Invasive Method Research Articles

Intra‐ and Postoperative Complications in 4565 vNOTES Hysterectomies: International Registry Cohort Study

ABSTRACTObjectiveTo present the rates of intra‐ and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise.DesignInternational register‐based cohort study.SettingHysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries.Population4565 patients undergoing vNOTES hysterectomy.MethodsDescriptive data are presented in frequencies (n) and percent (%).Main Outcome MeasureIntra‐ and postoperative complications. Conversions.ResultsIntraoperative and postoperative complication rates were 3.2% (n = 144) and 2.5% (n = 115), respectively. Conversions occurred in 1.6% (n = 72), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (n = 28), vault complications (n = 26) including 11 infected vault hematomas, cystitis (n = 18) and non‐specific infections (n = 14). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience.ConclusionsThe largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra‐ and postoperative complications. No implication was found of vNOTES being inferior to other minimally invasive methods.

Next step of molecular pathology: next-generation sequencing in cytology

The evolving landscape of precision oncology underscores the pivotal shift from morphological diagnosis to treatment decisions driven by molecular profiling. Recent guidelines from the European Society for Medical Oncology recomend the use of next-generation sequencing (NGS) across a broader range of cancers, reflecting its superior efficiency and clinical value. NGS not only updates oncology testing by offering quicker, sample-friendly, and sensitive analysis but also reduces the need for multiple individual tests. Cytology samples, often obtained through less invasive methods, can yield high-quality genetic material suitable for molecular analysis. This article focuses on optimizing the use of cytology samples in NGS, and outlines their potential benefits in identifying actionable molecular alterations for targeted therapies across various solid tumors. It also addresses the need for validation studies and the strategies to incorporate or combine different types of samples into routine clinical practice. Integrating cytological and liquid biopsies into routine clinical practice, alongside conventional tissue biopsies, offers a comprehensive approach to tumor genotyping, early disease detection, and monitoring of therapeutic responses across various solid tumor types. For comprehensive biomarker characterization, all patient specimens, although limited, is always valuable.

Possibilities of Peroral Transpapillary Cholangioscopy in Treatment of Complex Choledocholithiasis

Background: Сomplex choledocholithiasis remains an urgent socio-medical problem in modern medicine. This pathology is more common in patients with cholelithiasis and causes such complications as obstructive jaundice, acute and chronic pancreatitis, cholangitis, etc. Effective treatment depends on proper preoperative examination, which is quite challenging. In such cases, minimally invasive diagnostic methods play a fundamental role. Endoscopic cholangioscopy is an effective and highly informative method for diagnosis and treatment of biliary diseases including сomplex choledocholithiasis; in many cases it is the only examination technique that allows for a reliable diagnosis. The effectiveness of this technique and possibilities of its implementation by leading specialists in the Russian Federation and around the world remain important issues.Objective: To summarize available literature data on possibilities of using cholangioscopy in diagnosis and treatment of сomplex choledocholithiasis.Materials and methods: We conducted a literature review using PubMed and eLIBRARY. Our goal was to cover the most up-to-date medical articles published on the subject in the past 10 years. Studies included in our review are based on experimental and clinical data. Thus, we obtained the most reliable results that can be used in further research and practice.Results: We found that cholangioscopy has significant clinical value, which confirms its role as an important diagnostic and therapeutic approach in addition to endoscopic retrograde cholangiopancreatography in treatment of complex choledocholithiasis. This technique should be further thoroughly studied.

Exploring winter diet, gut microbiota and parasitism in caribou using multi-marker metabarcoding of fecal DNA.

