Initial Experience Research Articles

Challenges, coping strategies, and sources of support available to South African parents with children with autism spectrum disorder during the COVID-19 lockdown: a qualitative study

Parenting a child with autism spectrum disorder (ASD) is known to be complex and challenging and likely to be exacerbated under conditions of stress and uncertainty. We aimed to explore how parents experienced parenting their child with ASD during the initial COVID-19 lockdown in 2020. We also aimed to identify the coping strategies and sources of support available to them during this time. Using an exploratory qualitative design within an interpretivist paradigm, we interviewed 23 parents of children with ASD between the ages of 6 and 12 years. Parents were recruited from an online support group for ASD in South Africa. Interviews were semi-structured and transcribed verbatim for thematic analysis, using ATLAS.ti. We identified five themes: (1) The experience of communicating lockdown rules and disease containment measures to children, (2) Consequences of disruption to routine, (3) Parenting and interpersonal relationships in conditions of confinement, (4) Help-seeking and sources of support, and (5) Finding ways to cope amid a crisis. The findings demonstrate that the initial COVID-19 lockdown placed parents of children with ASD under considerable stress. Disrupted routines and interrupted access to financial, psychological, social, and educational support during the initial lockdown period exacerbated parenting experiences. This study highlights the importance of providing parents of children with ASD strategies to communicate significant change and various forms of support to navigate the negative effects of routine disruptions during conditions of uncertainty and crisis.

Penile inversion vulvo-vaginoplasty with scrotal graft for trans women: surgical technique and results of initial experience.

A significant proportion of trans women is demanding for a genital gender-affirming surgery, with vulvo-vaginoplasty being the most frequently requested procedure. The gold standard for primary vaginoplasty in trans women is the penile skin inversion technique with scrotal skin graft, which allows for increased depth of the vaginal cavity. The assessment of vulvo-vaginoplasty outcomes utilizing penile skin inversion and scrotal skin graft in individuals assigned male at birth in the surgeon's learning curve involves evaluating aesthetics, functionality, and sexual aspects. A total of 76 individuals assigned male at birth were included in 2 French university hospitals from 2020 to 2022. They underwent vulvo-vaginoplasty following 8 key steps: scrotal skin excision; bilateral orchiectomy; dissection between the rectum, bladder, and prostate; penile dissection; clitoroplasty; urethroplasty; penile skin inversion with scrotal skin graft; labioplasty. The average follow-up period was 12.4months, with participants averaging 35.7years of age. Each patient was invited to complete a questionnaire during follow-up. The study's outcomes encompassed the assessment of both early and late surgical complications, postoperative sexuality, aesthetic results, and voiding satisfaction. Of the total patients, 15.8% experienced major early postoperative complications, while 3% encountered major late postoperative complications. No complication was classified 4 or 5 in Clavien-Dindo scale. Most early complications were related to issues in vulvar healing, which did not compromise long-term aesthetic results. Patients-reported satisfaction was 82% after the procedure. Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a reproductive surgery procedure that can be successfully performed by experienced urologist. It achieves high patient-reported satisfaction even during the learning curve. The surgical procedures were consistent, and the sizable cohort of patients accurately reflects the learning curve of both surgeons. However, extrapolating long-term complications is challenging due to the relatively brief follow-up period. Additionally, there is a lack of self-reported sexual function data, and the scales used to assess patient-reported quality of life and urinary satisfaction are not specifically validated for transgender patients. Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a complex surgical procedure. It appears to be achievable by experienced urologists during their learning curve, resulting in similar functional and surgical outcomes, along with high patient satisfaction.

Impact of prior experience and gender on cognitive load during initial drone use

The purpose of this demonstration study was to determine the effect of prior experiences and gender on cognitive demands at the initial educational technology experience. The task of drone operation was selected as a novel educational technological tool and videogame use was determined to be a tangential prior experience. Through the framework of embodied cognition, the NASA Task Load Index was used to measure cognitive demand. Practicing middle- and high-school science teachers were recruited to participate in this study. Participants operated drones at three instances over two weeks. An additional challenging task was also presented. A mixed ANOVA suggested a significant interaction between videogame use and time: F(2, 28) = 3.77, p<\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p<$$\\end{document} 0.05. A significant interaction between gender and time was also observed: F(2, 29) = 3.72, p<\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p<$$\\end{document} 0.05. For both prior experience and gender, the differences were observed at the first instance of drone operation and not at subsequent trials. Results suggest prior experience and gender may only affect cognitive load at the initial experience and leveling of cognitive load occurs with continued practice. These findings can support an educator’s planning for drone-based activities and help to mitigate the stigma of gender differences regarding technology use. Additionally, these findings support the need to examine and enhance related and transferable skills, such as hand–eye coordination and spatial thinking, to lessen cognitive load at the initial educational experience.

