Individualized Treatment Plans Research Articles

Results of esketamine administration in a Greek population: a case series.

Esketamine is a non-selective, competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor in the brain. Through NMDA receptor antagonism, esketamine causes a transient increase in glutamate release, leading to increases in neurotrophic signaling and restoration of synaptic function in brain regions involved in mood regulation and emotional behavior. Several randomized clinical trials have shown its effectiveness in reducing the symptoms of depression in some people, despite its short-term side effects that include mainly disorientation, dizziness, nausea, and increased blood pressure. In 2019, the United States Food and Drug Administration (FDA) as well as the European Medicines Agency approved the use of esketamine nasal spray in combination with an oral antidepressant for treatment-resistant depression in adults. Our study aimed to evaluate the effectiveness of this new therapeutic proposal in a case series of five Greek patients with treatment- resistant depression. Intranasal esketamine was administered under medical supervision in combination with an oral antidepressant. Depressive symptoms were evaluated at three time points (baseline, end of treatment, and one-year post-treatment) using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Patient Health Questionnaire (PHQ-9), the CGI Clinical Global Impression Scale, and the Perceived Deficits Questionnaire for Depression (PDQ-D). Possible side effects were assessed using the Richmond Suppression Agitation Scale (RASS), the Sheehan Disability Scale (SDS), the CADSS Disruptive States Scale, and a predefined list of adverse events (AEs) and serious adverse events (SAEs). Patients followed an individualized treatment plan for seven to twelve months depending on the achievement of an adequate response. Statistical analysis of the results revealed a significant improvement (p<0.05) on all scales used. All participants maintained their level of improvement at follow-up after twelve months. Adverse effects were found to be mild and tolerable. It is worth noting that significant side effects were reported only by the two patients with comorbid personality disorder. The results, despite limited to a small sample, indicate the positive effect of esketamine on the stable reduction of depressive symptoms among patients with resistant depression, even after the completion of treatment.

Multi-omics research progress in early-onset colorectal cancer

Globally, the incidence of early-onset colorectal cancer (EOCRC) among individuals younger than 50 is escalating. Compared to late-onset colorectal cancer, EOCRC exhibits distinct clinical, pathological, and molecular features, with a higher prevalence in the left colon and rectum. However, the occurrence and development of EOCRC is a multi-factor and multi-stage evolution process, which is the result of the mutual effect of environmental, genetic and biological factors, and involves the multi-level regulation mechanism of other organisms. With the development and improvement of high-throughput sequencing technology, the application of multi-omics analysis has become an important development direction to resolve the pathogenesis of complex diseases and individualized treatment plans. This article aims to review the research progress of EOCRC at the multi-omics level, providing a theoretical foundation for earlier diagnosis and more precise treatment of this diseases.

#426 “Predict-PD”: a machine learning tool to predict patient survival in peritoneal dialysis patients

Abstract Background and Aims With the rising prevalence of chronic kidney disease (CKD), particularly among the elderly, the need for effective renal replacement therapy has become increasingly crucial. Peritoneal dialysis (PD), recognized as a gentler alternative to haemodialysis, offers advantages in cognitive preservation and overall quality of life. Patient survival on PD, a tangible outcome measure, gains particular importance, especially in an aging demographic confronting end-stage kidney disease. Predicting survival thus becomes vital in facilitating individualized treatment planning and has implications on resource allocation and patient counseling. Method Our study analysed data from the UK Renal Registry and included 22 711 incident dialysis patients choosing PD between 2007 and 2022. Our objective was to employ Artificial Intelligence (AI) algorithms in developing an advanced risk stratification indicator with high predictive capabilities, specifically tailored for use in the United Kingdom's transplant selection procedure. We conducted experiments using three distinct machine learning models and evaluated their performance in terms of calibration and discrimination, utilizing metrics such as the integrated Brier score (IBS) and Harrell's concordance index. We assessed the potential clinical utility using decision curve analysis. Results The XGBoost model demonstrated excellent predictive efficacy for patient survival, with a concordance of 0.78. Further scrutiny revealed AUC values at 1 year (0.81), 3 years (0.78), and 5 years (0.77). The integrated Brier score, a comprehensive measure of predictive accuracy, was 0.09. There was no statistical difference between the actual and predicted survival probabilities (P = 0.72). Decision curve analysis accentuated the model's clinical applicability. Conclusion This study illustrates the potential of machine learning in prognosticating patient survival in PD, offering a pathway towards individualized patient-centric management in nephrology. The findings advocate for the integration of data-driven methodologies in clinical decision-making, paving the way for enhanced personalized care in CKD management and can serve as a guide for future research.

