Future Recurrence Research Articles

Association between ablation-induced baroreceptor reflex modification and procedure efficacy in patients with atrial fibrillation.

The autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF). Catheter ablation (CA) is a well-established treatment method for AF and significantly affects the ANS, including baroreceptor (BR) function. However, little is known about the changes in BR function caused by radiofrequency (RF) or cryoballoon energy (CB) and its impact on future AF recurrences. To assess 1-year efficacy of CA of AF in relation to BR function modification and type of ablation energy used. The study group consisted of 78 patients (25 females, mean age 58 ± 9 years) with paroxysmal AF and first CA (39 patients in the RF group and 39 in the CB group). The BR function was assessed non-invasively, using tilt testing before and after CA, and three BR parameters were calculated: event count (BREC) depicting overall BR activity, slope mean depicting BR sensitivity (BRS), and BR effectiveness index (BEI). The efficacy of CA was assessed during 1-year follow-up, which consisted of ambulatory visits and 24-h Holter ECG recordings at 3, 6, and 12 months after CA. The quality of life was assessed by using a dedicated scale [University of Toronto Atrial Fibrillation Severity Scale (AFSS)]. The two groups did not show differences in terms of clinical or demographic data. One-year follow-up was completed for 35 (89.7%) patients from the CB group and for 34 (87.2%) from the RF group. The rates of efficacy of CB and RF were similar [31/35 (88.6%) vs. 26/34 (76.5%), respectively]. After CA, the BR function decreased in both groups, with a significantly greater decrease in the CB group. The changes in BR parameters were similar in both responders and non-responders after CA in the whole group [BREC 10.0 (2.0-24.0) vs. 12.0 (4.0-21.5), p = 0.939; BRS 5.4 (3.7-6.5) vs. 4.8 (3.6-7.2), p = 0.809; BEI 24.8 (15.9-27.4) vs. 17.5 (8.9-27.5), p = 0.508, respectively]. According to the AFSS, the AF symptoms were significantly reduced in both groups to a similar extent. CA for AF significantly decreased the BR function, especially in patients undergoing CB. There was no correlation between CA-induced changes in BR parameters and ablation outcome.

Recurrence rates after healing in patients with neuroischemic diabetic foot ulcers healed with and without sucrose octasulfate-impregnated dressings: A 1-year comparative prospective study.

To compare recurrence rates after a 1-year follow-up period of healed neuroischemic diabetic foot ulcers after treatment with or without sucrose octasulfate impregnated dressing. A 1-year prospective study with two arms was conducted between April 2021 and April 2023 on 92 patients with healed neuroischemic diabetic foot ulcers. Patients were divided into two groups; the treatment group, that includes patients healed with a sucrose octasulfate-impregnated dressing, and the control group, which includes patients treated with other local treatments different from sucrose octasulfate-impregnated dressings. After healing, patients were prospectively followed up during 1-year and assessed monthly in the specialised outpatient clinics. The main outcome of the study was ulcer recurrence after wound healing within 1 year follow-up. Secondary outcomes were minor or major amputation and all causes of death. Fifty patients in the treatment group and 42 patients in the control group were included. Fourteen (28%) patients suffered from a reulceration event in the treatment group compared to 28 (66.7%) in the control group, p < 0.001. Time to recurrence in the treatment group was 10 (16.26-2.75) and 11.50 (30.75-5.25) weeks in the control group, p = 0.464. There were no observed differences in the minor amputation rates between the two groups: 15.2% (n = 7) in the treatment group and 7.1% (n = 3) in the control group (p = 0.362). Major amputations and death outcomes were exclusively observed in the treatment group. Specifically, four major amputations (8.7%) in the treatment group were complications arising from recurring events complicated by infection during the SARS-CoV-2 period. Seven patients died due to complications not related with local therapy. The relative risk of recurrence was 20.18 times higher in the control group compared with those treated with octasulfate dressing (p < 0.001). Treatment with sucrose octasulfate-impregnated dressings can decrease recurrence rates of neuroischaemic diabetic foot ulcers more effectively than neutral dressings. Besides, it may enhance the foot's clinical properties in patients with poor microcirculation, which could aid in preventing future recurrences.

A noninvasive method of diagnosing membranous nephropathy using exosomes derived from urine.

