Individual Patient Characteristics Research Articles

Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)-WSES project.

Fluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtificial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologiesand artificial intelligence. The response rate was 96% (192/200). Responders affirmed that ICG fluorescence can support the performance of difficult surgical procedures in the emergency setting, particularly in the presence of severe inflammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fluorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fluorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of respondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) affirmed that ICG fluorescence changed always their intraoperative decision-making. Precision surgery effectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artificial intelligence. ICG fluorescence can serve as a valid and safe tool to guide emergency surgery in different scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of high-level evidence within this field, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fluorescence imaging systems and to support emergency surgeons in implementing ICG fluorescence in their daily practice.

#2754 Long-term renal outcomes in ICI-associated acute interstitial nephritis: a comprehensive comparative study

Abstract Background and Aims Immune checkpoint inhibitors (ICI) have transformed cancer treatment, but they may lead to immune-mediated acute interstitial nephritis (ICI-AIN), in 2-5% of patients. About 35-40% show full kidney function recovery three months post ICI-AIN. Limited evidence exists for long-term renal toxicity. The unknown difference in long-term renal function evolution between partial and complete recovery of the acute episode in ICI-AIN is an unexplored area for future research. Additionally, there's no comparative study on the long-term renal function evolution between ICI-AIN and cases associated with other drugs (Drug-AIN) or autoimmune causes (AI-AIN). Method Retrospective, descriptive and observational study. The medical records of all AIN cases diagnosed in the Nephrology Unit of the Bellvitge University Hospital between 2010 and 2023 were reviewed. Longitudinal data on treatments, comorbidities and kidney function were collected. Data was analyzed using descriptive statistics, Chi-square tests, Mann-Whitney U tests and Kaplan Meier analyses. Results A total of 94 out of 96 screened patients were diagnosed with AIN (AI-AIN n = 26; Drug-AIN n = 30; ICI-AIN n = 38). Of those, 89.4% were biopsy-confirmed. Median follow-up was 36.64 months (IQR 12.32-74.28). There were not differences in baseline serum creatinine (sCreat) across the groups, defined as sCreat 6 months prior to AIN. At diagnosis, sCreat was lower in ICI-AIN compared to Drug-AIN (267.62 ± 116.44 vs 553.20 ± 317.46, p < 0.001), but significant differences were not found comparing to AI-AIN. There were not differences in the cumulative dose and days of treatment with prednisone between the three groups. In the first year, 35.5% of ICI-AIN patients and 10.3% with Drug-AIN returned to baseline kidney function (p = 0.020). Over the course of three years, 45.9% reverted to baseline in the ICI-AIN cohort compared to 18.5% in the Drug-AIN cohort (p = 0.023). This trend continued at 5 years, with 45.9% in ICI-AIN and 22.2% in Drug-AIN recovering to baseline (p = 0.051). The proportion of patients who recovered baseline kidney function was comparable between the group diagnosed with ICI-AIN and the group diagnosed with AI-AIN at all evaluated time points. Kaplan-Meier analysis at 1, 3, and 5 years of follow-up revealed a shorter time to sCreat recovery to baseline in the ICI-AIN group compared to the Drug-AIN group, with Log-rank (Mantel-Cox) p-values of 0.016, 0.004, and 0.006, respectively. On the contrary, Kaplan-Meier analysis at the same time points did not reveal differences in time to basal sCreat recovery in ICI-AIN compared to AI-AIN. Among the evaluated variables, only baseline sCreat influenced the recovery of baseline kidney function in in the univariate analysis, with an odds ratio of 0.95 (95% CI 0.903-1, p-value 0.049) in the ICI-AIN group. The mean nadir sCreat and estimated glomerular filtration rate (eGFR) after treating AIN were comparable between ICI-AIN and Drug-AIN patients (nadir sCreat: 107.46 µmol/L and 102.24 µmol/L, respectively; nadir eGFR: 61.89 ml/min and 56.96 ml/min, respectively; p-value ns). However, ICI-AIN patients reached nadir renal function more rapidly after treatment initiation (10.99 vs. 28.06 months, p-value = 0.020). After reaching nadir function, 73.7% of ICI-AIN patients showed decline, similar to Drug-AIN (73.3%) and AI-AIN (88.5%, p ns). Yet, ICI-AIN patients had a higher yearly eGFR decline post-nadir compared to Drug-AIN (−17.05 (ml/min)/year vs. −3.99 (ml/min)/year, p-value 0.006) and autoimmune AIN (−4.09 (ml/min)/year, p-value 0.009). Conclusion In summary, the results of our study suggest that ICI-AIN patients demonstrate a distinctive pattern of recovery after the acute episode and long-term decline in kidney function after reaching the nadir kidney function compared to the Drug-AIN and AI-AIN groups. They exhibit a faster recovery to nadir kidney function but experience a higher yearly decline post-nadir in eGFR. The influence of baseline sCreat on recovery underscores the importance of considering individual patient characteristics in predicting outcomes and optimizing kidney function before initiating treatment with ICI.