A Review of Contemporary Image Guidance Techniques in Head and Neck Cancer.

Traditional head and neck cancer treatment involves open surgery, cytotoxic chemotherapy, and conventional radiotherapy planning. Emerging techniques aim to improve precision and reduce associated toxicity and functional impairment in current practice. This review article describes four such adaptations in image guidance, tailored to next generation therapies. This is a review of current literature, including feasibility studies from our cancer center, relating to: saline-aided intra-oral ultrasound-guided retropharyngeal biopsy; intra-oral ultrasound guided trans-oral robotic surgery (TORS); ultrasound-guided injection of "directly injectedtherapies"; and magnetic resonance imaging-guided radiotherapy. Presented within the context of the wider literature, initial local experience and data indicate good technical outcomes and patient tolerance, and low technical complications in all four image guidance techniques. Initial findings suggest a potentially important future role for these four image guidance techniques, on which next generation therapies are reliant. The broader implications on cross-disciplinary collaboration are also explored herein.

Initial Experience of Implementing a Pre-treatment Dry Run for HyperArc Stereotactic Radiosurgery Treatments With Optical Surface Imaging for Intra-fraction Motion Monitoring

Initial Experience of Implementing a Pre-treatment Dry Run for HyperArc Stereotactic Radiosurgery Treatments With Optical Surface Imaging for Intra-fraction Motion Monitoring

Compulsory treatment at home: an interview study exploring the experiences of an early group of patients, relatives and mental-health workers

BackgroundWhen introduced in 2020, the Netherlands’ Compulsory Mental Healthcare Act included provisions for compulsory community treatment (CCT) and compulsory treatment in patients’ homes (CTH). Although CCT has been incorporated into mental health care in many countries, its effectiveness is debated. We know of no other countries in which CTH has been adopted.The aim of this study is to evaluate how an early group of participants experienced CTH. They were drawn from three stakeholder groups: patients, relatives and mental-health workers.MethodsIn total, 17 open interviews were conducted with six patients, five relatives and six mental-health workers. All had experience with CTH. Thematic analysis was used to analyze the interviews.ResultsFive themes were identified: 1). Reasons for applying for a court order with options for CTH. The reasons included preventing harm, avoiding hospitalization, and providing a safety net. 2.) Participants’ experiences with CTH in practice. The four most noteworthy experiences were related to the process of applying for a court order; compulsory home visits and the compulsory use of medication; the involvement of relatives during treatment; and the influence of CTH on the relationship between patients and relatives. 3.) The advantages and disadvantages of CTH. The most important advantages were avoiding hospitalization; improving medication adherence; facilitating easy access to care; early signaling of deterioration; early intervention; and regained autonomy. The most important disadvantages were restricted autonomy; fewer options for monitoring compared to hospitalization; and problems regarding control of patient behavior. 4.) Participants’ preferences. All preferred CTH to hospitalization. 5.) Participants’ suggestions for improving CTH. These included the need not only to provide patients with better information, but also to improve the involvement of relatives during treatment.ConclusionThe interviewees found that CTH might help to avoid hospitalization by providing stakeholders with more options for arranging effective care at home. Although this suggests that initial experiences of CTH under the new Dutch mental health law were positive, it is still uncertain whether CTH as currently implemented really differs from CCT.

Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond

Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all p &lt; 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all p &gt; 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3–97.3] and 82.8% [95% CI, 68.1–97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications.