In conservation strategies, getting precise and repeatable information on the species' diet and health without relying on invasive or laborious methods is challenging. Here, we developed an efficient and non-invasive workflow for the sequencing and analysis of four taxonomic markers from fecal DNA to characterize the gut microbiota, parasites, and plants and lichens composing the winter diet of caribou (Rangifer tarandus), Canada's most iconic endangered species. Sequencing of the 18S rRNA gene of eukaryotes from seven locations in Manitoba and Saskatchewan, Canada, allowed for the detection of five genera of parasites in caribou feces (including Nematodirella and Parelaphostrongylus) with variable frequency of occurrence depending on sampling location and sex. Our workflow also revealed a rich winter plant and lichen diet in caribou, with respectively 29 and 18 genera identified across all samples through plant and fungal ITS2 sequencing. Relationships between the gut microbiota and both the diet and parasite richness were also identified. Of note, the Central Saskatchewan sampling location was characterized by a clearly distinct gut microbiota which could be linked to an epiphytic lichen-rich diet. Overall, our results showed the potential of this multi-marker DNA metabarcoding workflow as an efficient tool to provide insights into the species biology and ecology.

Laparoscopic access is the modern standard for extended liver resection

Objective. To evaluate the safety and early results of laparoscopic extended liver resection in case of focal liver pathology by retrospective comparison with the relevant parameters of a similar open intervention. Materials and methods. The study involved 162 patients who were divided into two groups: Group 1 – 50 patients who underwent laparoscopic extended liver resection, and Group 2 – 112 patients who underwent open extended liver resection. The groups were compared by age structure, sex, body mass index, type of pathology (benign/malignant), as well as by characteristics of surgical intervention and postoperative period. Statistical analysis included a t–test for independent samples, Pearson's chi–square test, and other appropriate methods with the calculation of the confidence level p (parametric criterion). The difference in indicators was considered statistically significant at p < 0.05. Results. Laparoscopic osshire for liver resection was longer (p = 0.0012), but was associated with a lower level of pain according to the visual analog scale (p = 0.02) and fewer bed days to discharge (p = 0.0007) than a similar open intervention. There was no statistically significant difference between the groups in terms of age structure, body mass index, number of liver tumors, blood loss, complication rate, and degree of ischemic liver damage. Conclusions. Laparoscopic extended liver resection is a less invasive method than open liver resection, and patients recover faster after it, although its duration is longer. At the same time, laparoscopic and open intervention had a similar incidence of complications, which indicates acceptable safety and high clinical efficacy of the laparoscopic approach in the treatment of patients with liver disease.

Comparative characteristics of minimally invasive and classical (median sternotomy) methods of coronary artery bypass grafting

Objective. To analyze the results and comparative characteristics of minimally invasive and classical coronary artery bypass grafting in multivessel coronary artery disease and the presence of critical stenosis. Materials and Methods. Over the past two years, the National Scientific Center of Surgery and Transplantation named after O. O. Shalimov performed mini­invasive coronary artery bypass grafting for multivessel lesions of the coronary arteries in 27 patients (group 1). The comparative study also included 27 patients operated on using the classical method (group 2). The average age of patients was (53.1 ± 3.9) years. There were 46 men (85.2%) and 8 women (14.8%). According to the main indicators, including the number of affected coronary arteries, age, physiological parameters, etc., the groups did not differ statistically significantly. The main methods of the study were coronary angiography, multislice computed tomography of the coronary arteries with 3D reconstruction of the architecture of the great vessels, chest and heart. Results. During the follow­up of patients in both groups for up to a year after the operation, no clinical manifestations of angina and heart failure were noted, which gives reason to state the good function of the shunts. Intra­ and postoperative complications in group 1 occurred in 2 patients: the need for conversion due to cardiac rhythm and hemodynamics (1) and repeated thoracotomy due to bleeding from the arterial shunt (1). In group 2, complications also occurred in 2 patients: sternal diastasis requiring sternoplasty (1) and surgical wound exudation requiring the installation of a vacuum device for 4 days with subsequent secondary suturing (1). Conclusions. Minimally invasive coronary artery bypass grafting is a safe method of myocardial revascularization in multivessel coronary artery disease and critical stenosis. The technique allows for rapid rehabilitation and shorter hospital stays, which is economically beneficial for the hospital. Minimally invasive coronary artery bypass grafting can be considered as an alternative to the classical method of coronary artery bypass grafting with midline sternotomy.