Utilizing machine learning to predict post-treatment outcomes in chronic non-specific neck pain patients undergoing cervical extension traction

This study explored the application of machine learning in predicting post-treatment outcomes for chronic neck pain patients undergoing a multimodal program featuring cervical extension traction (CET). Pre-treatment demographic and clinical variables were used to develop predictive models capable of anticipating modifications in cervical lordotic angle (CLA), pain and disability of 570 patients treated between 2014 and 2020. Linear regression models used pre-treatment variables of age, body mass index, CLA, anterior head translation, disability index, pain score, treatment frequency, duration and compliance. These models used the sci-kit-learn machine learning library within Python for implementing linear regression algorithms. The linear regression models demonstrated high precision and accuracy, and effectively explained 30–55% of the variability in post-treatment outcomes, the highest for the CLA. This pioneering study integrates machine learning into spinal rehabilitation. The developed models offer valuable information to customize interventions, set realistic expectations, and optimize treatment strategies based on individual patient characteristics as treated conservatively with rehabilitation programs using CET as part of multimodal care.

#2101 Beyond corticosteroids: rituximab in managing minimal change disease and glucocorticoid-related toxicity

Abstract Background and Aims Minimal Change Disease (MCD) is the primary cause of Nephrotic Syndrome in children, accounting for 10 to 20% of cases in adults. Glucocorticoids (GC) remain the cornerstone of treatment. Despite a positive response in the majority of patients, up to 25% experience frequent relapses, and up to 30% are GC-dependent, exposing them to significant GC-related toxicity. Rituximab has been increasingly used in these patients, although 2021 KDIGO guidelines still points to cyclophosphamide as the preferred second-line therapy. This study aims to describe a single-centre experience with RTX, examining its effectiveness and assessing its potential to reduce GC exposure. Method A retrospective cohort study was conducted on 19 patients with MCD who were considered for RTX at adult age at a tertiary hospital centre between 2015 and 2023. Patients who refused treatment, those with MCD associated with other glomerular diseases, and those with less than 6 months of follow-up post-RTX were excluded from the study. Results Twelve patients met the inclusion criteria, including 5 diagnosed before the age of 18. The mean age at RTX initiation was 38.8 ± 14.8 years, with 75% being male. The median MCD duration pre-RTX was 140.5 [18.8–353.5] months, and the median follow-up post-RTX was 18.0 [12.5–41] months. All patients had preserved renal function and exhibited GC-dependency and/or frequent relapses, with 8 patients having received prior cyclophosphamide and/or cyclosporine A (CsA) treatment. At RTX initiation, all patients were on GC therapy (median 11.1 [10–50] mg/day), with 4 also on CsA. 10 patients were in complete remission, while 2 were in a relapse phase, subsequently achieving complete remission. Various induction regimens were employed: 6 patients received 1000 mg of RTX twice within 2 weeks, 1 received a single dose of 1000 mg, and 5 received a single dose of 500 mg. Out of the 12 patients, 5 did not receive RTX maintenance administrations, while 6 received 500 mg of RTX every 6 to 9 months and 1 patient received 1000 mg every 6 months. Only one adverse event was reported, one uncomplicated upper respiratory tract infection. Regardless of the induction regimen, all patients maintained a sustained response with complete remission for the following 6 months. All the 7 patients who underwent RTX maintenance did not experience disease relapse, although 2 continued GC therapy (one due to an associated autoimmune disease). Among the 5 patients who did not undergo RTX maintenance, 3 maintained complete remission throughout the follow-up, with a mean time free from any immunosuppression of 14.8 ± 10.6 months. The other 2 patients relapsed at a mean time of 27.5 ± 0.7 months. After relapse, 1 patient resumed GC therapy, and both started RTX maintenance with 500 mg every 6 to 9 months, subsequently achieving and maintaining complete remission. Among the 12 patients, 9 discontinued GC (1 continued CsA) after an average of 5.9 ± 4.2 months post-RTX, with a mean GC-free period of 16.6 ± 13.2 months during the follow-up period. Conclusion RTX proved to be safe and effective for steroid-dependent and/or frequently relapsing MCD, even with a low induction single dose of 500 mg. This low induction regimen may be an effective and potentially preferable option to minimize toxicity. RTX can significantly reduce relapse rate and steroid dose, avoiding complications associated with extended and high-dose GC administration. Notably, this outcome was not achieved previously with cyclophosphamide or CsA. RTX maintenance therapy may not be universally required for all patients with MCD, since a long period without relapse can be observed after induction therapy. Considering the current absence of a marker for disease activity, it should be taken into account individual patient characteristics and disease severity, particularly previous relapses after RTX induction. Considering the RTX effectiveness, ability to extend remission, safety, and GC sparing ability, it should be seriously considered as the preferred second-line treatment.