Double port-a-cath implantation: initial experience in Brazil and technical note tips and tricks: a series report

BackgroundThis study was designed to evaluate the clinical benefit of double-lumen port catheters in patients receiving chemotherapy and parenteral nutrition concurrently or in those with vascular access failure. The advantages, complications, indications and duration of use of double port-a-cath were considered.MethodsThirteen Brazilian patients received a double-lumen port catheter that was implanted under ultrasonographic and fluoroscopic guidance in the radiologic interventional suite.ResultsAll double-lumen port systems were successfully implanted in all patients without immediate complications. The port-a-cath was removed in two patients due to infection of the reservoir. Three deaths occurred due to underlying disease with no correlation to the port-a-cath. No temporal interference between the administration of chemotherapy and parenteral nutrition was observed.ConclusionThe double-door approach is a safe technique with low complication rates. Indications for use of the dual port are numerous and should be encouraged because of the considerable benefits for critically ill patients.

Initial feasibility cohort of temporally modulated pulsed proton re-irradiation (TMPPR) for recurrent high-grade intracranial malignancies

Recurrent high-grade intracranial malignancies have a grim prognosis and uniform management guidelines are lacking. Re-irradiation is underused due to concerns about irreversible side effects. Pulsed-reduced dose rate radiotherapy (PRDR) aims to reduce toxicity while improving tumor control by exploiting dose-rate effects. We share our initial experience with temporally modulated pulsed proton re-irradiation (TMPPR), focusing on workflow, safety, feasibility, and outcomes for the first patient cohort. TMPPR was administered to patients with recurrent or progressive central nervous system malignancies using intensity modulated proton therapy with three fields. Patient and treatment data were collected, responses categorized using RANO assessment, and toxicities graded using CTCAE v5.0. Five patients received TMPPR between October 2022 and May 2023, with a median age of 54 years (Range: 32–72), and a median time from initial radiotherapy to re-RT of 23 months (Range 14–40). Treatment was completed without delay, with a median dose of 60 GyRBE in 30 fractions. Initial treatment response assessment showed complete (n = 1) or partial (n = 3) responses. Limited toxicity was observed, primarily grade 2 alopecia and one case of radiation necrosis graded at 2. This early experience demonstrates the feasibility of TMPPR delivery, highlighting the importance of prospective evaluations in the re-irradiation setting.

The short-term outcomes of laparoscopic enucleation of pancreatic tumors with exposing the Wirsung duct.

It is widely believed that the prerequisite for safely performing enucleation is that the distance between the tumor and the main pancreatic duct (MPD) is at least 2-3mm. However, enucleating a deep pancreatic tumor adjacent to the MPD remains challenging, particularly when exposure or repair of the MPD is necessary. This study reported our initial experience with this procedure and demonstrated the feasibility and safety of the MPD exposure or repair. Patients who underwent laparoscopic enucleation (LapEN) with exposing the MPD from January 2017 to August 2023 were collected and analyzed in this retrospective cohort study. Data from procedures of laparoscopic middle pancreatectomy (LMP) and LapEN for superficial tumors were collected for comparative analyses. A total of 26 patients were enrolled, 27 tumors were enucleated. Tumor located in the pancreatic head and neck (n = 20), and the body (n = 7). The mean tumor size, operating time, and blood loss were 2.3cm, 163min, and 63ml, respectively. MPD injuries occurred in 8 cases due to the need for complete tumor resection, which were repaired or reconstructed using 6-0 PDS-II with or not inserting a plastic stent. 10 cases (38.5%) developed surgical-related complications, seven (26.9%) were classified as Clavien-Dindo grade I, and three (11.5%) were Clavien-Dindo grade IIIa. Biochemical leakage occurred in 16 cases (61.5%), clinically relevant pancreatic fistula (CR-POPF) occurred in 10 cases (38.5%). Two patients (7.7%) experiencedpost-pancreatectomy hemorrhage. Further analyses indicated LapEN with MPD exposure had a longer operating time and higher incidence of CR-POPF compared to LapEN for superficial tumors, but a shorter operating time and less blood loss compared to LMP (P < 0.05). Laparoscopic enucleation with exposing the MPD is feasible and safe with the support of precise preoperative assessments, meticulous intraoperative dissection, well familiarity with the anatomy of the MPD, and excellent surgical skills.

