Long-term Outcome Of Patients Research Articles

Dose-escalated radiation for locally advanced unresectable pancreatic cancer.

750 Background: Patients with unresectable locally advanced pancreatic cancer have limited therapeutic options. Historical treatments have included systemic chemotherapy or palliative radiation. New advanced radiotherapy treatment techniques have allowed dose escalated ablative radiotherapy to be delivered for patients with cancer limited to the pancreas. This study retrospectively reviews the long term outcomes of patients receiving dose escalated radiation for unresectable localized pancreatic cancer. Methods: Patients with locally advanced unresectable pancreatic underwent neoadjuvant chemotherapy with either gemcitabine or FOLFIRINOX based regimens. When maximum response was achieved with chemotherapy or this was no longer tolerated, patients were reassessed with imaging. Patients with localized unresectable disease then proceeded to definitive dose escalated radiation with either SBRT radiosurgery (40Gy in 5 fractions) or IMRT radiation (65-70Gy in 30-35 fractions) with concurrent 5FU. Surveillance of disease was performed with CT imaging and Ca19-9 biomarker assessment. Results: A total of 38 patients (21 male, 17 female) underwent definitive radiation. Radiation technique was determined by treating physician based on patient anatomy, with 7 patients having SBRT and 31 IMRT/5FU. Average patient age at diagnosis was 71. All patients underwent at least 6 months of follow up and mean follow up was 14 months. At time of latest follow up, 30 patients had no evidence of local progression and 12 patients had no evidence of progression at any site. The most common side effect at last follow up was grade 2/3 duodenal ulcer experienced by 7 patients. Conclusions: Advances in systemic chemotherapy have increased the population of patients with locally advanced unresectable pancreatic cancer who have persistent pancreatic disease after induction chemotherapy. Definitive dose escalated radiation is a new and effective technique to provide local control in this setting. This approach is well tolerated with manageable toxicity and effective durable local control. Patients continue to experience distant disease failure despite improving local control rates, though at a lower rate than historical controls. Control of primary pancreatic malignancy with dose escalated radiation can potentially improve quality of life and function for these patients for whom additional chemotherapy or surgery is not indicated.

Long-term outcomes of 'temporary' defunctioning in patients with severe perianal Crohn's disease.

This study aimed to analyse long-term outcomes in patients undergoing temporary faecal diversion for therapy-refractory Crohn's perianal fistulas. In this retrospective study, Crohn's patients who underwent defunctioning for perianal disease between 2012 and 2022 were included. The primary endpoints were successful ostomy reversal and proctectomy/proctocolectomy rates. Secondary endpoints were clinical fistula closure, development of proximal colonic disease recurrence, and the influence of medication, patient and disease characteristics on ostomy reversal. In total, 53 patients were included, 35 colostomies and 18 ileostomies. Previous L2 disease was more frequently seen in the ileostomy group (colostomy 29%, ileostomy 83%; P = 0.004). Clinical closure of the fistula was seen in 26%. 21% (11/53 patients) underwent an attempt at ostomy reversal during a median overall follow-up of 90.1 months (interquartile range 17.5-82.5) of which nine ostomies (colostomy 23%, ileostomy 6%; P = 0.244) were closed successfully. In 35%, a proctectomy/proctocolectomy was required to control ongoing perianal sepsis. Factors associated with ostomy reversal were fistula closure (P < 0.001) and L1/L3 disease (P = 0.043). In patients with ostomy reversal attempt (n = 11), successful reversal was associated with colostomy (P = 0.055) and use of anti-tumour necrosis factor (anti-TNF) (P = 0.055) despite being previously classified as anti-TNF refractory. Ostomy reversal rates are low, so defunctioning ostomies should be carefully considered because in most patients the ostomy will be permanent. In one-third of the patients, a proctectomy/proctocolectomy is required to treat ongoing perianal sepsis. If a patient is eligible for ostomy reversal, reversal should preferably be done under anti-TNF to optimize chances of success.

Perioperative and long-term outcomes of bilateral cardiac sympathetic denervation via video-assisted thoracoscopic surgery in patients with refractory ventricular arrhythmias.