Orthodontic Management of Dental Anomalies in Patients with Cleft Lip and Palate- A Case Series

Introduction: Orthodontic management of patients with cleft lip and palate is a tedious process requiring meticulous treatment planning. However, in patients with a fairly good facial profile, non-surgical management using orthodontic treatment alone can produce astounding results in correction of malocclusion and to achieve a pleasing smile. A properly executed orthodontic treatment enhances not only the smile, but also the masticatory efficiency, speech and overall quality of life of the patients with cleft lip and palate. Methods: This case series describes orthodontic management of three patients with cleft lip and palate who have been treated by distinct treatment modalities. Results: An outline of the different orthodontic treatments along with possible interdisciplinary management has been explained in this case series. Conclusion: We therefore understand that in patients with cleft lip and palate who have a reasonably good facial profile, complete orthodontic therapy with individualized treatment plan is vital to provide good physiological, functional and aesthetic outcomes.

Cluster Analysis and Ablation Success Rate in Atrial Fibrillation Patients Undergoing Catheter Ablation

Atrial fibrillation (AF) is a disease of high heterogeneity, and the association between AF phenotypes and the outcome of different catheter ablation strategies remains unclear. Conventional classification of AF (e.g. according to duration, atrial size, and thromboembolism risk) fails to provide reference for the optimal stratification of the prognostic risks or to guide individualized treatment plan. In recent years, research on machine learning has found that cluster analysis, an unsupervised data-driven approach, can uncover the intrinsic structure of data and identify clusters of patients with pathophysiological similarity. It has been demonstrated that cluster analysis helps improve the characterization of AF phenotypes and provide valuable prognostic information. In our cohort of AF inpatients undergoing radiofrequency catheter ablation, we used unsupervised cluster analysis to identify patient subgroups, to compare them with previous studies, and to evaluate their association with different suitable ablation patterns and outcomes. The participants were AF patients undergoing radiofrequency catheter ablation at West China Hospital between October 2015 and December 2017. All participants were aged 18 years or older. They underwent radiofrequency catheter ablation during their hospitalization. They completed the follow-up process under explicit informed consent. Patients with AF of a reversible cause, severe mitral stenosis or prosthetic heart valve, congenital heart disease, new-onset acute coronary syndrome within three months prior to the surgery, or a life expectancy less than 12 months were excluded according to the exclusion criteria. The cohort consisted of 1102 participants with paroxysmal or persistent/long-standing persistent AF. Data on 59 variables representing demographics, AF type, comorbidities, therapeutic history, vital signs, electrocardiographic and echocardiographic findings, and laboratory findings were collected. Overall, data for the variables were rarely missing (<5%), and multiple imputation was used for correction of missing data. Follow-up surveys were conducted through outpatient clinic visits or by telephone. Patients were scheduled for follow-up with 12-lead resting electrocardiography and 24-hours Holter monitoring at 3 months and 6 months after the ablation procedure. Early ablation success was defined as the absence of documented AF, atrial flutter, or atrial tachycardia >30 seconds at 6-month follow-up. Hierarchical clustering was performed on the 59 baseline variables. All characteristic variables were standardized to have a mean of zero and a standard deviation of one. Initially, each patient was regarded as a separate cluster, and the distance between these clusters was calculated. Then, the Ward minimum variance method of clustering was used to merge the pair of clusters with the minimum total variance. This process continued until all patients formed one whole cluster. The "NbClust" package in R software, capable of calculating various statistical indices, including pseudo t2 index, cubic clustering criterion, silhouette index etc, was applied to determine the optimal number of clusters. The most frequently chosen number of clusters by these indices was selected. A heatmap was generated to illustrate the clinical features of clusters, while a tree diagram was used to depict the clustering process and the heterogeneity among clusters. Ablation strategies were compared within each cluster regarding ablation efficacy. Five statistically driven clusters were identified: 1) the younger age cluster (n=404), characterized by the lowest prevalence of cardiovascular and cerebrovascular comorbidities but the highest prevalence of obstructive sleep apnea syndrome (14.4%); 2) a cluster of elderly adults with chronic diseases (n=438), the largest cluster, showing relatively higher rates of hypertension, diabetes, stroke, and chronic obstructive pulmonary disease; 3) a cluster with high prevalence of sinus node dysfunction (n=160), with patients showing the highest prevalence of sick sinus syndrome and pacemaker implantation; 4) the heart failure cluster (n=80), with the highest prevalence of heart failure (58.8%) and persistent/long-standing persistent AF (73.7%); 5) prior coronary artery revascularization cluster (n=20), with patients of the most advanced age (median: 69.0 years old) and predominantly male patients, all of whom had prior myocardial infarction and coronary artery revascularization. Patients in cluster 2 achieved higher early ablation success with pulmonary veins isolation alone compared to extensive ablation strategies (79.6% vs. 66.5%; odds ratio [OR]=1.97, 95% confidence interval [CI]: 1.28-3.03). Although extensive ablation strategies had a slightly higher success rate in the heart failure group, the difference was not statistically significant. This study provided a unique classification of AF patients undergoing catheter ablation by cluster analysis. Age, chronic disease, sinus node dysfunction, heart failure and history of coronary artery revascularization contributed to the formation of the five clinically relevant subtypes. These subtypes showed differences in ablation success rates, highlighting the potential of cluster analysis in guiding individualized risk stratification and treatment decisions for AF patients.