A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I.

Chiari Malformation Type I (CM1) is characterized by the downward displacement of the cerebellar tonsils below the foramen magnum. The standard surgical treatment for CM1 is foramen magnum decompression and atlas laminectomy (FMD-AL). However, there is a growing interest in exploring minimally invasive techniques, such as neuroendoscopically assisted FMD-AL, to optimize surgical outcomes. The aim is to present the results of the less invasive neuroendoscopic-assisted system application as an alternative to decompression surgery in patients with CM-1 with/without syringomyelia. A retrospective analysis was conducted on 76 patients with CMI who underwent either neuroendoscopic-assisted FMD-AL (n = 23) or open surgery (n = 53). Preoperative and postoperative assessments were performed, including pain levels, functional assessment, outcome and serum creatinine kinase (CK) levels. Surgical parameters and radiological imaging were also evaluated and compared. Both surgical groups showed improvements in pain levels and increase in postoperative CK levels. There were no statistically significant differences between the groups in terms of postoperative JOA scores, VAS scores, CCOS, or syrinx resolution. However, the neuroendoscopic group had significantly lower CK levels, shorter hospital stays, less blood loss, and shorter operation times compared to the open surgery group, indicating reduced muscle damage and potential benefits of the neuroendoscopic assisted approach. Both neuroendoscopy and open surgery groups can effectively alleviate symptoms and improve outcomes in patients with CM1. The neuroendoscopic assisted technique offers the advantage of reduced muscle damage and shorter hospital stays. The choice of surgical technique should be based on individual patient characteristics and preferences. 3 (Retrospective case-control study) according to using the Oxford Centre for Evidence-Based Medicine (CEBM) Table.

An observational prospective cross-sectional study on extravascular lung water by lung ultrasound as a guide to fluid resuscitation therapy in adult septic shock in tertiary care hospital in central India

Background Septic shock is a life-threatening condition characterized by systemic inflammation and organ dysfunction, with fluid resuscitation being a cornerstone of management. However, indiscriminate fluid administration can lead to fluid overload and worsen outcomes. Extravascular lung water (EVLW) estimation by lung ultrasound has emerged as a promising tool for guiding fluid therapy in septic shock, allowing clinicians to assess pulmonary edema and tailor resuscitation strategies accordingly. Methods This prospective observational study aims to evaluate the utility of EVLW estimation by lung ultrasound in guiding fluid resuscitation therapy in adult patients with septic shock admitted to a rural tertiary care teaching hospital. Eligible patients admitted to the intensive care unit (ICU) will undergo baseline demographic and clinical assessments, including lung ultrasound, to quantify EVLW using B-line analysis. Fluid resuscitation therapy will be initiated based on EVLW findings, with subsequent adjustments guided by repeat lung ultrasound examinations at 6, 12, 24, and 48 hours post-initiation. Outcome measures include changes in mean PaO2/FiO2 ratios, respiratory parameters, renal function, fluid balance, and mortality rates. Expected Outcome We anticipate that EVLW-guided fluid resuscitation therapy will lead to more precise and tailored management of septic shock, potentially reducing the incidence of fluid overload, ARDS, and renal dysfunction. By optimizing fluid management strategies based on individual patient characteristics and responses, we aim to improve clinical outcomes and enhance the delivery of care for patients with septic shock.