Bilateral cardiac sympathetic denervation (CSD) performed via video-assisted thoracoscopic (VAT) surgery shows potential in managing ventricular tachycardia (VT), thereby reducing arrhythmic burden. In this setting, the scarcity of studies addressing both perioperative and long-term outcomes creates a substantial gap in the optimal management of patients with multiple comorbidities and limited treatment options. This observational study aimed to assess the medical comorbidities, as well as the short- and long-term outcomes of patients who underwent CSD for VT refractory to catheter ablation and medical therapy at a referral tertiary teaching hospital. We retrospectively analyzed data of all patients with VT who underwent bilateral CSD-VAT surgery at a single center. Unadjusted Kaplan-Meier survival curves were generated to analyze the survival rates at 1-year and 2-years following the procedure. Ten consecutive patients were unrolled between August 2014 and March 2024. Bilateral CSD-VAT surgery was successfully performed in all patients. Pre-operative ejection fraction was 33% (26-41). Two patients (22%) suffered cardiogenic shock and 1 vasoplegia. Half (50%) of the patients necessitated inotrope/vasopressor support and 1 an intra-aortic balloon pump. Median hospital stay was 12 (9-19) days. Three (33%) patients required postoperative ICU admission. All patients were alive upon hospital discharge. Neither major surgical complications nor complications typically associated with VAT-CSD (e.g., Horner's syndrome) were observed. The 1-year survival was 80% while the survival at 24months was 60%. CSD-VAT is a feasible rescue treatment in patients with refractory VT and is associated with limited intra- and postoperative complications alongside an acceptable long-term survival rate.

Abstract 33: A Novel Imaging Biomarker to Make Precise Outcome Predictions for Patients with Acute Ischemic Stroke

Introduction: Net water uptake (NWU) is a novel biomarker which measures edema and tissue injury from the degree of hypoattenuation on non-contrast CT and may serve as a precision tool for predicting outcomes after acute ischemic stroke (AIS). Using our recently developed algorithm, this study aimed to evaluate the relationship between NWU and post-stroke neurologic outcomes, including language impairment and motor weakness. Methods: Consecutive patients treated for AIS at certified stroke centers in Houston, TX were included. Patients’ precise functional outcomes at hospital discharge were recorded including decreased level of consciousness, presence of language impairment, visual deficit, arm and leg weakness, need for walking assistance, and gastrostomy placement. The primary outcome for this study was the performance of calculated NWU and clinical variables to predict language impairment at discharge. Baseline characteristics were compared, and then univariate and multivariate logistic regression were used to evaluate the association between clinical variables, imaging data, and the precise neurological outcomes. Results: Among 776 patients with AIS, average age was 67.0 +/- 14.8, 47.8% were female, median NIHSS was 10 [5,18], median ASPECTS was 9 [7,10], 42.6% received tPA, and 67.1% had a large vessel occlusion (see Table 1). In univariate logistic regression, higher NWU (OR 1.45, CI 1.30-1.63) and lower ASPECTS (OR 0.68, CI 0.63-0.74) were both significantly associated with higher likelihood of language impairment and other deficits at discharge (see Table 2). Additionally, higher NWU in all ten regions was significantly associated with deficit at discharge. In multivariate logistic regression, certain clinical and imaging variables remained significantly associated as described in Table 3. The ASPECTS and NWU-based regression models were directly compared when predicting language impairment using ROC curve analysis, and areas under the curve were 0.838 vs. 0.851 respectively (p = 0.152 with Delong test, see Figure 1). Conclusion: The novel NWU biomarker was significantly associated with precise post-AIS outcomes at discharge. When controlling for confounders, NWU was non-inferior to ASPECTS. Moving forward, region-based and overall NWU will need to be studied with long-term patient outcomes. Ultimately, this novel and open-access imaging biomarker could be used in the emergency setting to guide treatment decision-making and patient counseling.

Negative Impact of Low Serum Cholinesterase on Short- and Long-term Outcomes in Elderly Patients Undergoing Scheduled Surgery for Colorectal Cancer.

Cholinesterase (ChE) is important for estimating nutritional status and can be easily measured. This study aimed to investigate the effect of ChE on the short- and long-term prognoses of elderly patients with colorectal cancer. This study included 120 elderly patients who underwent scheduled surgery for colorectal cancer. ChE is a biomarker that can be easily measured using blood tests. The optimal cut-off level of ChE was determined using receiver operating characteristic analysis. We investigated the relationship of ChE with disease-free and overall survival using univariate and multivariate analyses. Seventy-two (60%) patients had low ChE levels (<255 U/l). In the multivariate analysis, low ChE (p=0.04) was an independent and significant predictor of postoperative complications. Low ChE (p=0.049), low prognostic nutritional index (p=0.04), and lymph node metastasis (p<0.01) were independent and significant prognostic predictors of poor disease-free survival. American Society of Anesthesiologists Physical Status 3 (p<0.01), low ChE (p<0.01), and lymph node metastasis (p<0.01) were independent and significant predictors of poor overall survival. ChE level is a significant predictor of short- and long-term outcomes in elderly patients undergoing scheduled surgery for colorectal cancer.

Long-term outcomes after postponing surgery to optimise patients with acute right-sided obstructing colon cancer.

