Multidisciplinary Therapeutic Approach Research Articles

A systematic review on the role of interventional radiotherapy for treatment of anal squamous cell cancer: multimodal and multidisciplinary therapeutic approach.

Aim was to compare the efficacy of interventional radiotherapy (IRT) boost vs. external beam radiotherapy (EBRT) boost after chemoradiation (CCRT) in patients with anal cancer (AC). The P.I.C.O. framework was: in patients with AC [P], is IRT boost [I] superior to EBRT boost [C] in terms of local control (LC), cancer specific survival (CSS), overall survival (OS), distant meta-static free Survival (DMFS), colostomy free survival (CFS) and toxicity [O]? 651 patients were analyzed. The median 5-year locoregional control rates was 87.8% in the IRT boost group versus 72.8% in the EBRT boost group. The 5-year cancer-specific survival rate was 91% in the IRT boost group versus 78% in the EBRT boost group. 5-years overall survival was 74.6% in IRT boost versus 67.7% in the EBRT boost. 5-years disease metastasis-free survival rate was 92.9% in IRT boost group vs. 85.6% for the EBRT boost group. Cancer-free survival rate was 76.8% in the IRT group vs. 63.1% in the EBRT boost group. Acute toxicity above grade 2 was less common in the IRT boost group while chronic toxicity was similar between both groups. IRT boost after CCRT could lead to better outcomes than EBRT boost in treating AC.

Resmetirom and Metabolic Dysfunction-Associated Steatohepatitis: Perspectives on Multidisciplinary Management from Global Healthcare Professionals.

The approval of resmetirom brings great hope to patients with metabolic dysfunction-associated steatohepatitis (MASH). The purpose of this review is to explore its impact on the global health environment. The implementation of multidisciplinary management MASH is proposed. Resmetirom has benefits in the treatment of MASH, and its safety and effectiveness have been studied. The adverse events (AEs) need to be noticed. To improve patient outcomes, a multimodal approach with medication such as resmetirom, combined with metabolic and bariatric surgery (MBS) and lifestyle interventions can be conducted. MASH, a liver disease linked with obesity, is a challenging global healthcare burden compounded by the absence of any approved pharmacotherapy. The recent conditional approval by the Food and Drug Administration(FDA) in the United States of resmetirom, an oral, liver-directed, thyroid hormone receptor beta-selective agonist, marks a significant milestone, offering a treatment option for adults with non-cirrhotic MASH and who have moderate to advanced liver fibrosis. This narrative review discusses the efficacy and safety of resmetirom and its role in the therapeutic landscape of MASH treatment. Despite the promising hepatoprotective effect of resmetirom on histological liver endpoints, its use need further research, particularly regarding ethnic differences, effectiveness and cost-effectiveness, production scalability, social acceptance and accessibility. In addition, integrating resmetirom with other multidisciplinary therapeutic approaches, including lifestyle changes and MBS, might further improve clinical liver-related and cardiometabolic outcomes of individuals with MASH. This review highlights the importance of a comprehensive treatment strategy, supporting continued innovation and collaborative research to refine treatment guidelines and consensus for managing MASH, thereby improving clinical patient outcomes in the growing global epidemic of MASH. Studies done to date have been relatively short and ongoing, the course of the disease is highly variable, the conditions of various patients vary, and given this complex clinical phenotype, it may take many years of clinical trials to show long-term benefits.

A Multidisciplinary Therapeutic Approach Proposal for Huge Hepatocellular Carcinomas Exceeding 10 cm in Diameter.