Abstract PR009: Application of Liquid Biopsy-RECIST (LB-RECIST) criteria to track metastatic colorectal cancer (mCRC) molecular response in first-line (1L) setting: Findings from the PLATFORM-B study

Abstract Introduction: Circulating tumor DNA (ctDNA) analysis is a minimally invasive and reproducible method to explore tumor molecular biology. Recently, Gouda et al. proposed the LB-RECIST criteria to monitor molecular response, validating them on a heterogeneous metastatic population. However, data on mCRC are lacking. Here, we report the first attempt to apply LB-RECIST in the multicenter prospective PLATFORM-B study, which enrolled 130 mCRC patients (pts) receiving 1L standard therapy, with ctDNA analysis performed at different time points. Materials and Methods: Baseline (BL) and week 8 (W8) plasma samples were analyzed using a targeted NGS-based approach (Ion S5 system). Changes in ctDNA detectability were assessed to determine molecular response as per qualitative LB-RECIST criteria: Group1 (G1, detectable ctDNA at BL and W8); Group2 (G2, detectable BL and undetectable W8); Group3 (G3, undetectable BL and detectable W8); Group4 (G4, undetectable at BL and W8). Changes in aggregate variant allele frequency (VAF) - the sum of all VAFs of the studied genes in a sample - were used to assess quantitative LB-RECIST responses: ctDNA Complete Response (CCR, clearance after initial detectability), Partial Response (CPR, decrease >10%), Stable Disease (CSD, no change or decrease <10%), Progressive Disease (CPD, increase >10% or new mutations), and Non-measurable Disease (CND, undetectable at BL and W8). Molecular results were correlated with clinical outcomes. Statistically significant differences were assessed across different groups using 2-sided P values with an α ≤ .05 level of significance. Results: Overall, 79 pts had paired BL and W8 samples. Quantitative LB-RECIST identified 32 CCR, 18 CND, 20 CPR, 8 CPD, and 1 CSD cases. Qualitative LB-RECIST found 22 G1, 32 G2, 7 G3, and 18 G4 cases. Radiological RECIST identified 6 CR, 47 PR, 21 SD, and 5 PD. CCR showed the highest survival rates: with a median follow-up of 25 months (mo) (range: 1–49), median progression-free survival (mPFS) was not reached (NR) and median overall survival (mOS) was 41.8 mo. The CND group had similar rates (mPFS NR; mOS 41.1 mo). CPR and CPD had the poorest outcomes: for CPR, mPFS was 12.7 and mOS 16.4 mo; for CPD, mPFS and mOS were 11.9 and 25.5 mo, respectively. In the G1, G2, G3, and G4 groups, mPFS was 11.9, NR, 14.2, and NR, respectively, while mOS was 16.4, 41.8, 33.4, and 41.1 mo. Kaplan-Meier analysis of the quantitative groups showed statistically significant differences (P < .0001) for both PFS and OS curves. The same level of significance was found in the qualitative groups. Conclusion: LB- RECIST can be a rapid and reproducible method to assess molecular response in mCRC. However, concerns remain. The CND group (23% of cases) showed survival rates similar to the CCR group, as observed also between G4 and G2. These data suggest that absence of ctDNA at W8 is the best surrogate for OS. Moreover, CPD had higher OS rates than CPR, but similar PFS. Further investigations in larger populations are needed to refine these criteria and improve molecular response stratification Citation Format: Valentino Martelli, Joana Vidal, Maria Concepción Fernández-Rodríguez, Pilar García-Alfonso, David Páez, Joan Gibert, Jennifer Linares, Annarita Sibilio, Vicente Alonso, Maria Teresa Cano, Cristina Santos, Gema Duran, Elena Élez, José Luis Manzano, Rocio Garcia-Carbonero, Reyes Ferreiro, Ferran Losa, Estela Pineda, Javier Sastre, Auxiliadora Gomez-España, Rodrigo Toledo, Fernando Rivera, Beatriz Bellosillo, Josep Tabernero, Ramon Ramon Salazar, Enrique Aranda, Clara Montagut. Application of Liquid Biopsy-RECIST (LB-RECIST) criteria to track metastatic colorectal cancer (mCRC) molecular response in first-line (1L) setting: Findings from the PLATFORM-B study [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr PR009.