Membranous nephropathy (MN) is a specific autoimmune disease affecting kidneys. It is characterized by the accumulation of immune complexes in the glomerular basement membrane. Renal biopsy is currently the standard procedure to confirm the diagnosis, although the presence of autoantibodies against the phospholipase A2 receptor (PLA2R) can also help diagnose. In this study, we aimed to investigate the potential of urinary exosomes as noninvasive markers for diagnosing MN. Exosomes were extracted from urine samples of five patients with MN and four healthy controls. The concentration of PLA2R was measured in both urine and isolated exosomes using enzyme-linked immunosorbent assay techniques. The measurements were adjusted based on the urine creatinine (UCr) level of each participant. The levels of PLA2R/UCr were investigated in urine and urine-derived exosomes from patients and controls. Results of the analysis revealed significantly higher expression of PLA2R/UCr in patients compared to the control group (p < 0.05). Furthermore, the expression level of PLA2R/UCr was higher in urine-derived exosomes than in urine samples. Additionally, a positive correlation was observed between the expression levels of PLA2R/UCr and the urine protein-to-creatinine ratio, with urine-derived exosomes exhibiting a stronger correlation than urine samples. Studies have indicated that measuring exosomal PLA2R/UCr levels in urine could be a noninvasive method for diagnosing MN. Using urine-derived exosomes could also reduce the burden of performing a biopsy on patients and facilitate follow-up treatment, such as monitoring for future recurrence.

Robotic-Assisted Pleurectomy Is a Safe and Effective Surgical Treatment for Spontaneous Pneumothorax

IntroductionSpontaneous pneumothorax is a common thoracic surgical problem. To prevent recurrence, surgical options include blebectomy, mechanical or chemical pleurodesis, pleurectomy, or a combination of these operations. Pleurectomy is associated with lower recurrence rates but may be technically challenging via video-assisted thoracoscopic surgery. We report the first series of robotic-assisted pleurectomy (RAP) for spontaneous pneumothorax. MethodsA retrospective, single-center analysis was conducted on consecutive patients undergoing RAP for spontaneous pneumothorax from 2017 to 2023. Patients with prior surgery on the same side for pneumothorax were excluded. Demographics, comorbidities, functional status, intraoperative and perioperative variables were collected. 30-d readmission, 30-d mortality, and recurrence were recorded. ResultsThirty-six patients underwent RAP during the study period with a median follow-up of 36 mo. Patients had a median age of 41.5 (interquartile range [IQR] 21.5-68) y and were mostly male (80.6%) and past smokers (44.4%) with 66.6% having a primary spontaneous pneumothorax. The median time to chest tube removal was 3 d (IQR 2-3) and the median length of stay was two days (IQR 2-4). Complications occurred in seven patients with the majority (85.7%) having a grade 2 Clavien-Dindo classification score. There was no 30-d mortality or recurrence. ConclusionsRobotic-assisted pleurectomy for spontaneous pneumothorax is a safe and effective operation that can be used to prevent future recurrence.

International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis.

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.

Fluid and Trace Element Content in Perifocal Edema in Glial Brain Tumors

Glial brain tumors are the most common brain tumors, and they are also in most cases malignant. Glial tumors in pathogenesis create an extensive pronounced zone of perifocal edema. The more malignant the glial tumor, the more pronounced the perifocal edema. According to the Monroe-Kelly doctrine, the equilibria of the three components must be observed in the skull, this position is disturbed in tumor diseases and neurological symptoms occur. The more malignant the tumor, the more pronounced the zone of perifocal edema. The severity of the clinical picture depends on the severity of perifocal edema. A small tumor node creates an extensive zone of perifocal edema, which in turn creates intracranial hypertension and dislocation syndrome that threaten the patient's life. An increase in intracranial hypertension leads to a violation of cerebral blood flow, this aggravates the increase in edema, edema, in turn, enhances the dislocation of brain structures, the dislocation of brain structures aggravates the severity of the patient's condition. Thus, a pathological closed circle is created, in which perifocal edema plays a major role. Perifocal edema in the acute period of the development of the disease is a buffer zone for healthy brain tissue, but subsequently serves as a beggar for migrating tumor cells, creating conditions for tumor recurrence in the near future.