STATISTICAL ANALYSIS OF THE PREVALENCE OF INTERNAL TEMPOROMANDIBULAR JOINT DISORDERS IN FEMALE PATIENTS BASED ON C. H. WILKES CLASSIFICATION

Introduction. Severity levels of temporomandibular joint dysfunction can be assessed by certain parameters based on images obtained using magnetic resonance imaging. In order to assess the condition of the joint and choose the optimal treatment plan depending on the detected changes on the magnetic resonance imaging images, the most common classification according to C. H. Wilkes was chosen. This study aimed to assess the severity of temporomandibular joint dysfunction symptoms in women of child-bearing and post-menopausal age according to the C. H. Wilkes classification. Participants and methods. 63 patients were selected: reproductive period n=45 and post-menopausal n=17. Magnetic resonance imaging is described in detail and the diagnosis according to the C. H. Wilkes classification is made. Statistical analysis was carried out by calculating the χ2 test in order to analyze the independence between categorical variables; Kendall's correlation coefficient was applied to assess the correlation between age and disease stages. Results. Diseases of the temporomandibular joint are more common among women of child-bearing age compared to women of postmenopausal age. This may be related to hormonal changes characteristic of the reproductive period: in the group of child-bearing age, there is a greater variety of stages of the disease, while in the group of post-menopausal age, stage IV prevails. This may indicate the influence of age factors on TMJ development. The relationship between age and diseases of the temporomandibular joint has a statistically significant correlation. The results of the χ2 test show a statistically significant relationship between age and TMJ disease stages. In addition, Kendall's correlation coefficient confirms the presence of a moderate degree of relationship between age and stages of the disease. Conclusion. The results of the analysis of the distribution of temporomandibular joint disease stages between age groups can serve as important data for optimizing clinical practice, improving treatment outcomes, and increasing patients' quality of life. For example, our study indicates that stage Ⅱ according to the classification of C. H. Wilkes is more common in women of reproductive age, and stage Ⅳ is more common in women of postmenopausal age. Clinicians should take this dada into account when developing individual treatment plans.

Management and Treatment of Obsessive-Compulsive Disorder (OCD): A Literature Review.

Obsessive-compulsive disorder (OCD) is a prevalent and debilitating mental health condition. This literature review examines the latest strategies in managing and treating OCD, with an emphasis on psychotherapy, pharmacological interventions, and neurosurgical options. A comprehensive literature search utilizing PubMed, Google Scholar, ClinicalKey, and Embase databases was conducted. Utilizing chosen keywords, the resulting articleswere filtered based on inclusion and exclusion criteria. Included articles were used to discuss current research regarding OCD treatment and management. Findings revealthe efficacy and obstacles of treatments such as cognitive-behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and evidence-based neurosurgical methods, offering a broad perspective on OCD management. We discuss the limitations of these established treatments and examine the innovative response of neurosurgery in treating patients with OCD. This review highlights the importance of individualized treatment plans and areas for future research.