The outcome of hepatectomy for a hepatocellular carcinoma (HCC) exceeding 10 cm (i.e., huge HCC) remains unfavorable. The aim of the current study was to evaluate the optimal therapeutic approach for huge HCCs. Between 2008 and 2018, patients with a huge HCC who underwent treatment at our institution were enrolled. Cases not meeting the criteria (Child-Pugh grade A or performance status 0/1) and patients with distant metastases were excluded. Patients were stratified into three groups: a) upfront hepatectomy (Upfront); b) hepatectomy subsequent to hepatic arterial infusion chemotherapy (HAIC-Hr); and c) HAIC alone (HAIC). Survival rates, including overall survival (OS) and progression-free survival (PFS), were analyzed. The cancer-specific mortality attributed to recurrence within one year after surgery was defined as "futile surgery"; the rate of futile surgery was also assessed. A total of 70 cases were censored (Upfront/HAIC-Hr/HAIC: 28/13/29). The 5-year PFS and OS rates for Upfront, HAIC-Hr, and HAIC were 7.7%, 69.2%, and 6.9%, and 37.1%, 79.1%, and 19.7%, respectively. The number of futile surgeries was 6 (21.4%) in the Upfront group, whereas no such cases occurred in the HAIC-Hr group. Although hepatectomy was advocated in the Upfront group due to the potential resectability, the outcomes were comparable to those of the HAIC group. Conversely, the HAIC-Hr group had promising outcomes, marked by a decreased prevalence of futile surgeries. Huge HCCs should be regarded as borderline resectable, even when deemed potentially resectable. Therefore, a multidisciplinary therapeutic approach might be reasonable.

Transcranial Direct Current Stimulation as Adjuvant to Gamified Rehabilitation for Upper Limb Function in Paediatric Brain Damage (CHILDBOOST Project): A Study Protocol for a Triple-Blind Randomised Controlled Trial

(1) Background and objectives: Paediatric brain injuries can lead to motor and cognitive deficits. Effective rehabilitation is critical for enhancing independence. While virtual reality (VR) and transcranial direct current stimulation (tDCS) have independently demonstrated beneficial effects on motor and cognitive functions, their combined efficacy and its cognitive effects remain to be explored in this population. We aim to investigate the effects of integrating tDCS with VR training on upper limb (UL) functionality and cognitive outcomes through a triple-blind randomised trial. (2) Methods: Twenty-eight children with hemiparesis secondary to non-progressive brain damage will be randomly allocated into two groups: active anodal tDCS (2 mA) plus UL VR training, and sham tDCS with identical VR training. The tDCS will target M1 of the affected or most affected hemisphere for 20 min, simultaneous to VR training. The following four assessments will be carried out: pre-intervention, post-intervention, and three- and six-months follow-up. (3) Results: This study will explore motor and cognitive outcomes of a motor-based intervention in paediatric brain damage. We hypothesise that the experimental group will show significant improvements in UL function and cognition, enhancing their functional recovery. (4) Conclusions: We propose a multidisciplinary therapeutic approach combining neuromodulation and VR to potentiate functional recovery through enhancing motor and cognitive performance in paediatric brain damage.

Concurrent Onset of Central Retinal Vein Occlusion and Inflammation of a Large Maxillary Odontogenic Cyst: Case Report and Analysis

Central retinal vein occlusion typically manifests in older individuals with underlying systemic pathology, leading to a spectrum of symptoms ranging from blurred vision to complete vision loss. While odontogenic infections are recognized for causing complications affecting the eye and vision, their potential role as an etiological factor in cases of sudden vision impairment merits consideration. This article presents a case involving central retinal vein thrombosis, wherein resolution was achieved through a combination of ophthalmic therapy and the surgical removal of a concurrently existing large inflamed odontogenic cyst located in the ipsilateral hemimaxilla. This case underscores the importance of recognizing odontogenic factors in the assessment of sudden vision impairment and the efficacy of a multidisciplinary therapeutic approach.

Survival in patients with cervical cancer undergoing chemo-radiotherapy in a middle-income country.

e17527 Background: Cervical cancer (CC), being a high-incidence pathology in Ecuador, requires a priority multidisciplinary therapeutic approach to obtain an optimal benefit in overall survival. The objective of the present study is to describe overall survival (OS) in patients with locally advanced CC treated with chemoradiation according to histological type and clinical stage. Methods: It is an observational, analytical, retrospective, longitudinal study of patients with stage IIB-IVA CHD who received treatment with chemoradiation from January 2010 to December 2014 with a 10-year follow-up. The SPSSv29 statistical system was used. Survival analysis was performed using the Kaplan-Meier method and the Log-Rank test. Results: Of 1909 patients, 1581 were excluded because they did not meet eligibility criteria. 328 received chemoradiation. The overall survival result was 43%. According to histological type, 276 patients presented squamous cell carcinoma (SCC) and 52 adenocarcinoma (AC), presenting a survival of 44% for SCC and 35% for AC. The calculation by clinical stage, II-B shows a survival of 46%. For stage IV-A 20% up to 46 months. The Log-Rank test (p=0.04) shows a significant statistical value. Conclusions: The 10-year overall survival was 43%, showing an essential difference for the histological type, being higher for squamous cell carcinoma, and also showing a significant difference between the stages. [Table: see text]