Salivary CD44 and Total Protein Levels to Detect Risk for Oral and Oropharyngeal Cancer Recurrence

Oral and oropharyngeal cancer have low survival rates, and incidence continues to increase. To determine whether soluble CD44 and total protein (TP) are useful for monitoring head and neck cancer recurrence, either used in a point-of-care (POC) test or as individual laboratory-based biomarkers. This multi-institutional nonrandomized clinical trial testing a novel diagnostic/screening assay took place across the University of California, San Diego; Johns Hopkins University; the Greater Baltimore Medical Center; New York University; and the San Diego Veterans Affairs Hospital. Patients with newly biopsy-proven, untreated oral cavity and oropharyngeal cancer were enrolled. Patients were enrolled April 2017 to April 2019, and data were analyzed December 2022 to June 2023. POC salivary oral rinse test. Oral rinses were collected at pretreatment baseline and 3, 6, 12, and 18 months after completion of therapy; participants were then followed up for 3 years to define disease status. Associations of baseline characteristics with a positive test were evaluated by Fisher exact test. The association of a positive value on the CD44 or TP test with progression-free survival was evaluated in an adjusted multivariable proportional hazards model. Of 172 patients enrolled, the mean (SD) age was 62.5 (10.2) years, and 122 (70.9%) identified as male. Additionally, 92 patients (53.3%) had never smoked, 99 (57.6%) formerly or currently drank alcohol, and 113 (65.7%) presented with oropharyngeal cancers, which were positive for human papillomavirus in 95 (84.1%). Tumor site was associated with test results at baseline; patients with oral cavity cancer had a higher baseline positive POC test rate (47 of 51 [92.2%]) compared to patients with oropharyngeal cancer (85 of 110 [77.3%]). Using Cox regression models with CD44 or TP level as a time-varying covariate, a higher CD44 level showed a statistically significant association with a higher hazard of recurrence (hazard ratio, 1.06; 95% CI, 1.00-1.12), though the TP level was not statistically significant. In multivariate adjusted analysis, higher CD44 and TP levels were associated with increased hazard ratios of recurrence of 1.13 (95% CI, 1.04-1.22) and 3.51 (95% CI, 1.24-9.98), respectively. In this multi-institutional nonrandomized clinical trial of an assay, posttreatment longitudinal monitoring for elevated salivary CD44 and TP levels using an enzyme-linked immunosorbent assay-based laboratory test identified patients at increased risk of future cancer recurrence. The CD44 and TP rapid POC test holds some promise, but further development is needed for this indication. ClinicalTrials.gov Identifier: NCT03148665.

Prospective Study: Utility of Anterior Segment Optical Coherence Tomography to Identify Predictive Factors of Recurrence in Pterygium Surgery.

Background/Objectives: The main purpose of this study is to determine, by anterior segment optical coherence tomography (AS-OCT), the anatomical characteristics, both preoperatively and postoperatively, that correlate with a higher rate of pterygium recurrence after surgery with exeresis and conjunctival autograft with biological glue. Methods: A total of 50 eyes which were listed for primary pterygium surgery at an ophthalmology tertiary centre were treated with standard pterygium excision and a conjunctival autograft with tissue glue. Ten variables were measured with AS-OCT (Casia 2; Tomey Corp., Nagoya, Japan) during six control visits with all patients. Finally, statistical analysis was performed using SPSS (SPSS stadistics®, IBM®, version 21.0.0.0) for descriptive variables and R-project (The R foundation©, version 3.0.2) for the rest of the analyses, including a descriptive analysis and an inferential analysis studying prognostic factors of recurrence and their predictive capacity. Results: Among the 50 patients who underwent surgery, recurrence was detected in 8 cases (rate 16%; 95% CI: 5.8-26.2%). Most cases (n = 6) were detected 3 months after surgery. The pattern of recurrences was atrophic in two thirds of the cases; none required reintervention. Preoperative total conjunctival thickness at 3 mm was significantly increased in patients who developed recurrence. One week after surgery, epithelial and stromal thickness at 1 mm and total thickness at 3 mm proved to be useful for predicting recurrence. Both models have significant discriminant capacity. Conclusions: By imaging the graft with AS-OCT preoperatively and 7 days after surgery, the risk of future recurrence can be predicted.