Imaging of Vaginal Yolk Sac Tumor: 2 Case Reports and Literature Review

Our article reports on two cases of pediatric vaginal yolk sac tumors (YSTs), underscoring the diagnostic challenges posed by their similarities to other vaginal tumors, particularly in differentiating from embryonal rhabdomyosarcoma based on clinical and radiological presentations. Emphasizing the critical role of MRI, histological examination, and alpha-fetoprotein levels in diagnosis, we highlight the complexities of treatment, which has evolved from radical surgeries to more conservative approaches with adjuvant chemotherapy, aiming to preserve future sexual and reproductive functions. Our findings advocate for individualized treatment plans and stress the importance of accurate diagnosis and the potential need for alternative therapeutic strategies in cases of atypical response to treatment.

Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine.

Depression is a highly heterogeneous disorder, often resulting in suboptimal response and remission rates. This underscores the need for more nuanced clinical characterization of patients to tailor individualized treatment plans. Emerging evidence highlights the critical role of cognitive and emotional dysfunction in major depression, prompting the exploration of novel therapeutic interventions that target these specific symptom domains. Vortioxetine, a multimodal antidepressant, enhances serotonergic activity while also modulating several other neurotransmitter systems involved in depressive symptoms such as emotional blunting, anhedonia, and cognitive dysfunction. Numerous randomized, placebo-controlled trials have demonstrated vortioxetine's efficacy and safety in treating depression, particularly in specific subgroups of depressed patients, including those with cognitive deficits and comorbid anxiety symptoms or disorders. Although not randomized or placebo-controlled, studies have also shown vortioxetine's efficacy in depressed patients with emotional blunting or anhedonia. Vortioxetine's ability to effectively treat a range of depressive symptoms, including anhedonia, emotional blunting, anxiety, and cognitive dysfunction, provides an individualized treatment solution for depressed individuals suffering from these symptoms. The purpose of this paper is to identify clinical profiles of patients who may benefit from vortioxetine, with the goal of optimizing therapeutic outcomes. Vortioxetine has been shown to be effective for patients with depression and symptoms such as anhedonia, emotional blunting, anxiety, and cognitive dysfunction. Tailoring treatment plans to individual needs and personalizing treatment choices based on the specific symptoms presented by depressed patients improve treatment outcomes.

Clinical Significance of a Novel Vasculogenic Mimicry-Based Prognostic Model in Hepatocellular Carcinoma.

Vasculogenic mimicry, a novel neovascularization pattern of aggressive tumors, is associated with poor clinical outcomes. The aim of this research was to establish a new model, termed VC score, to predict the prognosis, Tumor Microenvironment (TME) components, and immunotherapeutic response in Hepatocellular Carcinoma (HCC). The expression data of the public databases were used to develop the prognostic model. Consensus clustering was performed to confirm the molecular subtypes with ideal clustering efficacy. The high- and low-risk groups were stratified utilizing the VC score. Various methodologies, including survival analysis, single-sample Gene Set Enrichment Analysis (ssGSEA), Tumor Immune Dysfunction and Exclusion scores (TIDE), Immunophenoscore (IPS), and nomogram, were utilized for verification of the model performance and to characterize the immune status of HCC tissues. GSEA was performed to mine functional pathway information. The survival and immune characteristics varied between the three molecular subtypes. A five-gene signature (TPX2, CDC20, CFHR4, SPP1, and NQO1) was verified to function as an independent predictive factor for the prognosis of patients with HCC. The high-risk group exhibited lower Overall Survival (OS) rates and higher mortality rates in comparison to the low-risk group. Patients in the low-risk group were predicted to benefit from immune checkpoint inhibitor therapy and exhibit increased sensitivity to immunotherapy. Enrichment analysis revealed that signaling pathways linked to the cell cycle and DNA replication processes exhibited enrichment in the high-risk group. The VC score holds the potential to establish individualized treatment plans and clinical management strategies for patients with HCC.