Non-invasive testing in metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as non-alcoholic fatty liver disease (NAFLD), is a leading cause of chronic liver disease, affecting up to 30% of the global population. MASLD is strongly associated with metabolic risk factors such as obesity and type 2 diabetes, and can progress to advanced stages including cirrhosis and hepatocellular carcinoma. Early diagnosis and accurate staging of fibrosis are critical in managing the disease and preventing complications. While liver biopsy has long been considered the gold standard for assessing fibrosis, it is invasive and carries associated risks. In response, non-invasive tests (NITs) have emerged as essential alternatives for the diagnosis and monitoring of MASLD. Key methods include blood-based biomarkers such as the Fibrosis-4 (FIB-4) score, NAFLD Fibrosis Score (NFS), and Enhanced Liver Fibrosis (ELF) test, as well as imaging modalities like vibration-controlled transient elastography (VCTE) and magnetic resonance elastography (MRE). These tests provide safer, more accessible methods for identifying liver fibrosis and guiding clinical management. They are integral in assessing disease severity, guiding treatment decisions, and monitoring disease progression, particularly in light of emerging therapies. NITs have become increasingly recommended by clinical guidelines as they reduce the need for invasive procedures like liver biopsy, improving patient care and outcomes. In conclusion, non-invasive testing plays a crucial role in the effective management of MASLD, offering reliable alternatives for diagnosis and monitoring while minimizing risks associated with traditional invasive methods.

Abstract 4135025: Inflammation-related 5-hydroxymethylation signatures as markers for clinical presentations of coronary artery disease

Background: Coronary angiography, an invasive method, remains the gold standard technique for coronary artery disease (CAD) diagnosis in clinical practice. However, due to its invasive nature, it cannot be used for mass population screening. There is an urgent need in the clinical to identify new liquid biopsy molecular markers for screening patients with CAD. Methods: We utilized 5hmC-Seal to generate genome-wide 5hmC profiles in plasma cell-free DNA (cfDNA) from 724 CAD patients. To investigate the correlation between 5hmC modifications and CAD, we separated patients into training and validation cohorts and developed a 5hmC-based logistic regression model from the training cohort to predict CAD patients in the validation cohort. Furthermore, we incorporated an external cohort comprising 167 samples to validate the reliability of our model. Results: We found that the differentially hydroxymethylated genes (DhMGs) in people with the normal coronary artery (NCA), nonfatal stable CAD (sCAD), non-ST-elevation myocardial infarction (NSTEMI), as well as ST-elevation myocardial infarction (STEMI) enriched in neutrophil-mediated inflammatory response pathways, and inflammation-related DhMGs can reflect the progression of atherosclerotic plaque. Furthermore, we used machine learning algorithms to develop a predictive model for predicting the occurrence of myocardial infarction (MI) based on 19 inflammatory markers, and the predictive model could effectively predict MI (NSTEMI and STEMI) (AUC = 0.913). Simultaneously, our model has demonstrated strong performance in external validation. Conclusions: We have identified a novel biomarker, the inflammation-associated 5hmC markers, which can reflect the clinical manifestations of CAD and can effectively predict the occurrence of MI.

A novel sandwich technique of minimally invasive surgery for corneal perforation.

This study aimed to describe a novel sandwich technique of minimally invasive surgical implantation by using corneal stromal lenticules for corneal perforation. This prospective observational study included nine patients aged 23-79 years (mean, 54 ± 9) from Tianjin Eye Hospital. Corneal stromal lenticules with a central thickness of 120μm were obtained from small incision lenticule extraction(SMILE). With the corneal perforation as the central point, an iris-repositor was used to manually create a mid-stromal pocket; the stromal lenticular button was gently inserted into the intrastromal pocket and flattened. The graft was sandwiched between the anterior and posterior corneal stromal pockets; the incision was closed using two sutures. The primary health outcome measured in this study was the logMAR best spectacle-visual acuity at 6 months postoperatively. Corneal perforation closure and anterior chamber formation occurred immediately after surgery. No epithelial implantation, infection, or allogeneic rejection was observed during the follow-up. No patients required a penetrating keratoplasty. Anterior segment optical coherence tomography revealed a mean thickness of the grafted tissue of 122 ± 21μm, with a clear interface in all cases. Comparing the baseline and postoperative 6-month values, the mean logMAR best spectacle-corrected visual acuity was improved from 0.18 ± 0.12 to 0.52 ± 0.31 (P < 0.001). There was significant reduction in the mean manifest spherical equivalent, refractive cylinder, and mean keratometry readings. The novel minimally invasive surgical method for corneal implantation. It was an effective alternative treatment that could restore corneal integrity and improve vision in patients with corneal perforations. This method appears safe, easy, cost- and time-effective, and reliable.