To retrospectively analyse the short- and long-term oncological, morbidity and mortality outcomes in patients diagnosed with acute right-sided obstructing colon cancer. Patients who underwent pre-optimisation prior to the oncological resection were compared to patients who did not undergo pre-optimisation. All consecutive patients with right-sided obstructing colon cancer, either with a high clinical suspicion or confirmed diagnosis by histological analysis, who underwent curative-intent treatment between March 2013 and December 2020 were included. Patients were divided into two groups: an optimised group and a non-optimised group. Preoperative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. Data about disease-free survival and mortality were collected up to three years after surgery. Sixty-two patients were included. Thirty patients underwent the optimisation protocol before postponed surgery, and 32 patients received emergency surgery, without optimisation (surgery performed with a median of 9.6 days versus 22h after admission). The postoperative complication rate was significantly lower in the optimisation group (50% vs 78%, p=0.033). No significant differences were found in the 90-day mortality rate (7% vs 13%, p=0.672) and three-year overall survival rate (43% vs 56%, p=0.49). After three years, sixteen (53%) patients in the optimised group and twenty (63%) in the non-optimised were deceased (p=0.672). Postponing the surgery with preoperative optimisation in patients with obstructing right-sided colon cancer results in a significantly lower 90-day complication rate and suggests no negative effect on survival rates compared to an acute resection. Although, further research with a larger sample size is needed.

Long-term effects of attention deficit hyperactivity disorder (ADHD) on social functioning and health care outcomes.

Research on the long-term effects of treatment for attention deficit hyperactivity disorder (ADHD) on educational and social outcomes is limited. This study aims to evaluate long-term social functioning outcomes in patients with ADHD and the potential effects of pharmacological treatment for ADHD. We used National Patient Registry data from 1995 to 2016 to identify patients diagnosed with ADHD and those collecting ADHD medication. Eligible patients were under 30 years old or had reached 30 between 2005 and 2016, ensuring a minimum 10-year observation period. A case-control design was applied, matching ADHD patients in a ratio of 1:4 with the general population based on age, sex, and residential municipality at the index year. Patients with ADHD experienced substantial socioeconomic difficulties, indicated by increased direct health care costs, higher rates of psychiatric comorbidities, and greater co-medication use compared with controls. No association was found between adherence to ADHD medication and completion of education at age 30 years. Adherence to ADHD medication appeared to negatively impact employment status at age 30, confounded by the severity of psychiatric comorbidity. Despite available treatments, patients with ADHD lag in achieving social functioning outcomes. Further research is needed to better understand how to support patients with ADHD in order to close the gaps in health and socioeconomic status.

Abstract 13: Intravenous Tirofiban as An Adjunct to Endovascular Therapy for Posterior Circulation Strokes with Tandem Lesions: One-Year Outcomes

Background: The effectiveness and safety of intravenous Tirofiban as an adjunct to endovascular therapy (EVT) in posterior circulation patients with tandem lesions (PCTL) remain uncertain. Methods: This study utilized individual patient data pooled from two multicenter observational studies: the BASILAR and the PERSIST registries. We included patients with acute ischemic stroke due to PCTLs who were treated with EVT. The patients were divided into two groups based on whether they received adjunctive intravenous Tirofiban therapy or not. The primary efficacy outcome was favorable functional outcome, defined as modified Rankin Scale (mRS) scores of 0-3 at one year. Secondary outcomes included safety assessments, such as rates of symptomatic intracerebral hemorrhage (sICH), early neurological deterioration (defined as a decline in National Institutes of Health Stroke Scale [NIHSS] score by ≥4 points within 72h), and all-cause mortality at one year. We also evaluated procedural outcomes, including successful reperfusion, defined as modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3, and complete reperfusion, defined as mTICI 3. Results: Among 210 patients treated with EVT (126 Tirofiban, 84 Non-Tirofiban), successful reperfusion (mTICI 2b-3) was achieved in 109 (86.5%) Tirofiban patients versus 64 (76.2%) non-Tirofiban patients (Adjusted OR 1.75, 95%CI [0.76-4.03], P=0.19). Complete reperfusion (mTICI 3) was achieved in 74 (58.7%) Tirofiban patients versus 36 (42.9%) non-Tirofiban patients (Adjusted OR 2.08, 95%CI [1.04-4.14], P=0.04). Rates of sICH were 6 (4.8%) in the Tirofiban group versus 9 (10.7%) in the non-Tirofiban group (Adjusted OR 0.24, 95%CI [0.04-1.36], P=0.11). Early neurological deterioration occurred in 18 (14.3%) Tirofiban patients versus 32 (38.1%) non-Tirofiban patients (Adjusted OR 0.20, 95%CI [0.09-0.46], P&lt;0.001). One-year mRS 0-3 was achieved in 48/119 (40.3%) Tirofiban patients versus 24/82 (29.3%) non-Tirofiban patients (Adjusted OR 5.38, 95%CI [2.21-13.06], P&lt;0.001). One-year mortality was 45/119 (37.8%) in the Tirofiban group versus 43/82 (52.4%) in the non-Tirofiban group (Adjusted OR 0.26, 95%CI [0.12-0.59], P=0.001). Conclusion: Intravenous Tirofiban as an adjunct to EVT may improve long-term functional outcomes in acute ischemic stroke patients due to PCTLs without significantly increasing the risk of hemorrhagic complications. Further prospective studies are warranted to validate these findings.