Screening and Follow-Up Treatment Practices for Suicide Risk in Adolescent Primary Care: A Retrospective Chart Review.

Universal depression screening in adolescent primary care often encompasses questions about suicide risk. We conducted a retrospective chart review of well-child visits where adolescents (ages 13-17.9) had endorsed self-injurious thoughts and behaviors or suicidal ideation. The goal was to investigate primary care providers' follow-up actions, including documentation, further assessment, and referrals. Over 3-quarters of the progress notes showed evidence of further assessment, and two-thirds documented same-day actions, including mental health referrals, emergency department referrals, safety plans, medication changes, primary-care follow-up, and talking to parents. Actions varied by depression severity. Cases without interventions often had justifications. Owing to the variety of possible meanings and severity underlying positive screens, providers implemented an array of interventions, using clinical judgment to tailor actions to patients' individual needs and preferences. From these observations, we propose that standardized guidelines for suicide risk screening and follow-up should involve a clinical assessment and individualized treatment planning.

Outcomes of mechanical thrombectomy in octogenarians and nonagenarians patients with Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis

PurposeAcute ischemic stroke (AIS) imposes a major healthcare burden, with the elderly population often underrepresented in clinical trials. This systematic review and network meta-analysis aims to evaluate the safety and efficacy of mechanical thrombectomy (MT) among octogenarians and nonagenarians with AIS due to large vessel occlusion (LVO). MethodsA systematic search was conducted using PubMed, Web of Science, and Scopus databases. Outcomes of interest were modified Rankin Scale (mRS) score of 0–2, thrombolysis in cerebral infarction (TICI) score of 2b-3, 90-day mortality, and symptomatic intracerebral hemorrhage (sICH). The study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. ResultsThe analysis included 47 studies. Significantly lower rates of mRS score 0–2 were observed in nonagenarians (17.4 %) and octogenarians (21.3 %) compared to younger (40.2 %) patients (Odds Ratio (OR) = 3.30, 95 % Confidence Interval (CI):2.35–4.65 and OR = 2.47, 95 % CI: 2.07–2.94). 90-day mortality was significantly higher in nonagenarians (38.9 %) compared to octogenarians (25.4 %) and younger (14.0 %) patients (OR = 0.58, 95 % CI: 0.41–0.83 and OR = 0.31, 95 % CI: 0.21–0.44), and in octogenarians compared to younger patients (OR = 0.52, 95 % CI: 0.41–0.66). No significant differences were observed in TICI 2b-3 and sICH rates across groups. ConclusionsOur findings indicate that MT is a viable treatment option for AIS due to LVO among octogenarians and nonagenarians, albeit with nuanced differences. Specifically, octogenarians had lower 90-day mortality rates compared to nonagenarians. These insights support the need for individualized treatment plans for elderly patients with AIS due to LVO and highlight the importance of including this demographic in future clinical trials.

Impact of Replacement Therapy on Pregnancy Outcomes in Hemophilia Carriers: A Historical Cohort Study in Saudi Arabia.

This retrospective cohort study evaluates the safety and efficacy of replacement therapy with regard to pregnancy outcomes in hemophilia carriers. Hemophilia carriers face elevated bleeding risks during pregnancy, necessitating meticulous management, including replacement therapy with clotting factors. This research examines the records of 64 pregnant hemophilia carriers at King Fahad Medical City, Riyadh, from January 2010 to December 2023, analyzing their demographic details, hemophilia type and severity, replacement therapy specifics, and pregnancy outcomes. The study found that 62.5% of the participants had hemophilia A, with 43.8% categorized as severe. Most subjects (87.5%) received recombinant factor VIII at a median dosage of 30 IU/kg weekly. Adverse pregnancy outcomes included gestational hypertension (15.6%), preterm labor (18.8%), and postpartum hemorrhage (12.5%). The cesarean section rate was 28.1%. Neonatal outcomes were generally favorable, with median birth weights at 3100 g and mean Apgar scores of 8.2 and 9.1 at 1 and 5 min, respectively. Logistic regression analysis revealed no significant association between adverse events and therapy type or dosage, though a trend towards significance was noted with once-weekly administration (p = 0.082). The study concludes that replacement therapy is a viable method for managing hemophilia in pregnant carriers, leading to generally favorable maternal and neonatal outcomes. However, it underscores the importance of individualized treatment plans and close monitoring to effectively manage the risks associated with hemophilia during pregnancy.