COMPARATIVE ANALYSIS OF MEDICAL AND SURGICAL MANAGEMENT OF ECTOPIC PREGNANCY

A pregnancy that occurs in any place other than the endometrial cavity is called ectopic pregnancy. Objectives: The main aim of the study is to find a comparative analysis of medical and surgical management of ectopic pregnancy. Methods: This retrospective study was conducted at Hospital Civil/SPH Quetta. from January 2023 to December 2023. Data was collected from 220 patients. Comprehensive clinical and demographic data were extracted from electronic medical records. These included patient age, gravidity, parity, gestational age at diagnosis, presenting symptoms, imaging results, serum β-hCG levels, treatment modalities utilised, procedural specifics, and post-intervention outcomes. Results: Data were collected from 220 patients suffering from ectopic pregnancies. The mean age of patients in the medical management group was 29.2±4.3 years, and 29.8±4.1 years in the surgical management group. Nulligravid patients were more prevalent in the medical management group (58%) compared to the surgical management group (45%), while multigravida patients were more evenly distributed between the two groups (42% vs. 55%). In comparing medical and surgical management of ectopic pregnancy, surgical management demonstrated a higher success rate (95%) compared to medical management (85%). Medical management with methotrexate typically resolved ectopic pregnancies within an average of 17 days, whereas surgical interventions varied in time to resolution. However, surgical management had a slightly higher complication rate (12%) than medical management (10%). Conclusion: It is concluded that both medical and surgical management options demonstrate high efficacy in resolving ectopic pregnancy, with considerations for individual patient characteristics and clinical presentations.

Octreotide versus Terlipressin as Adjuvant to Endoscopic Variceal Band Ligation in Bleeding Oesophageal Varices: A Systematic Review and Meta-Analysis

Background: Acute variceal bleeding (AVB) is a critical complication of portal hypertension, contributing significantly to mortality worldwide. Pharmacological interventions, including terlipressin and octreotide, have evolved to manage AVB, yet consensus on their comparative effectiveness remains elusive. This study conducts a comprehensive systematic review and meta-analysis of randomized control trials (RCTs) comparing terlipressin and octreotide in the management of AVB, aiming to provide insights into their relative benefits. Methods: This study included RCTs with head-to-head comparisons of terlipressin and octreotide. The search strategy covered PubMed, Scopus, and Cinahl databases, and the included studies involved adult patients with confirmed AVB undergoing endoscopic variceal band ligation (EVBL). Results: Seven RCTs meeting inclusion criteria were included in the meta-analysis. The assessed outcomes were: achieving haemostasis within 24 h, rebleeding rate, and mortality rate. The pooled analysis revealed no statistically significant differences between terlipressin and octreotide in achieving haemostasis (OR: 1.30, p = 0.23), rebleeding rates at 5 days (OR: 0.7, p = 0.23), and mortality at 42 days (OR: 0.9, p > 0.5). Conclusion: This meta-analysis suggests that terlipressin and octreotide exhibit similar efficacy in reducing bleeding, rebleeding rates, and mortality when used as adjuvants to EVBL in AVB. Clinicians are encouraged to consider individual patient characteristics and the broader clinical context when choosing between these agents. Future research should focus on addressing existing evidence gaps and enhancing understanding of variables influencing EVBL outcomes.

International Knee Documentation Committee Subjective Knee Form Latent Growth Model Analysis: Assessing Recovery Trajectories.