Machine learning-based prediction of antipsychotic efficacy from brain gray matter structure in drug-naive first-episode schizophrenia

Predicting patient response to antipsychotic medication is a major challenge in schizophrenia treatment. This study investigates the predictive role of gray matter (GM) in short- and long-term treatment outcomes in drug-naive patients with first-episode schizophrenia (FES). A cohort of 104 drug-naive FES was recruited. Before initiating treatment, T1-weighted anatomical images were captured. The Positive and Negative Syndrome Scale and the Personal and Social Performance Scale were adopted to assess clinical symptoms and social function. At the 3-month follow-up, patients were categorized into remission and non-remission groups. At 1-year follow-up, patients were categorized into the rehabilitation and non-rehabilitation groups. Machine learning algorithms were applied to predict treatment outcomes based on GM volume, cortical thickness, and gyrification index, and the model performance was evaluated. Widespread regions, such as the superior temporal gyrus, middle frontal gyrus, supramarginal gyrus, the posterior central gyrus, anterior cingulate gyrus, and parahippocampal gyrus showed substantial predictive value for 3-month treatment efficacy (74.32% accuracy). The inferior frontal gyrus, anterior cingulate gyrus, and inferior occipital gyrus demonstrated significant predictive power for treatment outcome at 1-year follow-up (70.31% accuracy). We developed a machine learning model to predict individual responses to antipsychotic treatments, which could positively impact clinical treatment protocols for schizophrenia.

Long-term clinical outcomes in patients between the age of 50-70 years receiving biological versus mechanical aortic valve prostheses.

The last two decades have seen an incremental use of biological over mechanical prostheses. However, while short-term clinical outcomes are largely equivalent, there is still controversy about long-term outcomes. All patients between the ages of 50-70 years undergoing elective/urgent isolated aortic valve replacement at our institute between 1996 to 2023 were included. Trends, early and long term outcomes were investigated. A total of 1708 (61% male) patients with a median age of 63.60 (IQR : 58.28,67.0) years were included of which 1191 (69.7%) received a biological prosthesis.After inverse propensity score weighting, there were no short-term differences when comparing patients receiving biological and mechanical valves. However, patients who received mechanical prostheses had better long-term survival (p < 0.001). Sub-group analysis revealed that patients with biological size 19 mm prosthesis had the worse long-term survival. Patients with a size 21 mm mechanical prosthesis had better survival compared to both size 19 mm (HR: 0.25, 95% CI: 0.17,0.37, p < 0.001), 21 mm (HR: 0.33, 95% CI: 0.23,0.48, p < 0.001) and 23 mm (HR: 0.40, 95% CI: 0.27,0.60, p = <0.001) biological prosthesis.Additionally, patients with severe patient-prosthesis mismatch exhibited the lowest survival rate compared to those with moderate or no (HR 1.56, 95% CI 1.21, 2.00, p < 0.001). Patients aged between 50-70 years with a mechanical aortic prosthesis had better long-term survival compared to those with a biological prosthesis. Our study underscores the need for a critical re-evaluation of prosthesis selection strategies in this age group.

Long-term outcomes of total neoadjuvant treatment (TNT) for locally advanced rectal cancer: Maria Sklodowska Curie National Cancer Research Institute (MSCNCRI) cohort from Polish-II study.

84 Background: The data on long-term outcomes of TNT for locally advanced rectal cancer are still limited. The Polish-II study randomized 515 cT4/fixed cT3 rectal cancer to pre-operative chemoradiation (CRT) with 5fu/oxaliplatin or 5x5 Gy radiotherapy with consolidating chemotherapy (TNT). Despite the early separation of survival curves with benefit for TNT, the outcomes at the longer observation were similar reaching 49% in both arms surviving at 8 years. Here, we present the long-term oncological and functional outcomes of patients recruited to the study in MSCNCRI along with the quality of life in survivors at &gt;10 years of observation. Methods: Of 180 patients treated in the study in MSCNCRI 88 and 92 pts were randomized to TNT and CRT arms, respectively. The long-term follow-up was performed according to the standard protocol, FACT-C and EORTC QLQ-C30 scales were used to assess the functional outcomes. Results: Median survival in the TNT group and CRT was 115 and 61 months (p=0.191). At the cut-off in March 2023, 53.4% and 61.1% of pts died in the TNT and CRT group (p = 0.375). In the TNT group, 73.9% of deaths were attributed to cancer corresponding to 81.8% in CRT (p = 0.725). Late relapses diagnosed over 5 years from the end of the active treatment were identified in 5 of 94 patients in the follow-up (1 local recurrence in the TNT group, 4 patients with lung metastasis – 3 in TNT with one having also CNS relapse - and 1 in CRT). All late relapses in the TNT group could be salvaged with local therapies. Regarding long-term quality of life, no differences were observed in FACT-C and EORTC QLQ C30 in patients treated with either arm: QLQ C30 – TNT: 50.68 ± 12.74 in the range 34.00- 79.00; CRT: 48.61 ± 11.39 in the range 34.00-70.00 (p = 0.507); FACT-C - TNT: 113.00 in the range 42.00-136.00; CRT: 118.00 in the range 74.00-136.00; p=0.252). No difference in physical, family, and emotional status was observed. At the ultimate observation, stoma was present in 40.5% and 40.6% of TNT and CRT groups, respectively (p&gt;0.999). Conclusions: In this randomized cohort, after more than 10 years of observation TNT led to numerically longer OS than CRT, although this was not statistically significant. The functional outcomes of the long-term survivors are similar in both cohorts. Late relapses are rare but could be salvaged in most cases. This study further supports the use of TNT in patients with locally advanced rectal cancer. Clinical trial information: NCT00833131 .