Clinical application of high-resolution spiral CT scanning in the diagnosis of auriculotemporal and ossicle

Precision and intelligence in evaluating the complexities of middle ear structures are required to diagnose auriculotemporal and ossicle-related diseases within otolaryngology. Due to the complexity of the anatomical details and the varied etiologies of illnesses such as trauma, chronic otitis media, and congenital anomalies, traditional diagnostic procedures may not yield accurate diagnoses. This research intends to enhance the diagnosis of diseases of the auriculotemporal region and ossicles by combining High-Resolution Spiral Computed Tomography (HRSCT) scanning with Deep Learning Techniques (DLT). This study employs a deep learning method, Convolutional Neural Network-UNet (CNN-UNet), to extract sub-pixel information from medical photos. This method equips doctors and researchers with cutting-edge resources, leading to groundbreaking discoveries and better patient healthcare. The research effort is the interaction between the CNN-UNet model and high-resolution Computed Tomography (CT) scans, automating activities including ossicle segmentation, fracture detection, and disruption cause classification, accelerating the diagnostic process and increasing clinical decision-making. The suggested HRSCT-DLT model represents the integration of high-resolution spiral CT scans with the CNN-UNet model, which has been fine-tuned to address the nuances of auriculotemporal and ossicular diseases. This novel combination improves diagnostic efficiency and our overall understanding of these intricate diseases. The results of this study highlight the promise of combining high-resolution CT scanning with the CNN-UNet model in otolaryngology, paving the way for more accurate diagnosis and more individualized treatment plans for patients experiencing auriculotemporal and ossicle-related disruptions.

Patients’ Preferences Regarding Modes of Systemic Psoriasis Treatment – A Qualitative Study

Background Treatment with pathogenesis-directed biologics and oral systemic drugs have made complete clearance of psoriasis a realistic expectation for many patients with psoriasis. Patients’ preferences among these treatments varies. Objective To understand factors impacting psoriasis patients’preferences for injection vs oral medication. Methods Psoriasis patients who receive systemic psoriasis treatment were asked to participate in a semi-structured interview. Sample size was based on achieving saturation with equal number of patients preferring oral vs injectable medications to ensure equal representation of both groups. Qualitative analysis was performed to interpret the results. Results Twenty-two patients participated in the study, 12 males and 10 females. Ten patients were receiving oral medication (apremilast or methotrexate) and 12 patients were receiving injectables (guselkumab, adalimumab, risankizumab, secukinumab, ixekizumab, or tildrakizumab) due to self-reported preference. Five themes resulted from the analysis: patients receiving injectables more frequently discussed the positive impact of the medication on quality of life compared to patients on oral medication; fear of side effects, particularly fear of immunosuppression, is associated with injection medications; avoidance of needles drives patients away from injection medication and towards oral systemic medication; patients prioritize convenience when selecting systemic therapy, though the definition of convenience is subject to perception; and patients value the medication recommendation of the physician, regardless of the route of administration. Conclusion Improving medication adherence and disease outcomes through individualized treatment plans, with an emphasis on patients’ preferences using a shared decision-making approach, may be helpful.

Machine learning model for prediction of permanent stoma after anterior resection of rectal cancer: A multicenter study

BackgroundThe conversion from a temporary to a permanent stoma (PS) following rectal cancer surgery significantly impacts the quality of life of patients. However, there is currently a lack of practical preoperative tools to predict PS formation. The purpose of this study is to establish a preoperative predictive model for PS using machine learning algorithms to guide clinical practice. MethodsIn this retrospective study, we analyzed clinical data from a total of 655 patients who underwent anterior resection for rectal cancer, with 552 patients from one medical center and 103 from another. Through machine learning algorithms, five predictive models were developed, and each was thoroughly evaluated for predictive performance. The model with superior predictive accuracy underwent additional validation using both an independent testing cohort and the external validation cohort. The Shapley Additive exPlanations (SHAP) approach was employed to elucidate the predictive factors influencing the model, providing an in-depth visual analysis of its decision-making process. ResultsEight variables were selected for the construction of the model. The support vector machine (SVM) model exhibited superior predictive performance in the training set, evidenced by an AUC of 0.854 (95 % CI:0.803–0.904). This performance was corroborated in both the testing set and external validation set, where the model demonstrated an AUC of 0.851 (95%CI:0.748–0.954) and 0.815 (95%CI:0.710–0.919), respectively, indicating its efficacy in identifying the PS. ConclusionsThe model(https://yangsu2023.shinyapps.io/psrisk/) indicated robust predictive performance in identifying PS after anterior resection for rectal cancer, potentially guiding surgeons in the preoperative stratification of patients, thus informing individualized treatment plans and improving patient outcomes.