Decolonising mathematics education: Teachers’ initial experiences of using ethnomathematical games in the intermediate phase

The African Agenda 2063 strives to attain the goals of peace and prosperity, and to do so, there must be a process of political liberation and decolonisation. In the South African context, decolonisation involves transforming the mathematics curriculum to one that is African by employing cultural approaches such as ethnomathematics. However, South African mathematics teachers still rely on Eurocentric methods for teaching mathematics. To decolonise mathematics in the Intermediate Phase, a project was initiated that utilised indigenous games for teaching mathematics. This paper aims to identify whether such efforts to decolonise mathematics education will be accepted or rejected by the mathematics teachers involved in this study. The paper is framed by the Critical Mathematics Pedagogy Theory. A qualitative case study approach was employed to collect data through a focus group interview with ten mathematics teachers who teach in rural and semi-rural areas of KwaZulu-Natal, South Africa. The findings demonstrate that ethnomathematical games encourage mathematics learning, that teachers’ initial apprehensions gave way to enthusiasm, that learners were excited to play and learn, and that teachers found it effortless to integrate mathematical concepts such as addition, subtraction, multiplication, factorisation, and quadrilaterals with the indigenous games of Morabaraba, Tshetershere, Diketo, and Kgati. Recommendations include that mathematics educational policies incorporate ethnomathematics as a policy directive and that teachers receive training in alternative cultural pedagogical practices for teaching mathematics, such as the use of ethnomathematics. Future research endeavours should focus on finding avenues to sustain ethnomathematics in the classroom.

Initial Experience With Robotic Liver Resection in the United States.

This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.

High-Risk Biliary Anastomosis During Robotic Pancreaticoduodenectomy: Initial Experience with Biodegradable Biliary Stent

Background and Objectives: Biliary fistulas (BFs) occur in approximately 3–8% of patients undergoing pancreaticoduodenectomy (PD), and the bile duct diameter ≤ 5 mm is the most important risk factor. The aim of this study was to evaluate the efficacy of biodegradable biliary stents (BSs) in reducing complications in patients undergoing robotic pancreaticoduodenectomy (RPD) with a bile duct diameter of ≤5 mm. Materials and Methods: A retrospective single-centre observational study was conducted. Patients undergoing RPD after the completion of the robotic biliary anastomosis learning curve were included in this study. Only patients with a bile duct diameter ≤ 5 mm were included in the analysis. A prospectively held database was used. The intraoperative time for biliary anastomosis was extracted from surgical videos. Results: Of 30 patients, 20 received no biliary stent (nBS) and 10 received a biodegradable stent (BS). The decision to use a stent was based on product availability. The median operative time for biliary anastomosis was significantly shorter in the BS group compared to the nBS group, at 15 min versus 24 min (p &lt; 0.001). Three patients in the nBS group developed a BF, whereas none were observed in the BS group. No stent migration was observed in any of the patients. Conclusions: The use of biodegradable biliary stents in high-risk biliary anastomosis in RPD appears to effectively reduce the incidence of BFs and may serve as a viable strategy to mitigate early biliary complications. The use of biodegradable stents facilitates a faster and easier biliary anastomosis. These findings suggest a potential benefit of using biodegradable stents in complex biliary reconstruction. However, larger studies are needed to confirm these results.

PO0429: Initial Experiences from a Newly Established Prostate LDR Brachytherapy Program in a Developing Country

PO0429: Initial Experiences from a Newly Established Prostate LDR Brachytherapy Program in a Developing Country

Use of selective laser capsulotomy for mature white cataracts: Initial experience in Indian eyes.