Ultrasound-guided percutaneous microwave ablation of primary hyperthyroidism: security and efficacy analysis

Objectives This study aimed to analyze the safety, efficacy, and application prospects of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperthyroidism. Methods Eight patients with primary hyperthyroidism who underwent ultrasound-guided glandular volume reduction between January 2021 and December 2022 were included in this study. Pre- and postablative examinations, including grayscale ultrasound, contrast-enhanced ultrasound (CEUS), laboratory examination, antithyroid drug (ATD) dosage, and quality of life (QoL) assessment via Thyroid-Specific Patient-Reported Outcome Short-Form (ThyPRO-39), were analyzed retrospectively. The main ultrasound follow-up times were 1, 3, 6, and 12 months after ablation. Thyroid function was reviewed 1 week after ablation, and the subsequent reexamination time was determined according to the patient’s specific test results and ATD adjustment. The final efficacy was comprehensively analyzed according to the patient’s medication status, thyroid function, thyroid volume, and QoL score. Results All 8 patients successfully received MWA for primary hyperthyroidism, and none of them experienced serious complications. By the end of the follow-up, 5 of the 8 patients had stopped taking ATDs, 3 of the 8 patients had reduced ATD dosages, and all of them maintained stable thyroid function. Although descriptive analysis was performed because of the small sample size, patients’ thyroid volume reduction, and obvious improvements in goiter symptoms, hyperthyroid symptoms, anxiety, etc., were observed during our follow-up. Conclusion Ultrasound-guided MWA for reducing thyroid gland volume in primary hyperthyroidism patients is a new, safe, and effective minimally invasive treatment method that is a good choice for patients who cannot or refuse traditional treatment methods.

Diagnostic Utility of MicroRNAs in Pancreatic Cancers

Pancreatic cancer (PC) is a serious malignant tumor with a high mortality rate, mainly due to late diagnosis and a lack of effective therapeutic interventions. The possibility of recognizing this cancer with reliable biomarkers using minimally invasive methods is of great importance for improving early detection, prognostic assessment, and targeted treatment methods. In recent years, small non-coding RNAs, especially microRNAs, have emerged as promising candidates for biomarkers of pancreatic cancer. Despite the methodological and analytical limitations of microRNA determination and a lack of available automated and standardized tests, a prospective systematic assessment of this new parameter’s use in the detection of pancreatic cancer is warranted. This review provides general information on the diagnostic and prognostic utility of microRNAs, which appear to be well-established in many studies. In summary, microRNAs are promising non-invasive biomarkers of pancreatic cancer, offering potential opportunities for early detection, prognosis, and treatment monitoring. As research in this field progresses, microRNAs should become valuable tools in the fight against pancreatic cancer.

Murine vaginal secretory responses to a male volatile chemical messenger.

Many species use chemical messengers to communicate a remarkable range of information. Mice appear to make particular use of chemical messengers, including effects on estrous cycling and initiation, pregnancy, aggression, stress and of course attraction. Behavioral studies have helped identify several candidate messengers, or pheromones, that mediate attraction in mice. One question is whether attractive chemical messengers induced a physical vaginal secretory response. The preparation hypothesis posits that increased vaginal secretion would lubricate and protect the vagina in response to the prospect of imminent coitus, but this has been difficult to assess experimentally, particularly in mice. We developed a rapid, sensitive, minimally invasive method of quantifying vaginal moisture in mice and used this model to test vaginal secretory responses to male bedding. We report that female mice experience an increase in vaginal moisture after exposure to male, but not female, bedding. This response is induced by either physical or airborne exposure to male urine, to preputial gland extract, and to the preputial gland-derived pheromone alpha/beta farnesenes. This vaginal response is diurnally regulated, seen only during their active phase. The response is sensitive to the estrous phase, with a clear response during estrus but not during metestrus. We conclude that mice may serve as a model for aspects of vaginal function and that this assay will be readily applicable to other small animals. The identification of a pheromone-mediated vaginal secretory response offers a window into the regulation of the vaginal environment and the neurobiology of sexual responses in mice.