Pyrexia of unknown origin in a child with chronic diffuse alopecia- A predictor of pediatric systemic lupus erythematosus

ABSTRACT Systemic lupus erythematosus (SLE) is a chronic prototypic autoimmune disorder characterized by the inflammatory and autoimmune reaction leading to protean systemic manifestations. The incidence of childhood-onset SLE has been estimated at an average of 0.6 per 1,00,000 children-years. Childhood-onset SLE has an aggressive course with renal and nervous systems being more involved than in adults. The latest validated Systemic Lupus International Collaborating Clinics (SLICC) criteria, which exhibited a higher sensitivity includes eleven clinical and six immunological items. This criteria has been validated in children. A multidisciplinary therapeutic approach is important due to the complexity of lupus in pediatric patients. We report a case of 12-year-old female child diagnosed as SLE due to its rare occurrence in the pediatric age group.

Spontaneous hypoglycemia: should we mind the gap? Long-term follow-up of healthy people who met Whipple’s triad criteria

ContextPatients discharged as “healthy” with the symptoms of spontaneous hypoglycemia, commonly known as Whipple’s triad, need more attention.ObjectiveCharacterization and long-term follow-up of symptom development in patients with spontaneous hypoglycemia discharged as “healthy”. The objective was to ascertain whether any conditions related to the symptoms were diagnosed during the follow-up period.MethodsRetrospective analysis of patient data and evaluation of a specific questionnaire on the development of symptoms of spontaneous hypoglycemia. In addition, patient questionnaires were evaluated and primary care physicians were asked about possible diseases not recorded at baseline that occurred during the follow-up period.SettingCenter for Endocrinology, Diabetology, and Osteology at the University Hospital Marburg, Inpatient Department, Germany.PatientsAll patients who presented to our center for the 72-hour fast between 2005 and 2018 and were discharged without an internal medicine diagnosis were included.InterventionsSurvey by questionnaire, via telephone interview.Main outcome measuresPatient-reported information on current symptoms compared to original symptoms, diagnosis of insulinoma or diabetes mellitus during follow-up, matched with primary care physician data, and metabolic and biometric data such as body mass index (BMI), homeostasis model assessment for insulin resistance (HOMA IR), insulin sensitivity Matsuda Index (ISI-M), and area under the curve.ResultsA total of 41 datasets were evaluated at baseline and 38 patients were followed for an average of approximately 10 years. In total, 61% of respondents still reported the same symptoms as at baseline. No insulinoma was missed in these patients. Only two of the 38 patients developed diabetes mellitus.ConclusionThe high percentage of patients who are discharged as “healthy” and still have symptoms after many years is disturbing. It is possible that the symptoms are not due to low blood glucose. We urge caution with use of the term “healthy”. We advocate a multidisciplinary therapeutic approach after an organic cause of hypoglycemia has been ruled out. Psychosomatic treatment seems to be useful. In addition, more research should be conducted on this topic.

(088) Unconsummated Marriage: A Systematic Review of Etiological Factors and Clinical Management