EFFECT OF DAPAGLIFLOZIN ON CARDIOVASCULAR OUTCOMES IN HFREF PATIENTS: IMPACT OF DIABETES MELLITUS TYPE 2 STATUS

Dapagliflozin has shown promise in the treatment of heart failure with reduced ejection fraction (HFrEF), but its effects in patients with and without diabetes remain unclear. Objective: This study aimed to assess the effects of dapagliflozin in HFrEF patients, both with and without diabetes. Methods: From January to July 2023, a six-month case-control study was conducted in the cardiology department of a Tertiary Care Hospital in Peshawar, Pakistan. All patients received an additional dose of dapagliflozin (10 mg) alongside their usual treatment plans. The primary outcome was a composite of heart failure exacerbation or cardiovascular death. Data analysis was performed using SPSS version 22. Results: Patients with diabetes mellitus type 2 (DMT2) exhibited a higher rate of cardiovascular death (22%) and hospitalization for heart failure (14.4%) compared to those without diabetes. The hospitalisation rate for heart failure was also higher in the DMT2 group (12.21%) than in the non-diabetic group (8.6%). Over the trial period, cardiovascular death occurred in 12.44% of patients with DMT2 compared to 7.30% in those without DMT2. Patients with diabetes experienced a significantly higher number of first and recurrent hospitalizations for heart failure and cardiovascular death compared to those without diabetes (32.45% vs. 19.20%, p=0.021). Conclusion: Dapagliflozin therapy in HFrEF patients demonstrated varying effects between those with and without diabetes. The study underscores the importance of personalised management strategies considering comorbid medical conditions. Despite dapagliflozin treatment, patients with both heart failure and diabetes continued to experience cardiovascular complications, highlighting the need for individualised treatment plans that account for a patient's complete medical profile.

An Unusual Case Report of Cotard’s Syndrome with Depressive Delusions

Cotard’s Syndrome, also known as nihilistic delusion or Cotard’s delusion, is an exceptionally rare psychiatric condition characterized by delusional beliefs ranging from a sense of being dead to the conviction of bodily decay or nonexistence. This case report of a male patient, aged 21 years, with Cotard’s Syndrome highlights the difficulties in diagnosis, the course of therapy, and the clinical ramifications of this illness. The patient exhibited symptoms of severe depression along with nihilistic delusions, expressing the belief that he was deceased and experiencing bodily decay. Nihilistic delusions and depressed symptoms compatible with Cotard’s syndrome in the setting of major depressive disorder were found during the patient’s mental state evaluation, despite the absence of a serious physical disease or drug addiction. Treatment consisted of antidepressant and antipsychotic medication, along with individual psychotherapy sessions focusing on cognitive restructuring. Over time, the patient demonstrated gradual improvement in delusional beliefs and depressive symptoms, highlighting the importance of comprehensive psychiatric evaluation and individualized treatment planning.

Abstract PO2-03-01: Personalized 3D tumor models drive shared decision-making in early breast cancer