Pregnancy detection based on blood serum sample Raman spectroscopy.

In this research, women were diagnosed as pregnant based on blood serum samples Raman spectroscopy. Raman spectroscopy is a vibrational technique that provides information on the chemical composition of samples. The Raman techniques have significantly impacted the study of various degenerative diseases, particularly cancer detection, using less invasive methods such as the analysis of blood serum samples. Additionally, these techniques have been used to study the health status of patients, which is often difficult to monitor using conventional techniques. This study obtained serum samples from 12 women diagnosed as pregnant and 11 non-pregnant volunteers (controls). Spectra were collected using a LabRAM HR800 Raman Spectrometer (Horiba Jobin-Yvon) with an 830 nm wavelength laser. For each serum sample, 10 Raman spectra were obtained by focusing the laser, using a microscope objective, on different points of the sample with an exposure time of 40 seconds and an irradiation power of 17 mW. The raw spectra were processed using baseline correction and smoothing to remove noise, fluorescence, and shot noise. Subsequently, the spectra were normalized and analyzed using the multivariate statistical method of Principal Component Analysis (PCA). In these spectra, the characteristic bands of main blood serum biomolecules such as phenylalanine (Phe), tyrosine (Tyr), glutathione, amide III, phospholipid, carotene, and tryptophan (Trp) can be observed. Nevertheless, when analyzing the average spectra of pregnant and non-pregnant women, the main spectral differences were associated with variations in molecules like glutathione, tryptophan (Trp), tyrosine, and phenylalanine, which occur during the first trimesters of pregnancy. This aligns with findings previously reported by other studies. Furthermore, the serum samples from pregnant and non-pregnant patients can be effectively discriminated using PCA applied to the Raman spectra, revealing two distinct clusters in the PCA plot corresponding to each group's status. The results demonstrate that pregnancy can be determined based on blood serum samples Raman spectroscopy with sensitivity and specificity. Although there are very effective devices on the market to determine pregnancy based on the Human Chorionic Gonadotropin (HCG) hormone detection in urine samples, these preliminary results indicate an alternative method known as Raman spectroscopy. On the other hand, the results could also suggest the possibility of carrying out other gynecological or fetal-related studies in women using these Raman techniques.

The Emergence of Saliva as a Diagnostic and Prognostic Tool for Viral Infections

Saliva has emerged as a promising diagnostic fluid for viral infections, enabling the direct analysis of viral genetic material and the detection of infection markers such as proteins, metabolites, microRNAs, and immunoglobulins. This comprehensive review aimed to explore the use of saliva as a diagnostic tool for viral infections, emphasizing its advantages and limitations. Saliva stands out due to its simplicity and safety in collection, along with the convenience of self-collection without the need for healthcare supervision, while potentially being comparable to urine and blood in terms of effectiveness. Herein, we highlighted the significant potential of saliva in assessing viral loads and diagnosing viral infections, such as herpesviruses, HPV, PyV, TTV, SARS-CoV-2, and MPXV. The detection of viral shedding in saliva underscores its utility in early diagnosis, the monitoring of infection progression, and evaluating treatment responses. The non-invasive nature of saliva collection makes it an appealing alternative to more invasive methods, promoting better patient compliance and facilitating large-scale screening and surveillance. As such, we further highlight current evidence on the use of saliva as a prognostic tool. Although a significant amount of data is already available, further investigations are warranted to more comprehensively assess the added benefit from the utilization of salivary biomarkers in the clinics. Salivary biomarkers show great promise for the early detection and prevention of viral infection complications, potentially improving disease management and control at the population level. Integrating these non-invasive tools into routine clinical practice could enhance personalized healthcare strategies and patient outcomes. Future studies should focus on establishing standardization protocols, validating the accuracy of salivary diagnostics, and expanding clinical research to enhance the diagnostic and monitoring capabilities of salivary biomarkers.