Patient-Reported Outcome Measures (PROMs), such as the six-item International Knee Documentation Committee Subjective Knee Form (IKDC-6), play a crucial role in assessing health conditions and guiding clinical decisions. Latent Growth Modeling (LGM) can be employed to understand recovery trajectories in patients post-operatively. Therefore, the purpose of this study was to assess LGM properties of the IKDC-6 in patients with knee pathologies that require surgical intervention and to assess differences between subgroups (i.e., sex and age). A cross-sectional study was conducted using the Surgical Outcome System (SOS) database with patients who had undergone knee arthroscopy. Our results found that preoperative scores did not influence the rate of change overtime. Perceived knee health improved over time, with varying rates among individuals. The adolescent age subgroup and male subgroup exhibited faster recovery rates compared to the older age subgroup and female subgroup. While initial hypotheses suggested IKDC-6 could serve as a prognostic tool, results did not support this. However, results indicated favorable outcomes irrespective of preoperative perceived knee impairment levels. This study provides valuable insights into recovery dynamics following knee surgery, emphasizing the need for personalized rehabilitation strategies tailored to individual patient characteristics.

ChatGPT's Gastrointestinal Tumor Board Tango: A limping dance partner?

ObjectivesThis study aimed to assess the consistency and replicability of treatment recommendations provided by ChatGPT 3.5 compared to gastrointestinal tumor cases presented at multidisciplinary tumor boards (MTBs). It also aimed to distinguish between general and case-specific responses and investigated the precision of ChatGPT's recommendations in replicating exact treatment plans, particularly regarding chemotherapy regimens and follow-up protocols. Material and methodsA retrospective study was carried out on 115 cases of gastrointestinal malignancies, selected from 448 patients reviewed in MTB meetings. A senior resident fed patient data into ChatGPT 3.5 to produce treatment recommendations, which were then evaluated against the tumor board's decisions by senior oncology fellows. ResultsAmong the examined cases, ChatGPT 3.5 provided general information about the malignancy without considering individual patient characteristics in 19% of cases. However, only in 81% of cases, ChatGPT generated responses that were specific to the individual clinical scenarios. In the subset of case-specific responses, 83% of recommendations exhibited overall treatment strategy concordance between ChatGPT and MTB. However, the exact treatment concordance dropped to 65%, notably lower in recommending specific chemotherapy regimens. Cases recommended for surgery showed the highest concordance rates, while those involving chemotherapy recommendations faced challenges in precision. ConclusionsChatGPT 3.5 demonstrates potential in aligning conceptual approaches to treatment strategies with MTB guidelines. However, it falls short in accurately duplicating specific treatment plans, especially concerning chemotherapy regimens and follow-up procedures. Ethical concerns and challenges in achieving exact replication necessitate prudence when considering ChatGPT 3.5 for direct clinical decision-making in MTBs.

Surgical cystogastrostomy: Is it still worthwhile?

The article by Ker et al explores the treatment of peripancreatic fluid collection (PFC). The use of percutaneous drainage, endoscopy, and surgery for managing PFC are discussed. Percutaneous drainage is noted for its low risk profile, while endoscopic cystogastrostomy is more effective due to the wider orifice of the metallic stent. Surgical cystogastrostomy is a definitive treatment with a reduced need for reintervention, especially for cases with extensive collections and significant necrosis. The choice of treatment modality should be tailored to individual patient characteristics and disease factors, considering the expertise available.

Drug Coated Balloon vs. Drug Eluting Stent in Multiculprit Primary Percutaneous Revascularization

Background: Patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) frequently face multivessel coronary artery disease (CAD). The optimal interventional approach remains debated. Objective: To systematically review and analyze the effectiveness and safety of drug-coated balloons (DCB) versus drug-eluting stents (DES) in multiculprit primary PCI through a randomized controlled trial. Methods: This prospective, single-center, randomized controlled trial included 100 patients with STEMI and multivessel CAD at Lady Reading Hospital Peshawar from April 2023 to March 2024. Patients aged 18 years or older requiring revascularization of two or more culprit lesions were randomized into two groups: one received DCBs and the other DES. Exclusions were based on contraindications to dual antiplatelet therapy, allergies to study drugs, bleeding disorders, or life expectancy under one year. Results: Each group comprised 50 patients. The prevalence of hypertension (56% in DCB vs. 60% in DES, p=0.68) and diabetes (36% in DCB vs. 40% in DES, p=0.72) was similar. TVR rates were 10% for DCB and 8% for DES (p=0.45). MACE rates were 14% for DCB and 12% for DES (p=0.37). Conclusion: The study supports the use of DCB as an alternative to DES in specific clinical scenarios, emphasizing the need for tailored treatment decisions based on individual patient and lesion characteristics.