Abstract TP378: Malondialdehyde as a Clinical Indicator for Oxidative Stress: Associations with Age, BMI, and Cognitive Impairment

Introduction: The molecular and metabolic changes that occur after acute ischemic stroke (AIS) are not fully understood. One mechanism known to trigger systemic inflammatory responses and neuronal death during ischemic stroke cascades the rapid increase in Reactive Oxygen Species (ROS). Accumulation of oxidative stress has been shown to trigger the initiation and progression of cognitive deficits, including mild cognitive impairment (MCI) and Alzheimer’s Dementia (AD). One emerging biomarker able to reliably measure oxidative stress is Malondialdehyde (MDA), a reactive carbonyl compound originating from polyunsaturated fatty acid oxidation and lipid peroxidation. Due to its composition, MDA readily reacts with lipid membranes, making it a sensitive oxidative stress biomarker. This study assessed MDA levels in the plasma of AIS patients to evaluate its ability to predict cognitive impairment and long-term functional outcomes. Hypothesis: We hypothesized that oxidative stress correlates with long-term functional outcomes in AIS patients and varies based on non-modifiable risk factors such as sex and race. Methods: In this study, we used peripheral blood plasma from healthy volunteers (HV, N=24), and from ischemic stroke patients (N=27) at 3d and 7d post-stroke to capture the temporal profile of MDA after injury. Cognitive impairment was assessed during hospitalization with the Brief Neurocognitive Screening Test (BNST), with a score of 8 or below denoting cognitive impairment. Results: AIS patients had an increase in MDA levels compared to the control group, as seen in prior literature. There was a significant correlation with increase age of stroke patients and higher levels of MDA (p&lt;0.05). Higher levels of oxidative stress was also associated with increased levels of cognitive impairment among the stroke population (p&lt;0.05). There was no relationship between levels of MDA during hospitalization and functional outcome at 3 months post discharge. Conclusion: MDA appears to be a promising biomarker for oxidative stress in AIS patients, with notable associations with age and cognitive impairment. These findings underscore the possible mechanisms behind the rapid development of cognitive impairment seen in patients post stroke.

Abstract TMP70: Intracortical type of lobar cerebral microbleed predicts risk of recurrent intracerebral hemorrhage in spontaneous intracerebral hemorrhage survivors

Introduction and Objective: Lobar cerebral microbleed (CMB) is frequently found in patients with spontaneous intracerebral hemorrhage (ICH) and is closely linked to cerebral amyloid angiopathy (CAA) and risk of recurrent ICH. Lobar CMB could be further topographically categorized into intracortical type or subcortical white matter (WM) type, and our previous study showed that CAA is more related to the intracortical lobar CMB. The current study aimed to determine if the types of lobar CMB can predict risks ofrecurrent ICH and long-term vascular outcomes in patients with spontaneous ICH. Methods: A total of 587 patients with spontaneous ICH were included. Clinical data, neuroimaging markers, and 2-year follow-up outcomes (recurrent ICH, incident ischemic stroke, vascular mortality and composite outcome) were collected. We categorized patients into 4 different groups based on their lobar CMB types: Type 1 (strictly intracortical type, n=52), Type 2 (strictly subcortical WM type, n=127), Type 3 (mixed intracortical and subcortical WM type, n=86), and Type 4 (no lobar CMB, n=277). The associations between lobar CMB type and follow-up outcomes were assessed using multivariable Cox regression models with adjustment of age, sex, hypertension, diabetes mellitus and hyperlipidemia. We also examined the dose-relationship between intracortical lobar CMB number and ICH recurrence risk. Results: Compared to patients without lobar CMB (Type 4), patients with strictly intracortical lobar CMB type (Type 1) had higher ICH recurrence rate (HR 3.90[1.30-11.75], p=0.015) and composite outcomes (HR 2.55[1.26-5.17], p=0.009], p&lt;0.001), while patients with strictly subcortical WM lobar CMB type (Type 2) was associated with high risk of composite outcomes (HR 2.22[1.31-3.79], p=0.003) and a trend toward risk of incident ischemic stroke (HR 2.12 (0.89-5.05), p=0.091) but not ICH (HR 1.66 [0.66-4.19], p=0.282). Mixed type (Type 3) was not associated with follow-up vascular events. For patients with at least one lobar CMB, three or more intracortical CMBs significantly elevated ICH recurrence risk (HR 2.85 [1.18-6.88], p=0.020). Conclusions: Topographical type of lobar CMB may have clinical significance in predicting ICH recurrence risks and vascular outcomes in ICH survivors. Patients with lobar CMBs restricted in the intracortical region, or with multiple number of intracortical lobar CMBs, are predisposed to higher ICH recurrence rate.