Endoscopic bariatric surgery for adults with overweight and obesity: a systematic review and network meta-analysis.

Endoscopic bariatric surgery (EBS) is a new treatment for obesity. We compared the efficacy, safety, and probability of metabolic complications of different EBSs with laparoscopic sleeve gastrectomy (LSG). This systematic review and network meta-analysis (NMA) included searches of PubMed, Web of Science, and the Cochrane Library from January 1, 2017, to December 27, 2022, to find comparative trials of EBS procedures and EBS with LSG. We performed a frequentist model NMA to summarize the evidence and ranked the interventions according to SUCRA scores. The search for this NMA yielded 14,160 articles, of which 18 eligible trials recruited 766,135 participants for procedures including LSG, endoscopic sleeve gastroplasty (ESG), nonadjustable intragastric balloon (NIB), BioEnterics Intragastric Balloon (BIB), and adjustable intragastric balloon (AIB). Definitive evidence suggests that LSG is most effective for weight reduction. Compared with LSG, NIB, SMD = -0.49 [95% CI -0.79, -0.18]; AIB, SMD = -0.41 [95% CI -0.76, -0.06] and ESG, SMD = -0.31 [95% CI -0.33, -0.29] in the index of percentage total weight loss under six months. In terms of safety outcomes, ESG had the lowest incidence of adverse events; the order of the observed incidence of adverse events from small to large was ESG, NIB, AIB, LSG, and BIB. ESG is an effective and safe minimally invasive surgical method for people with overweight and obesity. Its 12-month effect is better than that of NIB, and its influence on lipid metabolism makes it more protective of the cardiovascular system and liver. CRD42022375343.

BIOM-48. UTILITY OF CIRCULATING TUMOR DNA (CTDNA) FROM CEREBROSPINAL FLUID (CSF) FOR PROGNOSIS OF PATIENTS WITH RECURRENT HIGH-GRADE GLIOMA

Abstract High-grade gliomas (HGGs) are the most aggressive primary brain tumors, and molecular characterization is vital for their diagnosis and treatment. Due to their location, tumor sampling is often challenging. Therefore, developing minimally invasive diagnostic methods is urgently needed. Here we report that circulating tumor DNA (ctDNA) from cerebrospinal fluid (CSF) can identify key genomic alterations and track clonal evolution in HGGs. Detection of CSF ctDNA correlates with leptomeningeal disease and overall survival, indicating its potential for integration into clinical decision-making. Our study includes 313 samples from 253 patients with recurrent glioma treated at MSKCC who underwent CSF collection using the MSK-IMPACT targeted sequencing assay. 37% of genomic alterations were detected using our less stringent variant calling criteria and Gaussian Mixture Model to call copy number events. CSF ctDNA positivity was determined by the presence of at least one oncogenic disease-defining alteration or any shared alteration with the tumor. We found 212 CSF ctDNA positive (68%) and 101 CSF ctDNA negative (32%) samples. CSF ctDNA positivity was the highest amongst histone mutant tumors (96%). We noticed 44% of alterations shared between the tumor and the CSF, additionally, we noted considerable tumor evolution particularly within the growth signaling pathways (e.g. PDGFRA). Our cohort demonstrated that patients with positive CSF ctDNA had a significantly shorter overall survival compared to those who were CSF ctDNA negative (4.83 months vs 14.14 months, HR 2.4, p &amp;lt; 0.001). Radiographic findings such as enhancing disease and contact of the tumor with the ventricular space were positively associated with CSF ctDNA positivity. Additionally, CSF ctDNA was associated with positive cytology in 12/12 cases (100%). With our improved pipeline, we hypothesize CSF ctDNA may be used as a prognostic biomarker for survival, but confirmation requires further validation in a prospective study.