Factors Influencing the Self-management of Breast Cancer-Related Lymphedema: A Meta-synthesis of Qualitative Studies.

Patients with breast cancer have an estimated 14% to 60% risk of developing lymphedema after treatment. Self-management behavior strategies regarding lymphedema are essential in preventing and alleviating the severity of lymphedema. The aim of this study was to evaluate qualitative research evidence on the potential influencing factors for self-management behaviors of lymphedema in patients with breast cancer. A systematic search of 10 electronic databases was conducted to identify qualitative studies on patient experience of lymphedema self-management. The following databases were included and appraised using the Joanna Briggs Institute Critical Appraisal Checklist: Cochrane Library, PubMed, EMBASE, Web of Science, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang Med Online, and Chinese Biomedical Database. The literature search yielded 5313 studies, of which only 22 qualitative studies fulfilled the eligibility criteria. Five synthesized findings were derived encompassing personal characteristics, personal knowledge and experience, personal health beliefs, self-regulation skills and abilities, and social influences and support. Patients with breast cancer are confronted with many challenges when performing self-management of lymphedema. Therefore, it is important to recognize potential facilitators and barriers to further offer practical recommendations that promote self-management activities for lymphedema. Healthcare professionals should receive consistent training on lymphedema management. On the basis of individual patient characteristics, tailored education and support should be provided, including transforming irrational beliefs, and improving related knowledge and skills, with the aim to promote self-management behaviors with respect to lymphedema.

Abstract PO5-21-04: Leveraging Digital Twins for Patient Stratification and Treatment Optimization in geriatric oncology: A Breast Cancer Multivariate Clustering Analysis

Abstract Context: Geriatric oncology necessitates an accurate evaluation of a patient's health status and cancer characteristics. Digital twins, virtual replicas of a patient and their cancer, can aid in predicting real-world behaviors and support therapeutic decision-making. Objectives: This study aims to demonstrate how digital twins can optimize treatments by simulating various scenarios based on the individual characteristics of patients and their cancers. Methods: Creation of a digital twin relies on the use of advanced manifold learning technologies. A model is built to represent the variability present in the reference cohort, capturing complex relationships and inherent data structures. A reference digital twin is generated by drawing samples from this model, thus reflecting the characteristics distribution of the reference population. Stratification (MeanShift algorithm) enables cohort structure visualization and classical statistics estimation for each stratum. Multivariate analysis was performed on a French monocentric population of 1345 patients aged over 70 years who underwent surgery for HER2-negative early breast cancer. Results: 8 cluster, created by manifold learning based on biological, demographic, and tumoral variables, exhibits unique five-year survival rates and influential factors. The clusters represent specific patient subgroups, each with its distinct set of characteristics and prognostic indicators. Table 1 provides a summary of these variables' averages within each cluster. we can thus see that the variables of clusters 3 and 6 (including only HR+ cancers) do not show statistically significant differences, unlike their 5-year survival rates (cluster 3 : 80,9% (CI95 :70-88.5) and 63.9% (CI95 :47.6-77.5) for cluster 6, p= 0,04). Provided with model results, the relative importance of these variables varies from one cluster to another, underscoring the heterogeneity among patient subgroups. Interestingly, Hormonal receptor status, nodal involvement and tumoral grade were not the predominant variables in these clusters, which challenges traditional perspectives. Table 1 : Mean value of variables per cluster (SBR grade 0=grade 1 and 2 ; 1= grade 3) Discussion: The findings underscore the vast variability of individual variable importance across clusters. Digital twins enabled the modeling of these complex interactions, providing valuable insights for clinical decision-making. Conclusion: Digital twins offer a valuable tool for personalizing care in oncogeriatrics, facilitating the identification of patient subgroups, yielding more accurate treatment outcomes, and guiding future research directions. The results affirm that incorporating digital twins into oncogeriatric care could potentially lead to the enhanced personalization of therapeutic approaches, ultimately improving patient outcomes. Table. Citation Format: Pierre Heudel, Mashal Ahmed, Felix Renard. Leveraging Digital Twins for Patient Stratification and Treatment Optimization in geriatric oncology: A Breast Cancer Multivariate Clustering Analysis [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 PO5-21-04.