Abstract Introduction Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse. Objective To systematically review current evidence regarding the etiological factors and clinical management of UCM. Methods A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples (S) who never had sexual intercourse (PI) in case report or case series (D) evaluating the related causes and/or management (E) and reporting data with qualitative, quantitative or mixed methods (R). Quantitative data were reported as found in the original studies. Evaluation of level of evidence and quality of studies were based on Oxford Centre for Evidence-Based Medicine 2011 and Murad scale, respectively. The review was reported according to PRISMA statement and registered in PROSPERO with ID CRD42023433040. Results A total of 27 studies including 1,638 males and 1,587 females were selected (Fig 1). Eight articles (29.6%) were case-report involving a single couple and 19 studies (70.4%) were case series. Mean (range) Murad score was 4.1 (1–8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of the studies were reported from Egypt (5, 18.4%), Israel (4, 14.9%), and USA (4, 14.9%) (Fig 2). Mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 studies (85.2%), inability to conceive in 1 article (3.7%), and mixed in 3 papers (11.1%). The mean duration of UCM before a medical visit varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4–81%) and ED (10.5–61%) were the most common causes of UCM. Three articles reported that 16.6–26% of all UCM cases were due to both male and female factors. Basic sex education was advised in all treatment programs. A multidisciplinary therapeutic approach involving urologist, gynecologist, psychiatrist, and physiotherapist was applied to 135 patients, achieving a consummation rate of 97%. Sildenafil 50 mg on demand for 1–3 months was used in the management of ED leading to a consummation rate of 84.6–100%. Tadalafil was prescribed both on-demand and daily, achieving consummation rates of up to 91%. Vaginismus was treated with desensitization sessions and graded vaginal dilators, leading to penetrative intercourse in 66.6–100% of cases after 1 month-5 years of therapy. Strengths & Limitations: The first systematic review covering the entire spectrum of UCM. The low quality of most of the included papers and the large percentage of UCM cases are probably not published. Conclusions ED and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM. Disclosure No.

Low-FODMAP diet and hidradenitis suppurativa: the role of nutritionists in the management of dermato-endocrine disorders.

Hidradenitis suppurativa (HS) is a chronic inflammatory, immune-mediated, debilitating skin disease, characterized by subcutaneous nodules, with a still not clear pathophysiology. Although the prevalence is rather low (about 1% in Europe), its clinical complications, as well as the disabling symptomatology, make it necessary multidisciplinary therapeutic approaches. Not recently several authors described the involvement of the well-known gut-skin axis in both pathogenesis and progression of dermatological diseases. In particular, a high frequency of intestinal disorders (such as irritable bowel syndrome and inflammatory bowel disease) has been reported in HS patients, leading to speculate the existence of a relationship between such gut and skin diseases. The keystone in this relationship seems to be an impairment of the physiological gut mucosal barrier structure, resulting in the so-called leaky gut. The leaky gut, thus, might be responsible for a dietary compound-caused activation of the local immune system, with consequent trigging of both local and systemic inflammation, resulting in exacerbation of skin symptoms in HS patients. The current literature suggests the use of a low fermentable, oligo-, di, mono-saccharides and polyols (FODMAP) diet as a valid nutritional strategy in leaky gut. In light of this, we want to evaluate and consider the potential use of low-FODMAP diet in HS patient.

Ocular Tuberculosis - Uncommon Presentation in Pediatric Age

Ocular tuberculosis is a clinical challenge due to heterogeneous presentation and difficulty in obtaining ocular samples for microbiology. The incidence is difficult to specify because it is almost exclusively a presumptive diagnosis based on epidemiology and concordant ophthalmologic and systemic findings. The need for a high rate of clinical suspicion and the consequent delay in diagnosis is often responsible for advanced clinical presentations that require a multidisciplinary therapeutic approach. Thus, early onset of therapy is essential to suppress ocular inflammation and prevent progressive and irreversible damage.

Effects of a Multidisciplinary Therapeutic Approach to ''Diabetic Foot'' Complications: A Single-Center Pilot Study from Turkey

Effects of a Multidisciplinary Therapeutic Approach to ''Diabetic Foot'' Complications: A Single-Center Pilot Study from Turkey

Unifying the Puzzle: Cardiac Amyloidosis in the Spectrum of Generalized Edematous Syndromes