Assessment of conjunctival autograft reperfusion after pterygium surgery by optical coherence tomography angiography (OCT-A)

PurposeTo investigate the healing process of conjunctival autografts (CAG) following pterygium surgery using optical coherence tomography angiography (OCTA). MethodsTwenty-one eyes of 21 patients diagnosed with pterygium underwent pterygium excision with CAG without using Mitomycin-C. Over a 12-week follow-up period, changes in vascular density (VD), vascular density index (VDI), and vascular length density (VLD) were assessed at two distinct depths: superficial (<200 μm) and deep (>200 μm) using OCTA. Additionally, the revascularization rate and pattern were evaluated. ResultsDuring the first week, the CAG was edematous and no sign of neovascularization was observed. In 4th week edema decreased and early signs of vascular formation appeared. In the 12th week, the deep vasculature demonstrated a greater density of interconnectivity compared to the superficial layers. VD and VLD significantly increased during the follow-up period (P < 0.05). The CAG blood flow signals exhibited a chaotic pattern, deviating from the expected centrifugal vascular pattern in the surrounding normal conjunctiva. ConclusionOCTA imaging emerges as a reliable tool for the assessment of CAG vascularization, improving the monitoring of the healing process in the postoperative period. The evaluation of CAG revascularization patterns appears to be promising biomarkers that can predict the potential future recurrence.

Pay As You Earn (PAYE) Tax as Panacea to Backlog of Gratuities and Pensions of Civil Servants in Nigeria

Gratuities and pensions are payments due to retired civil servants; however, payments of these have not been timely and consistent to the extent that 23 state governments are owing N836.40 billion as gratuities and pension liabilities as of the end of 2022. Non-payment of these retirement benefits is often accompanied by social and health problems, leading to the premature death of retirees. Consequently, this study aims to examine the potential of monthly Pay As You Earn (PAYE) tax to eliminate the backlog of retirement benefits owed to retired civil servants. To achieve this aim, quantitative secondary data of PAYE tax collections by state governments is collected from the annual Internally Generated Revenue reports of states published by the National Bureau of Statistics (NBS) 2010-2022. Descriptive statistical analysis tools are employed to analyze collected data while Burgess’s activity theory and public policy analytical framework guided the conduct of the study. On the overall, results from the study revealed that while the 23 state governments owe N836.40billion as liabilities of retirement as at 2022, the same states have collected the sum of N5,672billion as PAYE tax 2010-2022. On individual states, 20 states have collected PAYE tax 2010-2022 more than their liabilities of retirement benefits, while only three states collected PAYE tax less than their accumulated liabilities of retirement benefits. The short-run policy implication is for states to set aside collected PAYE tax to settle the backlog of benefits and adopt the Contributory Pension Scheme (CPS) to avoid future recurrence of the backlog

PET-CT-guided, symptom-based, patient-initiated surveillance versus clinical follow-up in head neck cancer patients (PETNECK2): study protocol for a multicentre feasibility study and non-inferiority, randomised, phase III trial

BackgroundApproximately 40% of treated head and neck cancer (HNC) patients develop recurrence. The risk of recurrence declines with time from treatment. Current guidelines recommend clinical follow-up every two months for the first two years after treatment, with reducing intensity over the next three years. However, evidence for the effectiveness of these regimes in detecting recurrence is lacking, with calls for more flexible, patient-centred follow-up strategies.MethodsPETNECK2 is a UK-based multi-centre programme examining a new paradigm of follow-up, using positron emission tomography-computed tomography (PET-CT)-guided, symptom-based, patient-initiated surveillance. This paradigm is being tested in a unblinded, non-inferiority, phase III, randomised controlled trial (RCT). Patients with HNC, one year after completing curative intent treatment, with no clinical symptoms or signs of loco-regional or distant metastasis will be randomised using a 1:1 allocation ratio to either regular scheduled follow-up, or to PET-CT guided, patient-initiated follow-up. Patients at a low risk of recurrence (negative PET-CT) will receive a face-to-face education session along with an Information and Support (I&S) resource package to monitor symptoms and be in control of initiating an urgent appointment when required. The primary outcome of the RCT is overall survival. The RCT also has an in-built pilot, a nested QuinteT Recruitment Intervention (QRI), and a nested mixed-methods study on patient experience and fear of cancer recurrence (FCR). An initial, single-arm feasibility study has been completed which determined the acceptability of the patient-initiated surveillance intervention, the completion rates of baseline questionnaires, and optimised the I&S resource prior to implementation in the RCT.DiscussionWe hypothesise that combining an additional 12-month post-treatment PET-CT scan and I&S resource will both identify patients with asymptomatic recurrence and identify those at low risk of future recurrence who will be empowered to monitor their symptoms and seek early clinical follow-up when recurrence is suspected. This change to a patient-centred model of care may have effects on both quality of life and fear of cancer recurrence.Trial registrationISRCTN: 13,709,798; 15-Oct-2021.