Impact of unplanned readmission to the same facility within 30 days following robot-assisted and laparoscopic hemicolectomy for early-onset non-metastatic colon cancer.

111 Background: Colon cancer in younger populations has risen in recent years, prompting changes in screening guidelines. Hemicolectomy remains integral for standard treatment for non-metastatic early-onset colon cancer, and many institutions have adopted robot-assisted approaches for this procedure. However, high costs associated with this technology along with mixed data regarding survival benefits and post-surgical complications warrant further investigations on the specific advantages of robot-assisted surgery. This study aims to examine the impact of unplanned readmission to the same facility within 30 days following surgery for patients receiving robot-assisted and laparoscopic hemicolectomy on long-term survival for early-onset non-metastatic colon cancer to see how current paradigms of colon cancer treatment extend to early-onset patients. Methods: The National Cancer Database was used to identify patients under the age of 50 receiving a minimally invasive hemicolectomy for primary non-metastatic colon cancer diagnosed between 2016-2020. Patients were stratified based on surgical approach and whether they underwent an unplanned readmission to the same facility within 30 days following surgery, and survival differences were calculated log-rank test and Cox regression analysis that included co-variates related to tumor characteristics, patient demographics, and facility characteristics. Results: 5,076 patients were identified, with 577 receiving a robot-assisted approach and 4,499 receiving a laparoscopic approach. Multivariate analysis found no significant difference in long-term survival between patients receiving a laparoscopic versus robot-assisted approach (HR: 0.893, 95% CI: 0.687-1.161, p=0.398). Additionally, multivariate analysis found that unplanned readmission within 30 days did not have a significant impact on long-term survival outcomes for patients receiving a robot-assisted approach (HR: 0.856, 95% CI: 0.257-2.848, p=0.800), but it did find worsened survival outcomes for the laparoscopic approach (HR: 1.535, 95% CI: 1.070-2.203, p=0.020). Conclusions: Patients receiving laparoscopic hemicolectomy for early-onset non-metastatic colon cancer appear to have worsened overall long-term survival outcomes when undergoing an unplanned readmission to the same facility within 30 days of surgery when compared to patients receiving a robot-assisted surgical approach. However, it also appears that overall, both surgical approaches have similar overall long-term survival. Further research on how robot-assisted surgery impacts survival and post-surgical complications in patients with early-onset non-metastatic colon cancer is warranted to examine how this advancing technology could improve cancer care.

Acute kidney injury in critically ill COVID-19 patients in a tertiary hospital: short and long-term kidney and patient outcomes.

Acute kidney injury (AKI) in the setting of COVID-19 is associated with worse clinical and renal outcomes, with limited long-term data. To evaluate critically ill COVID-19 patients with AKI that required nephrologist consultation (NC-AKI) in a tertiary hospital. Prospective single-center cohort of critically ill COVID-19 adult patients with NC-AKI from May 1st, 2020, to April 30th, 2021. Kidney replacement therapy (KRT), recovery of kidney function, and death at 90-day and 1-year follow-up were evaluated. 360 patients were included, 60.6% were male, median age was 66.0 (57.0-72.0) years, 38.1% had diabetes, and 68.6% had hypertension. AKI stages 1, 2, and 3 were detected in 3.6%, 5.6%, and 90.8% of patients, respectively. KRT was indicated in 90% of patients. At the 90-day follow-up, 88.1% of patients died and 10.0% had recovered kidney function. Female gender (p = 0.047), older age (p = 0.047), AKI stage 3 (p = 0.005), requirement of KRT (p < 0.0001), mechanical ventilation (p < 0.0001), and superimposed bacterial infection (p < 0.0001) were significantly associated death within 90 days. At 1 year, mortality was 89.3%. Amongst surviving patients, 72% recovered kidney function, although with significantly lower eGFR compared to baseline (85.5 ± 23.6 vs. 65.9 ± 24.8 mL/min, p = 0.003). Critically ill COVID-19 patients with NC-AKI presented a high frequency of AKI stage 3 and KRT requirement, with a high 90-day mortality. Surviving patients had high rates of recovery of kidney function, with a lower eGFR at one-year follow-up compared to baseline.