To report the initial experience of performing capsulotomy in eyes with mature white cataracts using selective laser capsulotomy (SLC) in Indian eyes. This was a prospective, noncomparative, open-label study. All adults presenting to our institution with mature cataracts whose pupils dilated >6 mm and who were willing for phacoemulsification were invited to participate. During surgery, after staining the anterior capsule with a proprietary trypan blue, the CAPSULaser device (Excel-Lens Inc, Los Gatos, CA, USA) was used to create a capsulotomy of size ranging from 5 to 5.5 mm and phacoemulsification was carried out. The primary outcome was the size, centration, and continuity of the capsulotomy edge at the end of the surgery. Secondary outcomes were the surgical time for capsulotomy, capsulotomy centration on the intraocular lens (IOL) at 3 months, and adverse effects. Thirty eyes were studied of 30 patients who were recruited with a mean age of 66.4 ± 8.3 years, of which 17 (57%) were men. The intraoperative size of capsulotomy was the same as intended in all eyes and the edges were smooth. None of the eyes experienced any visible capsular tears or run out events; one had a capsular tag. The time for capsulotomy including capsular staining was 3 ± 0.23 min. All IOLs were well centered at 3 months with a capsulotomy size remaining the same. The endothelial cell count had dropped by 8% at 3 months post-op, and the vision improved significantly to 0.03 log of minimum angle of resolution. None of the eyes experienced any intraoperative complications or laser-induced adverse effects. SLC was a safe and effective technique providing precise, well-centered anterior capsulotomies in mature white cataracts.

Exploring the potential of Self-Management and Recovery Training (SMART Recovery) mutual-help groups for supporting people who use methamphetamine: A qualitative study examining participant experience of initiation and engagement

IntroductionImproving support options for people who use methamphetamine is of critical national and global importance. The role of mutual-help groups within the treatment-seeking journey of people who use methamphetamine is unclear. Self-Management and Recovery Training (‘SMART Recovery’) mutual-help groups are led by a trained facilitator and support participants to work on individual goals, including, but not limited to abstinence. This study examined how people who use methamphetamine came to be involved in SMART Recovery mutual-help groups and factors associated with engagement. MethodsA sample of Australian SMART Recovery participants who self-reported using methamphetamine in the preceding 12-months (n = 18) discussed their history of substance use and experience of service provision in a semi-structured telephone interview. Interviews were audio-recorded, transcribed, and analysed using iterative categorization. ResultsParticipant initiation of SMART Recovery groups was described across two themes: i) delayed attendance and ii) use as an adjunct to other services. Factors associated with engagement were discussed in terms of: i) the ‘fit’ of SMART Recovery mutual-help groups; ii) coping and tolerance of discomfort; iii) the power of shared lived experience; iv) choice and autonomy; and v) short-term goal setting supports self-efficacy and the possibility of change. Discussion and conclusionsSMART Recovery mutual-help groups show promise for engaging people who use methamphetamine. There is a clear need to improve awareness of mutual-help group options amongst service users, providers and the general community. Offering choice over mutual-help groups may help to engage people earlier and support improved linkage between services.

Robotic surgery of the urothelial carcinoma of the upper urinary tract single surgeon initial experience, 66 consecutive cases

PurposeRobotic surgery is increasingly utilized in the treatment of urothelial carcinoma of the upper urinary tract (UTUC). This study investigates the advantages and burden of robot-assisted surgical treatment of the urothelial carcinoma of the upper urinary tract in a referral urological department, along with their functional and oncological results.MethodsThe study included 66 prospectively enrolled patients who were surgically treated by a single, robotically specialized surgeon between July 2019 and December 2023. Patients were divided into three groups. Group 1: 50 patients underwent robot-assisted radical Nephroureterectomy (RANU) with bladder cuff excision, Group 2: 11 patients underwent RANU simultaneously with robot-assisted radical cystectomy (RARC), and Group 3: 5 patients underwent robot-assisted segmental ureterectomy (RASU). Clinical and oncological parameters were compared. Perioperative morbidity according to Clavien-Dindo was the primary endpoint of our study. The secondary endpoint was oncologic outcomes.Results37.8% of patients had locally advanced carcinomas. The average console time of RANU with bladder cuff excision was 69 min. The rate of positive surgical margins was n = 1/66 (2%). Lymphadenectomy (LAD) was performed on 30% of patients, with a mean of 13.7 lymph nodes removed. Of those who received LAD, 33% had lymph node metastasis. n = 6/66 (9%) patients received blood transfusion. The overall complication rate was 24%. The readmission rate was 7.5%. With a median follow-up of 26 months, the 2-year recurrence-free survival rate was 84.4%, and the 2-year overall survival rate was 94%.ConclusionRobotic surgery is a feasible option for treating UTUC that can be adapted to meet the surgical needs of each patient. Prospective studies are warranted to confirm its benefits.