Abstract Background: Decision-making for early (Stages 1-3) breast cancer (eBC) care is complex and highly personal, requiring discussions between patients and multiple physicians. Shared decision-making (SDM) is an accepted process that combines input from both patients and physicians, although its overall use is low due to a lack of time and incentives, complicated application techniques, and few communication tools. Reviews show that SDM results in “improved affective-cognitive outcomes” but evidence linking to patient outcomes is sparse. Consequently, patients often receive mixed messages and feel anxious when making treatment decisions. SimBioSys (SBS) developed the TumorSight(TM) platform for individualized treatment planning, coordinated care, and SDM. The first application on this platform, TumorSight Viz, rapidly builds 3D computational models from standard breast MRI data, and further integrates deep learning, genomic/genetic testing, metabolomics, and clinical and demographic data to tailor these models for each individual diagnosed with eBC. The platform can also transform acquired data (e.g., prone) to surgical position (e.g., supine) to create realistic images for precision surgical planning and tools for better SDM with eBC patients. We are assessing how surgeons and patient advocates (PA) perceive TumorSight, and how it may support better SDM and treatment implementation. Methods: SBS conducted an exploratory survey with 31 eBC surgeons to assess the utility of TumorSight Viz visualizations across a range of didactic and planning applications and to query preferences for future components like predicted response to chemotherapy and immunotherapy. Questions were developed with input from breast surgeon advisors. More exploration on TumorSight Viz utility is planned with semi-structured qualitative interviews to assess patient advocates’ perceptions of 3D visualizations, surgical planning, and ability to support decision making. PAs will represent geographic, experience, and race/ethnicity diversity. Questions to elicit patient needs, perception of SBS tools, and quality-of-life are being finalized with academic advisors. These will also be used to develop a future eBC patient survey. Results: The SBS surgeon survey revealed that 96% of breast surgeons find visualization important to surgical planning, and these depictions were considered to be critical by a third of breast surgeons surveyed. 96% also listed the conversion of prone to supine visualizations as important (45% critical, 35% valuable, 16% nice to have, 0% not important) for surgical planning value. Surgeons also assigned strong utility for: Graphical 3D rotation to determine tumor shape, size, location, positioning, and landmarks relative to other breast structures – 100% Ability to instantly provide tumor-to-breast volume determination with high accuracy – 96% Ability to instantly provide anticipated tumor extirpation volume to breast volume with high accuracy – 96% Automatic tumor-to-landmark structures measurements (nipple, chest, skin) – 96% Visualization of tumor in the context of other anatomical structures (e.g., skin, blood vessels, chest, heart) – 87% Initial PA discussions (n=3) listed the importance of individualized treatment based on evidence instead of hunches; reasons to avoid prophylactic mastectomies; and ways to lower patient anxiety. Conclusions: Survey-based feedback shows value to eBC surgeons and patients to coordinate care and personalize approaches for optimal outcomes. Computational tools can facilitate patient understanding and patient-tailored treatment. Additional surveys are planned with patients and eBC patient advocacy groups to assess the utility and potential expansion of patient-specific 3D tumor visualizations, both of which will be further discussed. Citation Format: Deborah Collyar, Matthew Biancalana, Anuja Antony, Nicole Liadis, Jyoti Palaniappan, Rebecca Seago-Coyle. Personalized 3D tumor models drive shared decision-making in early breast cancer [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 PO2-03-01.

Obese boys penile length: is it micropenis or just Buried?

Background Obesity in childhood is an escalating public health crisis with profound implications, including potential impacts on penile development. This study aimed to measure penile size in obese children and adolescents to detect the presence of micropenis and buried penis. Methods An observational cross-sectional study was conducted on 680 obese boys (BMI &gt;95th percentile) aged 9.4±3.22 years. Stretched penile length (SPL) was measured using a conventional method. Anthropometric measurements, laboratory tests, and penile length categorization (normal, micropenis, buried penis) were performed. Results Sixty percent of participants had normal penile length, while 9.12% were diagnosed with micropenis, and 30.88% had buried penis. SPL positively correlated with age, weight, height, and BMI but negatively with height and BMI Z-scores. No significant correlations were found between SPL and glycated hemoglobin or impaired glucose tolerance diagnosis. Dyslipidemia and impaired glucose metabolism were observed. Conclusions and recommendations A high prevalence of micropenis and buried penis among obese boys underscores the profound impact of childhood obesity on penile development. Early screening and management strategies are crucial to mitigate long-term consequences. Adopting a multidisciplinary approach, involving pediatric endocrinologists, urologists, and psychologists, ensures a holistic treatment addressing both physical and psychological aspects of the condition. Furthermore, individualized treatment plans should be developed, potentially incorporating hormonal therapy, surgical interventions, or a combination of both.