After Surgically Induced Remission, Ileal and Colonic Mucosa-Associated Microbiota Predicts Crohn’s Disease Recurrence

Investigating the tissue-associated microbiota after surgically induced remission may help to understand the mechanisms initiating intestinal inflammation in Crohn's disease. Patients with Crohn's disease undergoing ileocolic resection were prospectively recruited in 6 academic centers. Biopsy samples from the neoterminal ileum, colon, and rectosigmoid were obtained from colonoscopies performed after surgery. Microbial DNA was extracted for 16S rRNA gene sequencing. Microbial diversity and taxonomic differential relative abundance were analyzed. A random forest model was applied to analyze the performance of clinical and microbial features to predict recurrence. A Rutgeerts score ≥i2 was deemed as endoscopic recurrence. A total of 349 postoperative colonoscopies and 944 biopsy samples from 262 patients with Crohn's disease were analyzed. Ileal inflammation accounted for most of the explained variance of the ileal and colonic mucosa-associated microbiota. Samples obtained from 97 patients who were in surgically induced remission at first postoperative colonoscopy who went on to develop endoscopic recurrence at second colonoscopy showed lower diversity and microbial deviations when compared with patients who remained in endoscopic remission. Depletion of genus Anaerostipes and increase of several genera from class Gammaproteobacteria at the 3 biopsy sites increase the risk of further recurrence. Gut microbiome was able to predict future recurrence better than clinical features. Ileal and colonic mucosa-associated microbiome deviations precede development of new-onset ileal inflammation after surgically induced remission and show good predictive performance for future recurrence. These findings suggest that targeted microbial modulation is a plausible modality to prevent postoperative Crohn's disease recurrence.

Fragile X Syndrome: A Review for General Pediatricians.

Fragile X syndrome is the most commonly inherited form of intellectual disability. Identifying fragile X syndrome at a young age can be quite challenging because the classical physical features usually present in late childhood or early adolescence; therefore, it is important to consider genetic testing for all males with unexplained developmental delays, intellectual disability, and autism, females with developmental delays, intellectual disability or autism, and a family history of fragile X gene disorders. There is no specific treatment to manage fragile X syndrome. Still, a prompt referral for early intervention is essential to help maximize the child's learning potential, as well as a referral to child psychology if any behavioral concerns are present. It is of paramount importance for families with a history of fragile X syndrome to have access to genetic counseling as it can aid in future reproductive decisions and the risk of future recurrences of this condition. [Pediatr Ann. 2024;53(7):e269-e271.].

Longitudinal risk prediction for pediatric glioma with temporal deep learning.

Pediatric glioma recurrence can cause morbidity and mortality; however, recurrence pattern and severity are heterogeneous and challenging to predict with established clinical and genomic markers. Resultingly, almost all children undergo frequent, long-term, magnetic resonance (MR) brain surveillance regardless of individual recurrence risk. Deep learning analysis of longitudinal MR may be an effective approach for improving individualized recurrence prediction in gliomas and other cancers but has thus far been infeasible with current frameworks. Here, we propose a self-supervised, deep learning approach to longitudinal medical imaging analysis, temporal learning, that models the spatiotemporal information from a patient's current and prior brain MRs to predict future recurrence. We apply temporal learning to pediatric glioma surveillance imaging for 715 patients (3,994 scans) from four distinct clinical settings. We find that longitudinal imaging analysis with temporal learning improves recurrence prediction performance by up to 41% compared to traditional approaches, with improvements in performance in both low- and high-grade glioma. We find that recurrence prediction accuracy increases incrementally with the number of historical scans available per patient. Temporal deep learning may enable point-of-care decision-support for pediatric brain tumors and be adaptable more broadly to patients with other cancers and chronic diseases undergoing surveillance imaging.

Deep learning for 4D modeling of glioblastoma multiforme with tumor treating fields (TTFields) therapy.