Introduction: Addressing the diagnostic challenges posed by nephrotic syndrome and congestive heart failure, this article underscores the pivotal role of comprehensive investigations in unraveling underlying etiologies. Amid the diverse spectrum of potential causes, the focus is directed towards amyloidosis—a distinct category characterized by abnormal amyloid fibril accumulation in organs. Despite its infrequency, the gravity and potential for targeted interventions accentuate the importance of considering amyloidosis in the differential diagnosis. Case Presentation: A detailed case study of a 68-year-old female with generalized edematous syndrome revealed a complex clinical scenario involving cardiac and renal manifestations. AL amyloidosis was confirmed through thorough diagnostic assessments, guiding a targeted therapeutic approach. Discussion: The discussion delves into the pathophysiology of AL amyloidosis, diagnostic considerations, and the significance of ECG and echocardiographic findings. It highlights the importance of laboratory assessments, especially immunologic tests, and emphasizes the role of biopsy in confirming the diagnosis. Conclusion: The complexity of AL amyloidosis is underscored, emphasizing the interplay of cardiac, renal, and hematologic aspects. Early diagnosis and a tailored multidisciplinary therapeutic approach yielded positive outcomes, contributing valuable insights to the evolving understanding of amyloidosis management.

Bullous Pemphigus: A Comprehensive Review of a Complex Autoimmune Disease of the Skin and Mucous Membranes

Pemphigus bullosus, also known as pemphigus vulgaris, is a rare and potentially serious autoimmune disease affecting the skin and mucous membranes, characterized by the formation of intraepidermal blisters due to the loss of cellular cohesion at desmosomal junctions. In this article, we present a comprehensive review of the entity, covering its epidemiology, etiopathogenesis, clinical manifestations, diagnosis and therapeutic options. We highlight the complexity and diagnostic challenges associated with bullous pemphigus, emphasizing the importance of careful clinicopathologic and immunofluorescent correlation for its proper identification. We also discuss in detail the multidisciplinary therapeutic approach required to achieve disease control, emphasizing the use of systemic immunosuppressants and biological therapies. In addition, we highlight the relevance of local therapy and care management, along with the need for close medical follow-up to assess response to treatment and minimize adverse effects. Finally, we highlight the importance of continued research in this complex clinical entity, in order to improve the understanding of its immunopathological mechanisms and to develop more specific and personalized therapies. In conclusion, this article provides a comprehensive and updated view of bullous pemphigus, with the aim of improving its clinical management and promoting a more efficient and effective therapeutic approach.

Multidrug-Resistant Pathogens in Burn Wound, Prevention, Diagnosis, and Therapeutic Approaches (Conventional Antimicrobials and Nanoparticles).

Multidrug-resistant pathogens are one of the common causes of death in burn patients and have a high risk of nosocomial infections, especially pneumonia, urinary tract infections, and cellulitis. The role of prolonged hospitalization and empirical antibiotics administration in developing multidrug-resistant pathogens is undeniable. In the early days of admitting burn patients, Gram-positive bacteria were the dominant isolates with a more sensitive antibiotic pattern. However, the emergence of Gram-negative bacteria that are more resistant later occurs. Trustworthy guideline administration in burn wards is one of the strategies to prevent multidrug-resistant pathogens. Also, a multidisciplinary therapeutic approach is an effective way to avoid antibiotic resistance that involves infectious disease specialists, pharmacists, and burn surgeons. However, the emerging resistance to conventional antimicrobial approaches (such as systemic antibiotic exposure, traditional wound dressing, and topical antibiotic ointments) among burn patients has challenged the treatment of multidrug-resistant infections, and using nanoparticles is a suitable alternative. In this review article, we will discuss different aspects of multidrug-resistant pathogens in burn wounds, emphasizing the full role of these pathogens in burn wounds and discussing the application of nanotechnology in dealing with them. Also, some advances in various types of nanomaterials, including metallic nanoparticles, liposomes, hydrogels, carbon quantum dots, and solid lipid nanoparticles in burn wound healing, will be explained.