Abstract PO1-07-06: Sonographic assessment of breast implants using strain elastography and shear wave elastography in an animal model

Abstract Purpose: To date, MRI remains the gold standard for the diagnosis of breast implant rupture. As MRI is an expensive procedure with limited availability, improvement in sonographic assessment is desirable. A potentially useful tool in this regard is the assessment of tissue stiffness using ultrasound elastography. Strain elastography provides a qualitative analysis by producing a coloured map in the B-mode image comparing the stiffness of adjacent tissues in the region of interest, whereas shear wave elastography provides a quantitative analysis. To evaluate the diagnostic utility of both methods under standardised conditions, we developed an animal model. Under natural conditions, the physiology of the patient (e.g. the amount and stiffness of the breast tissue covering the implant in question) can influence the measurements and alter the data. Therefore, the animal model provides an excellent opportunity to compare ruptured and intact implants of different types and sizes under exactly the same conditions, neglecting individual characteristics of real patients. Methods: An animal model was created by preparing an implant site in a chicken breast, mimicking the layers of tissue typically covering a breast implant after mastectomy (skin, fat, muscle). Different fractured and intact implants were inserted. Measurements were made using strain elastography and shear wave elastography by an investigator with no further experience of breast ultrasound. Implants were scanned in five pre-defined planes in both intact and ruptured conditions. For strain elastography, the resulting images were examined for repetitive patterns. Shear wave elastography data were analysed for significant differences between ruptured and intact implants. Results: The chicken breast animal model produced realistic images and measurements comparable to those of a human breast. Therefore, ruptured and intact implants could be compared under standardised conditions. Statistical analysis showed no significant difference between intact and ruptured implants in shear wave elastography data. However, qualitative analysis using strain wave elastography showed different patterns when comparing intact and ruptured implants in the animal model. Intact implants showed a characteristic three-layer sonographic image at certain levels. Conclusion: Shear wave elastography does not appear to provide reliable data for the evaluation of breast implants, whereas qualitative analysis using strain wave elastography may be a useful tool to improve diagnostic accuracy. Citation Format: Hanna Fritsch, Melisa Celik, Matthias Warm, Fabinshy Thangarajah, Anett Pisek, Christian Eichler. Sonographic assessment of breast implants using strain elastography and shear wave elastography in an animal model [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 PO1-07-06.

The Future Role of Abdominal US in Hepatocellular Carcinoma Surveillance.

Abdominal US is currently the best-validated surveillance strategy for hepatocellular carcinoma (HCC) in at-risk patients. It is the only modality shown to have completed all five phases of validation and can achieve high sensitivity and specificity for HCC detection, especially when conducted by expert sonographers in high-volume centers. However, US also has limitations, including operator dependency and varying sensitivity in clinical practice. Further, the sensitivity of US for early-stage HCC detection is lower in patients with obesity or nonviral liver disease, increasingly common populations undergoing surveillance. Imaging-based and blood-based surveillance strategies, including abbreviated MRI and biomarker panels, may overcome some limitations of US-based surveillance. Both strategies have promising test performance in phase II and phase III biomarker studies and are undergoing prospective validation. Considering the variation in HCC risk and test performance between patients, there will likely be a shift away from a one-size-fits-all approach and toward precision screening, in which the "best" test is selected based on individual patient characteristics. In this upcoming era of precision HCC screening among patients with cirrhosis, US will likely continue to have an important, albeit reduced, surveillance role.

Coccydynia: A Review of Anatomy, Causes, Diagnosis, and Treatment.

