cancer patients in Ain Shams University Maternity Hospital from 2012 to 2017 in the aspects of demographic characteristics, treatment modalities used, survival and morbidity. Patients and Methods the data includes patients diagnosed as having cervical cancer from 1-1-2012 to 31-12-2017 in Ain Shams University Maternity Hospital as retrospective analytical study. We collect name, age, parity stages, Histopathology, treatment, morbidity and survival about each woman and analyze this data. Results study included 147 women diagnosed as having cervical carcinoma from 2012 to 2017 in Ain Shams University Maternity Hospital. the most frequent residence was greater Cairo (81%). Majority of patients and their husbands were illiterate (91.8%). Two thirds of the studied cases were married (66.7%). Less than two thirds of the studied cases were postmenopausal (64.6%). The mean age of cases included in this study was 52.3 years. SSC was the most frequent pathology (82.3%). the overall survival rate was 61.7% (survival duration 1.2year with IQR (1→ 2.5 year). By the end of our study 81.8 % of the cases survived in stage I, 65.7 % in stage II, 55.6 % in stage III and 33.3 in stage IV. The most frequent treatment modality was primary radiotherapy without surgery 53.2% with 60% survival with median duration 1year (0.8-2 year) .Then primary radiotherapy with surgery 22.5 % (19.8 % with completion surgery and chemotherapy and 2.7% with salvage surgery) with 56.2 % survival with median duration 1.1 year (1-2.5 year) and the least frequent was 1ry surgery (21.6 %) with 80% survival with median duration 1.8 year (1-3.9 year). Recurrence was in less than tenth of cases (9.3%), the most frequent site was extrapelvic (75.0%). Conclusion In Ain Shams University Maternity Hospital the cases are usually clinically presented in late stages and usually with complications due to lack of screening. In developing countries like Egypt, brachytherapy may not be available for all patients. Our study proved that completion surgery after whole pelvic radiation can take place with comparable survival rates and morbidity. Our survival rates are comparable with other studies conducted in developed countries and are good with our limited resources but are less than other studies performed in developed countries.

Abstract B34: Immune response after combining radiotherapy and gene electrotransfer of plasmid DNA encoding shRNA against melanoma cell adhesion molecule in B16F10 melanoma and TS/A carcinoma

Abstract Radiotherapy is one of the most frequent treatment modalities of cancer. To improve its efficacy, it can be combined with adjuvant treatments. One of the possibilities is gene electrotransfer (GET) of plasmid encoding shRNA against melanoma cell adhesion molecule (MCAM; pMCAM). GET of pMCAM has dual action: vascular targeted effect mediated by silencing of MCAM and immunologic effect mediated by presence of foreign plasmid DNA in the cytosol, which activates cytosolic DNA sensors. The aim of our study was to determine the effects of GET of pMCAM combination with radiotherapy in two murine tumors, which differ in in immunologic status: B16F10 melanoma (immunologically “hot” tumor) and TS/A carcinoma (“cold” tumor) and to elucidate the underlying mechanisms. B16F10 melanoma, growing in C57Bl/6 mice, and TS/A carcinoma, growing in BALB/c mice, were treated by triple GET (repeated every 2 days) and single dose of irradiation (IR) 15 Gy performed 1 day after the first GET. Tumor growth delay and tumor cures were determined. Proliferation, apoptosis, necrosis, vascularization, hypoxia, and infiltration of immune cells were evaluated histologically. Silencing of MCAM potentiated the effect of IR in both tumor models. However, melanoma was significantly more responsive, even to GET of pMCAM without irradiation, than carcinoma. Combined therapy resulted in 81% complete responses (CR) in melanoma and 27% CR in carcinoma, while GET of pMCAM without irradiation resulted in 36% CR and 0% CR, respectively. Moreover, after secondary challenge of mice with CR, there was 59% CR in melanoma and 0% CR in carcinoma model. GET of pMCAM combined with IR reduced the number of blood vessels, induced hypoxia, apoptosis, necrosis, and reduced tumor cell proliferation in both tumor models to similar extent. However, the significant increase of infiltrating immune cells was observed only in melanoma model. Moreover, expression of IL-12 and TNF-γ in melanoma was elevated after combining GET with IR. Immune response can participate in overall antitumor response of combined treatment, but only in immunologically “hot” tumors, while in immunologically “cold” tumor the enhancement of IR can be ascribed only to the action of the expression of the therapeutic molecule. Thus, the properties of tumor microenvironment are crucial for sufficient immune system contribution to overall antitumor effect. Citation Format: Masa Bosnjak, Simona Kranjc Brezar, Monika Savarin, Tanja Jesenko, Valter Mrak, Gregor Sersa, Maja Cemazar. Immune response after combining radiotherapy and gene electrotransfer of plasmid DNA encoding shRNA against melanoma cell adhesion molecule in B16F10 melanoma and TS/A carcinoma [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr B34.

Primary hypophysitis: Experience of a Single Tertiary Center.

The authors review the clinical outcomes of patients with primary hypophysitis (PH). Patients with PH who were followed up between 2007 and 2018 at our clinic were evaluated. Clinical, endocrinologic, pathologic, radiologic findings and treatment modalities were assessed. Seventeen patients with PH were assessed. The median follow-up was 24 (range, 6-84) months. Histologic confirmation was available in 8 patients (6 lymphocytic hypophysitis, 1 lymphocytic-granulomatous hypophysitis, 1 xanthomatous hypophysitis). None of the cases were diagnosed after pregnancy. Two patients had an autoimmune disease. The most commonly seen symptom was headache. The most common anterior pituitary deficiencies were hypocortisolemia and hypothyroidism. The radiologic findings of the patients at the time of diagnosis revealed various results including space-occupying lesion (41.2%), loss of posterior hypophysis bright spot (47.1%), pituitary stalk thickening (41.2%), uniform contrast enhancement (17.6%), partially empty sella (11.8%), optic chiasm compression (11.8%). The most frequent initial treatment modality was observation. Ten patients who were followed up conservatively had no endocrinologic deterioration; additional treatment was not needed in 8 of these 10 patients. The second most frequent initial treatment modality was pituitary surgery. Five patients received steroid treatment. We found serious adverse effects during steroid treatment in 3 of 5 (60%) patients; unilateral avascular necrosis of the femoral head (n=2), diabetes mellitus(n=1). Correctly diagnosing PH and giving appropriate treatment is challenging. It is unclear whether active treatment with steroids improves clinical outcomes. The serious adverse effects of steroids are also taken into account. Observation, surgery and/or radiotherapy can be appropriate treatment modalities for selected patients.