e14032 Background: Prediction of future tumor growth and recurrence are critical in the management of patients with glioblastoma multiforme (GBM). This study develops a deep learning method for estimating future areas of GBM spread across multiple timepoints using MRI in patients receiving tumor treating fields (TTFields) therapy. Methods: A single institutional database was queried to identify adult patients with histologically confirmed newly diagnosed and/or recurrent GBM undergoing TTFields therapy. For newly diagnosed GBM, patients received TTFields with temozolomide after maximal debulking surgery and chemoradiation therapy. For recurrent GBM, patients received TTFields as monotherapy. For each patient, all serial follow-up MRI exams were obtained, including T1 (pre-/post-contrast), T2, and T2/FLAIR sequences. On each exam, all regions of enhancing tumor core (excluding peritumoral edema, necrotic core, or resection cavity) were delineated and aligned across time points using nonlinear deformable registration. For any given pair of serial exams, a convolutional neural network (CNN) was designed to predict future GBM tumor on the follow-up exam given the precursor exam and time interval between the studies. The model is implemented as a 3D encoder-decoder architecture yielding a dense per-voxel prediction of future tumor probability optimized using a binary cross-entropy loss function. Class weights were used to develop high sensitivity and high positive predictive value (PPV) model variants. To generate final logit scores, time information is concatenated to the penultimate feature map as an additional feature channel, allowing the model to calibrate each estimate based on elapsed time between any pair of exams. Upon convergence, a 4D learned representation allows for prediction of spatial distribution of GBM tumor at any future time point. Results: A total of 123 patients (1112 total MR exams) were identified. For any given single patient, a median of 6 follow-up exams (IQR 2.5-12.5) at a median interval follow-up time of 46 days (IQR 15.75-63 days) between exams was observed. Upon five-fold cross-validation, the model demonstrated a 0.44 Dice score overlap between predicted and true areas of future GBM tumor growth. The high sensitivity model yielded a per-voxel sensitivity of 0.91 (IQR 0.77-0.99) and PPV of 0.26 (IQR 0.17 to 0.32), while the high PPV model yielded a per-voxel sensitivity of 0.14 (IQR 0.00 to 0.46) and PPV of 0.75 (IQR 0.56 to 0.94). Upon visual confirmation, model predictions across incremental time values for any given exam yielded expected gradual growth of tumor over time. Conclusions: A deep learning model can accurately predict future areas of GBM tumor growth in patients receiving TTFields therapy, with optimal performance that may be calibrated for high sensitivity or high PPV based on clinical use case.

THE INCIDENCE OF ADDITIONAL HERNIA DEFECTS IN A DIASTATIC LINEA ALBA, NOT REPORTED ON PRE-OPERATIVE CT IMAGING

Abstract Aim Patients with ventral primary or incisional hernias with significant recti diastasis are frequently refered to abdominal wall reconstruction (AWR) services. We audited the rate of incidental intra-operative ventral defects related to diastatic linea alba. Method A retrospective analysis of a prospectively maintained database was carried out from March 2023 to January 2024. All patients who underwent AWR using a minimally invasive approach (MIS) were included. Data on the following variables were collected: sex, age (years), BMI (kg/m2), length of hospital stay (LOS, days), operative time (hours), and ventral defects. Results 27 patients underwent MIS AWR (22 robotic; 8 laparoscopic). Male to female ratio was 16:11. Median age was 58 years (IQR 48–66) and BMI 36 kg/m2 (IQR 32–37). All patients underwent eTEP retro-rectus Rives-Stoppa + diastasis plication using macroporous polypropylene non-absorbable synthetic mesh. Median operating time was 3.3 hours (IQR 3.1–3.5) and LOS was 2 days (IQR 1–2). 1 (3%) patient had laparoscopic converted to open procedure due to bowel involvement. 13 (48%) of patients had extra defects associated with diastatic linea alba which were not visualized in pre-operative cross-sectional imagining. Conclusion When compared to a local repair, the MIS AWR approach in patients with ventral hernias and significant diastasis is justified when considering the high likelihood of synchronous linea alba defects and therefore a risk for future recurrence. These extra defects are rarely detected on pre-operative cross-sectional images. In addition, the plication of diastasis during AWR allows surgeons to recreate a more functional linea alba.

Mutational Profiles of Cutaneous Squamous Cell Carcinomas with Different Patterns of Clinical Aggression from Head and Neck Regions.

Cutaneous squamous cell carcinoma is a prevalent malignancy with a rising incidence and a notably high mutational load. Exploring the genetic nuances of cSCC and investigating molecular approaches stands as a potential avenue for improving outcomes in high-risk patients. This retrospective case-control study involved two cohorts, one of 14 patients (the "discovery cohort") and the other of 12 patients (the "validation cohort"), with cSCC located in the head/neck anatomical region and diagnosed at the pT2 stage. Overall, cases developed early local relapses of the disease, whereas controls never relapsed during the entire follow-up period. A next-generation sequencing (NGS) approach conducted on histological samples revealed that TP53 and CDKN2A were the most frequently mutated genes in our series. No specific mutations were identified as potential prognostic or therapeutic targets. Controls exhibited a tendency toward a higher mutational rate compared to cases. It is possible that an increased number of mutations could prompt the cSCC to expose more antigens, becoming more immunogenic and facilitating recognition by the immune system. This could enhance and sustain the immunological response, potentially preventing future recurrences.