The "oncological trace": circulating tumor DNA in uveal melanomas

Cell-free DNA (cfDNA) and the tumor DNA it contains can be detected in various body fluids and can be obtained in aminimally invasive manner using a liquid biopsy. The fragmented cell-free tumor DNA (ctDNA) serves as amarker for the presence of tumor cells in the body and its analysis enables genetic tumor characteristics to be determined. For some nonocular tumors ctDNA is already approved as apredictive or prognostic marker. This literature review article describes examples of the use of ctDNA as abiomarker in nonocular tumors and the current status of ctDNA analysis in cases of uveal melanomas. For this purpose, aselective literature search was carried out via PubMed. Uveal melanomas are nowadays usually treated by eye-preserving therapy. In these cases, there is usually no tumor tissue available for further diagnostic testing. Alternatively, molecular characteristics of the tumor can be determined by the genetic analysis of ctDNA. In uveal melanomas the presence of ctDNA in the plasma at the time of the primary diagnosis is controversial; however, an increase in the amount of ctDNA, which can be used to investigate diagnostically and prognostically relevant genetic changes, was detected during irradiation therapy of the primary tumor in some patients. In the later course of the disease, the amount of ctDNA in the plasma is asuitable marker for metastatic progression. In some cases, an increase in ctDNA levels could be recognized several months before the clinical detection of metastases. The analysis of cfDNA in patients with a uveal melanoma is apromising and minimally invasive method for obtaining information about the tumor or the course of the disease. It is currently being investigated which patients could benefit from it in the future. Several issues related to standardization and technical validation must be addressed for its routine clinical application.

Investigating the Effects of Shockwave and Percussion Massage Gun on Subacute Myofascial Pain in Gasterocenemious Muscle

Introduction: Myofascial pain syndrome is a common musculoskeletal injury, especially among athletes, typically treated with symptomatic invasive and non-invasive methods. This study compares the effects of massage guns and radial extracorporeal shock wave therapies on myofascial pain syndrome symptoms in amateur athletes. Materials and Methods: In this clinical trial, 45 amateur athletes (18-30 years old) were recruited, who were randomly assigned to 15-member groups of shock wave, massage gun, and control (routine treatment included electrotherapy and stretching, which was applied on three groups). After initial evaluations of the pain intensity, pain pressure threshold (PPT), isometric muscle strength, and range of motion (ROM), the patients received single-session treatment and were immediately reassessed. Results: The results showed pain relief and improved PPT following shock wave plus routine treatment (P=0.03). The control group had less pain, while pain intensity and PPT did not change. The variables were not significantly different between the groups (P=0.12). Shock wave along with routine treatment increased plantar flexion ROM (P=0.00), unlike the massage gun. Additionally, dorsiflexion ROM (P=0.63) and maximal isometric gastrocnemius muscle strength (P=0.95) remained unchanged in all groups. Conclusion: One session of massage gun therapy immediately reduced gastrocnemius muscle pain, while it failed to change PPT, maximal isometric gastrocnemius muscle strength, or dorsiflexion and plantar flexion ROM. However, shock wave therapy immediately increased plantar flexion ROM and PPT, and reduced pain intensity. These modalities led to limited changes, suggesting the need for repeated sessions and supplementary treatments.

Voiding sonography: Technical description of a novel ultrasound method for assessment of micturition in women

AbstractVoiding sonography (VS) is a novel non‐invasive method that can be used to assess micturition in real time. When performed in a functional seated position and combined with free uroflowmetry, detailed evaluation of voiding can be conducted. VS presents advantages over current invasive assessment methods such as urodynamics. This methodological paper describes the rationale; advantages and disadvantages of VS; participant preparation; technique; a practical approach to obtain the video/image (including transducer placement to achieve an assessment of voiding with minimal obstruction of urine flow); recommended machine and transducer specifications; and the potential usefulness of ultrasound measurements. These measurements might provide information regarding the function of the pelvic floor muscle and urethral dynamics during voiding. Measures assessed with VS can also provide information regarding urine storage. In summary, VS is a new method to assess female voiding. Future work should evaluate the potential utility of the method to evaluate characteristics and mechanisms for voiding dysfunction in females with a variety of relevant clinical conditions. Use of VS as a screening tool before and after surgical or non‐surgical treatment intervention may also be a future consideration to assess progress and provide feedback to clinicians and patients.