» Coccydynia is a painful condition affecting many patients at the terminal caudal end of the spine.» An understanding of coccyx anatomy and variations of morphology is necessary for proper diagnosis. A multifactorial etiology for pain may be responsible for this clinical entity.» Several treatment options exist. Successful outcomes for patients depend on individual patient characteristics and the etiology of pain.

МАТЕМАТИЧЕСКИЕ МОДЕЛИ И ЧИСЛЕННЫЕ МЕТОДЫ В КАРДИОЛОГИИ: СОБСТВЕННЫЙ ОПЫТ

Вackground. In the era of digital transformation in medicine, which is radically changing the way patient information is stored, processed and used, medical professionals need new tools and approaches that can efficiently process and interpret data for fast and accurate decision making. These methods also enable the creation of personalized treatment approaches, taking into account individual patient characteristics and risks. In this article, the authors share their own experience in applying numerical methods in cardiology. Purpose of the study. To develop methods of effective risk assessment of cardiovascular outcomes in different categories of patients. Characteristics of patients and methods of the study. Three variants of outcome prediction were included in the study. The 1st - assessment of the total risk of one-year cardiovascular outcomes after myocardial infarction with ST-segment elevation, the 2nd - assessment of the risk of postinfarction chronic heart failure, the 3rd – assessment of the risk of progressive course of atherosclerosis. Statistical analysis methods included the free cross-platform visual programming system Orange, the SPSS 22.0 package, and the C programming language console. Results and Conclusion. The conducted study has shown that the application of different approaches: regression analysis, machine learning, Excel programming capabilities, C programming language and console interface allows to develop models of cardiovascular outcomes prediction with high accuracy.

Predict the Heart Attack Possibilities Using Machine Learning

Heart disease remains one of the leading causes of mortality worldwide, making early detection and prevention crucial. Machine learning techniques offer promising avenues for predicting heart attack possibilities by analyzing patient data and identifying risk factors. This study explores the development of a predictive model using machine learning algorithms to assess the likelihood of a heart attack based on individual patient characteristics and medical history. The dataset comprises a comprehensive range of features including demographic information, lifestyle factors, medical history, and results from diagnostic tests such as electrocardiograms (ECG), cholesterol levels, and blood pressure readings. Preprocessing techniques such as data cleaning, normalization, and feature engineering are applied to prepare the dataset for analysis. Looking ahead, the article identifies promising avenues for future research, including the integration of multimodal data sources, real-time risk assessment systems, and collaborative efforts to develop standardized benchmarks and evaluation protocols. By synthesizing the collective knowledge gleaned from decades of research, this historical review aims to inform and inspire ongoing endeavors in leveraging machine learning for proactive cardiovascular health management and prevention strategies.

Determining individual suitability for neoadjuvant systemic therapy in breast cancer patients through deep learning.

The survival advantage of neoadjuvant systemic therapy (NST) for breast cancer patients remains controversial, especially when considering the heterogeneous characteristics of individual patients. To discern the variability in responses to breast cancer treatment at the individual level and propose personalized treatment recommendations utilizing deep learning (DL). Six models were developed to offer individualized treatment suggestions. Outcomes for patients whose actual treatments aligned with model recommendations were compared to those whose did not. The influence of certain baseline features of patients on NST selection was visualized and quantified by multivariate logistic regression and Poisson regression analyses. Our study included 94,487 female breast cancer patients. The Balanced Individual Treatment Effect for Survival data (BITES) model outperformed other models in performance, showing a statistically significant protective effect with inverse probability treatment weighting (IPTW)-adjusted baseline features [IPTW-adjusted hazard ratio: 0.51, 95% confidence interval (CI), 0.41-0.64; IPTW-adjusted risk difference: 21.46, 95% CI 18.90-24.01; IPTW-adjusted difference in restricted mean survival time: 21.51, 95% CI 19.37-23.80]. Adherence to BITES recommendations is associated with reduced breast cancer mortality and fewer adverse effects. BITES suggests that patients with TNM stage IIB, IIIB, triple-negative subtype, a higher number of positive axillary lymph nodes, and larger tumors are most likely to benefit from NST. Our results demonstrated the potential of BITES to aid in clinical treatment decisions and offer quantitative treatment insights. In our further research, these models should be validated in clinical settings and additional patient features as well as outcome measures should be studied in depth.