Abstract PO5-26-07: Surgery for Invasive Lobular Carcinoma: A Patient Experience Survey from the Lobular Breast Cancer Alliance

Abstract The Lobular Breast Cancer Alliance (LBCA) is a nonprofit, patient advocacy organization committed to raising awareness and promoting research into invasive lobular carcinoma (ILC). While ILC accounts for 15% of breast cancers, knowledge about ILC remains limited. ILC’s hallmark is lack of E-cadherin, which results in non-cohesive formation and impacts accuracy of imaging tests and staging. Consequently, patients with ILC have higher rates of positive surgical margins, mastectomies, and axillary lymph node (LN) dissections. To understand the surgery experience of individuals with ILC, LBCA conducted an anonymous online survey from 6/21-7/2/23, distributed via the LBCA newsletter, social media, and partner organizations. Questions addressed pre-operative imaging, type of surgery, surgical margins, LN status, decision making about and patient experience with surgery. Analyses were limited to those respondents who had surgery. Study limitations include potential recall and selection bias. Results 1,482 individuals with a diagnosis of ILC completed the survey and 1,426 had undergone surgery. 76% were from North America, 11% from England, and 4% from Australia. Average age at diagnosis was 56 (range 31-86). At diagnosis, 38% were clinically stage 1; 37% stage 2; 17% stage 3; and 4% de novo metastatic. 75% had a mammogram that indicated dense breasts. Of 1,426 surgery respondents (SR), 95% reported that ILC was identified in only one breast at diagnosis. 80% had a pre-surgical MRI. MRI revealed larger tumors than seen on other imaging for 43% and revealed previously unseen contralateral ILC for 3%. 375 (26%) of SRs were diagnosed with ipsilateral disease and had a pre-surgical MRI that did not reveal new information about their ILC. Of these, post-surgical pathology reports indicated 16% had additional ipsilateral foci, 2% contralateral disease, and 40% had larger tumors than seen on pre-surgical imaging. 614 (43%) of SRs had one or more lumpectomy (L), 560 (39%) of SRs had a double mastectomy (DM), and 451 (32%) of SRs had a single mastectomy (SM). 123 (20%) of SRs who had one or more Ls, had a subsequent SM or DM. For those undergoing L (614), reasons for this choice included: recommendation from their care team (83%), wanted to keep their breast (25%), thought it was better for their overall survival (OS) (14%), and 13% indicated they wanted breasts but did not want reconstruction. Of the 560 women who had a DM, 60% indicated that they thought a DM would improve their OS, 50% were concerned about the risk of local recurrence, 47% doubted that imaging would detect future ILC tumors, and 45% noted concern that ILC is more likely to be bilateral. Of note, only 9% had ILC or ILC and another invasive breast cancer in both breasts at initial diagnosis and 31% who had a pre-surgical MRI changed their initial surgical treatment plan. Post surgery, pathology for DM group revealed larger tumors than seen on imaging (57%), and 6% had tumors found in a second breast that were not seen on imaging. For those 451 who had an SM, reasons for this choice included: 75% said it was what their care team recommended, 35% thought it would improve OS, 20% feared risk for local recurrence, and 15% doubted imaging would detect future ILC. Of 614 respondents who had L, 33% had positive margins at first surgery. Of those, 17% reported multiple Ls and M; and 24% reported clear margins were never achieved. Of the 1011 SM or DMs reported, 10% did not achieve clear margins after these surgeries. Conclusion The survey demonstrates the experience of a large cohort of women with ILC, reporting high rates of uncertainty about accuracy of imaging, high rates of repeat surgery, bilateral mastectomies, and positive margins. Patients are factoring concerns about potential extent of disease and future recurrence in their surgical decision making. These results support the need for improved pre-operative staging and imaging modalities specific to ILC. Citation Format: Laurie Hutcheson, Janice Axelrod, Tracy Cushing, Colleen Fitzwater, Rinath Jeselsohn, Gitte Joergensen, Maria Karsten, Miranda Kimm, Megan Kruse, Theresa Langdon, Julia Levine, Mason Mitchell-Daniels, Rita Mukhtar, Barbara Neilsen, Shani Paluch-Shimon, Therese Pross. Surgery for Invasive Lobular Carcinoma: A Patient Experience Survey from the Lobular Breast Cancer Alliance [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 PO5-26-07.