Thresholds for the value judgement of health technologies in the United Arab Emirates: a consensus approach through voting sessions

BackgroundIn the evolving healthcare landscape of the United Arab Emirates (UAE), establishing cost-effectiveness thresholds (CETs) is pivotal to informing decision-makers about the value of health technologies.ObjectiveThis study aimed to establish...

Robot-assisted kidney transplantation: initial experience from a tertiary hospital in China

Abstract Background Robot-assisted kidney transplantation (RAKT) has currently become an effective alternative to open kidney transplantation (OKT), which has long been considered the gold standard for kidney transplant surgery. This study aimed to summarize our initial experience with RAKT and explore its safety and feasibility. Materials and methods Ten cases of RAKT, including 8 cases of deceased-donor kidney transplantation and 2 cases of living-donor kidney transplantation, were performed at our center from March 2023 to November 2023. Perioperative clinical data and follow-up results of patients were collected and statistically analyzed. Results All RAKT surgeries were performed successfully with no complications. The average operative time was 297.90 ± 65.59 minutes, and the median estimated blood loss was 100 mL. The average serum creatinine level decreased from 918.14 ± 166.63 μmol/L preoperatively to 109.89 ± 29.89 μmol/L at discharge. The postoperative outcomes of RAKT from both deceased and living donors were satisfactory during the follow-up period. Conclusions RAKT is an effective alternative to OKT and is suitable for both deceased- and living-donor kidney transplantations. The postoperative outcomes were satisfactory, and the postoperative complications were acceptable. RAKT appears to be a safe and feasible procedure for transplantation teams skilled in OKT and robot-assisted surgery.

Feasibility, Tolerability, and Preliminary Clinical Response of Fractionated Radiopharmaceutical Therapy with 213Bi-FAPI-46: Pilot Experience in Patients with End-Stage, Progressive Metastatic Tumors.

Radiopharmaceutical therapies (RPTs) based on fibroblast activation protein (FAP) and FAP inhibitors (FAPIs) are a new option for progressive metastatic cancer in patients pretreated multiple times. To date, published in-human data refer to initial experiences with β-emitting 90Y- and 177Lu-based RPT. However, the short tumor retention time of FAPI ligands is considered a major limitation of FAPI RPT. Therefore, fractionated FAPI RPT with 213Bi, an α-emitter with a half-life of 46 min, appears to be a promising FAPI RPT regimen. Here, we report on our initial experiences with regard to the feasibility, tolerability, and response of fractionated 213Bi-FAPI-46 RPT. Methods: Six patients (4 women and 2 men) with progressive metastatic solid tumors (3 colon cancer, 1 anal cancer, 1 breast cancer, and 1 prostate cancer) aged 16-77 y were treated with a mean of 1,609 MBq of 213Bi-FAPI-46, fractionated into 53 single applications (range, 5-12 RPT applications per patient; mean, 8.8 applications) over a period of up to 107 h per patient. Of the 6 patients, 4 patients received adjuvant treatment with pembrolizumab. 18F-FDG (4 patients) and 68Ga-FAPI-46 (5 patients) PET/CT scans were performed before and after RPT. PET images were assessed visually and by calculating total lesion glycolysis and total lesion FAPI. Results: RPT with 213Bi-FAPI-46 was well tolerated without adverse side effects. In terms of visual response assessment, there was 1 partial response (16.7%), 1 patient with stable disease (16.7%), and 4 patients with progressive disease (66.7%). Concordantly, total lesion glycolysis and total lesion FAPI were decreased in the responding patient (not applicable and -24.3%, respectively), slightly decreased in the patient with stable disease (-10.6% and -5.9%, respectively), and increased in the 4 patients with progression (mean, +104.4% and +321.3%, respectively). Conclusion: Fractionated FAPI RPT with the short-half-life α-emitter 213Bi-FAPI-46 is a promising approach that matches the pharmacokinetics of FAPI-46 better than the 177Lu- or 90Y-labeled compounds. In this pilot project, fractionated RPT with 213Bi-FAPI-46 showed good clinical tolerability and even led to regressive or stable disease in the short term in 2 of 6 patients. Further studies with larger patient cohorts are required to evaluate the actual efficacy and long-term effects of this variant of FAPI RPT.