Don’t mix it up! Long-term outcomes of different proximal aortic cuffs with the AFX endograft

The AFX unibody endograft offers advantages in treating abdominal aortic aneurysms (AAAs) with narrow aortic bifurcations due to its unique design, where the flow divider sits at the native aortic bifurcation. However, its limited length options may limit complete proximal neck utilization. As per device instruction for use, the implant should be completed with an aortic cuff. This study aims to evaluate the long-term outcomes of patients treated with an all-Endologix implant versus a combination of Endologix and Medtronic devices. This retrospective, single-center study included 134 consecutive AAA patients who underwent endovascular aneurysm repair (EVAR) using the AFX unibody endograft paired with suprarenal aortic cuffs from Endologix (n=86) or Medtronic (n=48) between November 2011 and November 2022. Patients were divided into 2 groups based on the type of aortic cuff used. The primary outcome was the occurrence of type 3A endoleaks at the longest available follow-up. Secondary outcomes included any endoleak, reintervention rates, all-cause mortality, and aneurysm-related death. The median follow-up was 41months, and type 3A endoleaks occurred after a mean 34.8months in 6 patients (4.5%), which is significantly more frequent in the mixed-device group (12.8%) (P<0.001). Type 3A endoleak occurred regardless of overlap and developed over time. Endoleaks of any type were reported in 17 patients. Reinterventions were needed in 12 patients. The use of an Endurant cuff was associated with a significantly increased risk of type 3A endoleaks (hazard ratio [HR] 16.5; 95% [CI] 1.9-143; P=0.011) and reinterventions (HR 9.67; 95% CI 1.9-49.6; P=0.006). Combining endografts from different manufacturers, especially those with differing materials and sealing mechanisms, may compromise the long-term integrity of certain EVAR repairs. Clinicians should exercise caution when considering mixed-device configurations and ensure rigorous follow-up for patients with such implants.

A multimodal deep learning approach for the prognostic stratification of patients with colorectal cancer (CRC).

287 Background: Traditional prognostic systems like the AJCC TNM staging for colorectal cancer (CRC) often fall short in predicting long-term patient outcomes. These systems often rely on limited pathologic features, leading to generalized approaches to treatment despite diverse tumor heterogeneity, such as the complex interaction between the tumor-host microenvironment. There is therefore a pressing need for more accurate, scalable tools to enhance decision-making and predict outcomes for patients with CRC. Methods: Tumor sections from 191 CRC patients were comprehensively stained for CD8 to examine CD8-positive tumor-infiltrating lymphocytes (TILs). To account for tumor heterogeneity, multiple areas of the tumor were evaluated to include intertumoral and peritumoral areas. Slides were digitized and quantitatively analyzed using a cloud-based platform (SpatialX Diagnostics, Inc. USA). Additionally, clinicopathologic features including patient demographics, 8th edition AJCC staging, lymphovascular invasion (LVI), perineural invasion (PNI), mismatch repair (MMR) protein status, tumor location, presence/development of distant metastases, and patient follow-up were collected. Merging CD8 AI findings with clinicopathologic features, a complete data set was available for 175 patients. Cases were randomly assigned into 70% training and 30% validation. In the training set, unsupervised artificial intelligence (AI) models integrated clinicopathologic data and CD8-positive TIL counts using vision transformer models. The final model combined spatially resolved pathologic features with clinical variables to statistically predict overall survival (OS) and distant metastasis risk (DMR). Results: In the validation cohort, the model stratified patients into two groups based on a deep learning-derived risk score, with statistically significant differences between low-risk and high-risk groups for OS (p&lt;0.02) and DMR prediction (p&lt;0.0001), For OS prediction, the model selected tumor site, PNI, MMR status, epithelial and stromal CD8-positive TILs, and 5 deep vision features as the top 10 clinically significant features. For DMR prediction, the age, T- and N-stage, PNI, and 6 deep vision-derived features as key predictors. Conclusions: As captured by vision transformers, the distribution and spatial arrangement of CD8-positive TILs are critical factors in patient stratification for OS and DMR. AI-driven models like the one herein offer the potential for more personalized management strategies, advancing CRC management and improving patient outcomes beyond traditional prognostic staging systems and parameters.