DEVELOPMENT AND INTERNAL VALIDATION OF A PREDICTION MODEL TO PREDICT THE PROBABILITY OF FUTURE RECURRENCE OF HYPERTENSION IN PATIENTS WITH HYPERTENSIVE DISORDERS OF PREGNANCY

Objective: This study aimed to obtain a clinical prediction model for the future recurrence of hypertension in women with a history of gestational hypertension or Preeclampsia-Eclampsia by analyzing the basic data and laboratory indicators in their pregnancy. Design and method: We retrieved hypertensive disorders of pregnancy (HDP) patients of the First Affiliated Hospital of Dalian Medical University and the Second Affiliated Hospital of Dalian Medical University from 2001 to June 2021. After telephone follow-up, a total of 605 pregnant women with previous HDP were followed up. The baseline data of the cases were followed by binary logistic regression analysis according to the follow-up hypertension outcome, Nomogram plotted according to independent risk factors, and the model discrimination was tested by operating characteristic curve (ROC), The reproducibility of the model was verified by internal validation on the development dataset (Bootstrap self-sampling method, internal cross-validation and Jackknife validation), verify the calibration of the model through the calibration curve (Hosmer-Lemeshow goodness of fit test), and Validation of clinical predictive value by Decision Curve Analysis (DCA). Results: data analysis showed that A total of 200 (33.06%) pregnant women with a previous history of HDP had recurrent hypertension during follow-up (median follow-up time was 5 years). The predictors in the Nomogram were the highest diastolic blood pressure (DBP) during pregnancy, the highest systolic blood pressure (DBP) during pregnancy, peak Alkaline phosphatase value, age at delivery, peak uric acid value, and positive urine protein, Contrary to the remaining 5 predictors, a low level of peak alkaline phosphatase value predicted a high risk of postpartum hypertension. the Area Under Curve (AUC) of ROC about the nomogram was 0.797, and a similar C-index was obtained in the internal validation, and this model show a high fitting degree in the calibration curve and show clinical predictive value. Conclusions: The results of this study can provide predictive indicators for women with HDP to suffer from hypertension after delivery, which can be used for clinical decision-making, and aid with follow-up blood pressure monitoring and the selection of primary prevention treatment groups.

Predicting glioblastoma recurrence using multiparametric MR imaging of non-enhancing peritumoral regions at baseline

BackgroundTo assess the feasibility of multiparametric magnetic resonance imaging in predicting tumor recurrence in nonenhancing peritumoral regions in patients with glioblastoma at baseline. MethodsFifty-eight patients with recurrent glioblastoma underwent multiparametric magnetic resonance imaging, including T2-weighted fluid-attenuated inversion recovery, diffusion-weighted imaging, and dynamic susceptibility contrast perfusion-weighted imaging. Nonenhancing peritumoral regions with glioblastoma recurrence were identified by coregistering preoperative and post-recurrent magnetic resonance images. Regions of interest were placed in nonenhancing peritumoral regions with and without tumor recurrence to calculate the apparent diffusion coefficient value, and relative ratios of T2-weighted fluid-attenuated inversion recovery signal intensity, apparent diffusion coefficient, and cerebral blood volume values. ResultsSignificant lower relative T2-weighted fluid-attenuated inversion recovery signal intensity, apparent diffusion coefficient, and relative apparent diffusion coefficient but higher relative cerebral blood volume values were found in the nonenhancing peritumoral regions with tumor recurrence than without recurrence (all P < 0.05). The threshold values ≥ 0.89 for relative cerebral blood volume provide the optimal performance for predicting the nonenhancing peritumoral regions with future tumor recurrence, with the sensitivity, specificity, and accuracy of 84.7%, 83.6%, and 85.8%, respectively. The combination of relative T2-weighted fluid-attenuated inversion recovery signal intensity, apparent diffusion coefficient, and relative cerebral blood volume can provide better predictive performance than relative cerebral blood volume (P = 0.015). ConclusionThe combined use of T2-weighted fluid-attenuated inversion recovery, diffusion-weighted imaging, and dynamic susceptibility contrast perfusion-weighted imaging can effectively estimate the risk of future tumor recurrence at baseline.