Effects of immediate extubation in the operating room on long-term outcomes in living donor liver transplantation: a retrospective cohort study

Background: Living-donor liver transplantation (LDLT) is a viable alternative to deceased-donor liver transplantation. Enhanced recovery after surgery protocols that include early extubation offer short-term benefits; however, the effect of immediate extubation in the operating room (OR) on long-term outcomes in patients undergoing LDLT remains unknown. We hypothesized that immediate OR extubation is associated with improved long-term outcomes in patients undergoing LDLT.Methods: This retrospective cohort study included 205 patients who underwent LDLT. The patients were classified based on the extubation location as OREX (those extubated in the OR) or NOREX (those extubated in the intensive care unit [ICU]). The primary outcome was overall survival (OS), while secondary outcomes included ICU stay, hospital stay duration, and various postoperative outcomes.Results: Among the 205 patients, 98 (47.8%) underwent extubation in the OR after LDLT. Univariate analysis revealed that OR extubation did not significantly affect OS (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.24–1.05; P = 0.066). Furthermore, multivariate analysis revealed no statistically significant association between OR extubation and OS (HR: 0.79, 95% CI: 0.35–1.80; P = 0.580). However, OR extubation was significantly associated with a lower incidence of 30-day composite complications and shorter ICU and hospital stays. Multivariate analysis indicated that higher preoperative platelet counts, increased serum creatinine levels, and a longer surgery duration were associated with poorer OS.Conclusions: Immediate OR extubation following LDLT surgery was associated with fewer 30-day composite complications and shorter ICU and hospital stays; however, it did not significantly improve OS compared with ICU extubation.

Managing persistent neonatal hyperinsulinemic hypoglycemia: Insights from nesidioblastosis research

Background: Persistent neonatal hyperinsulinemic hypoglycemia (PNHH), frequently associated with nesidioblastosis, poses significant diagnostic and therapeutic challenges due to dysregulated insulin secretion. Congenital hyperinsulinism (CHI), the primary cause of PNHH, exhibits diverse genetic and phenotypic presentations, necessitating tailored management strategies. This review integrates insights from 20 studies, examining genetic, therapeutic, and psychosocial dimensions of CHI. Objectives: To evaluate genotype-phenotype correlations and their implications for therapeutic outcomes in CHI, compare long-term medical and surgical outcomes, and identify risk factors affecting growth, metabolism, and neurodevelopment. Additionally, the study explores effective strategies to address the psychosocial and dietary challenges associated with CHI. Methods: A systematic review of 20 studies, encompassing over 2,000 patients, was conducted. Diagnostic criteria included genetic analyses of mutations in KATP channel genes (ABCC8, KCNJ11), GLUD1, and HNF4A, along with imaging and histopathological assessments. Treatment efficacy, long-term outcomes, and the impact of caregiver burden were analyzed. Data were synthesized into thematic categories, supported by statistical and qualitative assessments. Results: Dominant KATP mutations exhibited high responsiveness to diazoxide (70%), whereas recessive mutations necessitated surgical interventions, particularly near-total pancreatectomy. Focal CHI resolved hypoglycemia effectively with lesionectomy, whereas diffuse CHI presented ongoing risks, including diabetes and neurodevelopmental impairments. Personalized dietary strategies, such as high-protein diets and gastrostomy feeding, were effective in stabilizing glucose levels. Psychological stress in caregivers emerged as a significant concern, emphasizing the need for supportive interventions. Emerging therapies like lanreotide showed promise in refractory CHI cases. Discussion: The findings align with prior research, confirming the role of genetic mutations in determining treatment responsiveness. Surgical interventions, though effective in resolving hypoglycemia, carry long-term metabolic risks. Recent advances in genetic diagnostics and personalized medical therapies highlight opportunities for optimizing outcomes. However, caregiver burden and psychosocial challenges remain underexplored areas that require structured support systems. Conclusion: Managing CHI necessitates a multidisciplinary approach, integrating genetic insights, advanced therapies, and psychosocial support. Continued research is essential to develop innovative solutions for refractory CHI cases and to improve long-term outcomes for patients and families.

Postoperative complications and long-term outcomes after total and subtotal thyroidectomy: a retrospective study

The choice between total thyroidectomy (TT) and subtotal thyroidectomy (STT) can affect postoperative complications and long-term outcomes in these patients. This study aimed to investigate postoperative complications and long-term outcomes in patients who underwent TT and STT. This retrospective study investigated 1.022 patients who admitted to Ghaem and Razavi hospitals, Mashhad, and underwent thyroidectomy between 2011 and 2017. Data related to postoperative complications, recurrence rate and overall survival were collected and analyzed. The data collection tool used in this research was a checklist. In this study, women accounted for 863 and men for 159 of the total population. The highest number of thyroidectomy surgeries was found in 2013 and in all years the majority of thyroidectomy surgeries were performed on women. The results demonstrated that 71.2% of the patients underwent TT and 28.8% underwent STT. The percentage rate of recurrent laryngeal nerve injury after thyroidectomy surgery (regardless of the type of selected surgery) was 6.1%, affecting 62 individuals. No significant relationship was observed between the type of selected surgery and damage to this nerve (P > 0.05). In addition, a statistically significant correlation was reported between thyroidectomy and suffering from hypocalcemia (P < 0.05). The study revealed that TT was associated with a higher postoperative complication rate compared to STT. Individual treatment plans must be developed based on the risks and benefits of each surgical approach.