Episod maniacal indus prin corticoterapie postalblaţie de meningiom spinal. Rolul realităţii virtuale în psihoterapia anxietăţii postoperatorii

Corticosteroids have been linked to various neuropsychiatric adverse effects, including mood disorders. This case study describes a post-surgical manic episode (spinal meningioma ablation D11-D12) in a 57-year-old female patient on corticosteroids. This presentation aims to highlight corticosteroids’ potential psychiatric adverse effects and to emphasize the importance of recognizing and treating such complications. In this case, the management strategy involved discontinuing corticosteroids, initiating mood-stabilizing medications, and closely monitoring the symptoms. A mood stabilizer and a second-generation antipsychotic were administered to the patient to treat transient manic symptoms and prevent relapse. After discontinuing corticosteroids and beginning therapy with mood stabilizers, the patient’s bipolar symptoms improved. Psychoeducation and therapeutic support were provided to aid the patient in managing acute symptoms and encourage adherence to the treatment plan. As anxiety persisted after manic symptoms were controlled, the case management involved a psychotherapy technique facilitated by virtual reality. Relaxation breathing techniques were emulated through a virtual reality Oculus Quest 2 headset, improving patient-physician trust, subjectively relieving correlated anxiety, and ensuring therapeutic compliance during the admission and at home. Healthcare professionals must be vigilant to identify and effectively treat these complications of steroid anti-inflammatory medication. Immediate cessation of corticosteroids, the initiation of mood stabilizers and psychoeducation are essential for managing these cases. By presenting this case report, we hope to increase healthcare professionals’ awareness on the psychiatric consequences of corticosteroid use, the necessity of a multidisciplinary therapeutic approach, and the role of add-on virtual reality as integrated, personalized patient care to alleviate anxiety.

Spinal aspergillosis: a rare clinical case and review of the literature

Objective. To analyze long-term results of treatment of a patient with recurrent lumbar aspergillosis and to systematize the literature data.Material and Methods. Long-term follow-up results of treatment of recurrent Aspergillus spondylitis in a 48-year-old patient who underwent primary surgery for reconstruction of the anterior spinal column through the anterior approach were studied. Literature data on the treatment of spinal aspergillosis from 2000 to 2022 were systematized.Results. The key method for the etiological verification of spinal aspergillosis is percutaneous bone biopsy from the lesion, followed by histological and bacteriological examination of the material. Isolated anterior spinal column reconstruction through the anterior approach ensures the achievement of local control of the infection process, but a short course of antimycotic chemotherapy after surgery is a factor of disease recurrence. The optimal duration of antimycotic chemotherapy in the postoperative period is at least 3 months, with voriconazole being the drug of choice.Conclusion. Spondylitis caused by Aspergillus spp. is a special form of inflammatory spine disease requiring obligatory percutaneous bone biopsy for etiological verification. A multidisciplinary therapeutic approach including a course of conservative antimycotic therapy for at least 3 months, surgical debridement and reconstruction of the affected spinal motion segments provide the best clinical results.

Abstract 4487: Effective anti-tumor effect in a rare metastatic Wilms tumor xenograft by inhibition of RAS/PI3K hyperactivation

Abstract Wilms Tumor (WT) is an embryonal renal tumor that accounts for more than 90% of kidney tumors in children. Significant advances in multidisciplinary therapeutic approaches have increased survival rates up to 90%. However, approximately 15% of patients with favorable histology and 50% of patients with anaplastic WT experience recurrence of disease. Thus, there is still a critical need to develop therapies that are effective and safe for these patients with progressive disease. To address this, we have developed a pipeline of patient derived xenograft (PDX) models from single academic institution patients with metastatic and aggressive cancers. Among these we have developed 3 xenograft models derived from patients with WT. To gain a detailed understanding of the complex array of mutations and identify therapeutic targets, molecular signatures were obtained at the DNA and protein levels via whole genome sequencing and reverse phase protein array analyses respectively. While PDX derived from encapsulated WT specimens exhibited basal levels of PI3K and MAPK pathway activation, which are well-known for promoting tumor survival, growth, and metastasis, no mutations that drive hyperactivation of these pathways were identified in these PDX. In contrast, a rare WT xenograft (PDX120) was established from a female patient with recurrent disease and metastatic cancer in the liver. -OMICS data indicated hyperactivation of PI3K (PIK3CA p.H1047R) and MAPK (KRAS p.G12_G10ins) which was validated by qPCR and immunoblotting in original tumor sample and serially passaged PDX120 xenografts. -OMICS data also confirmed the fidelity of the molecular signature between the original tumor sample and the serially passaged PDX120. The metastatic WT model was screened with two FDA approved drugs as single agents: Trametinib (MAPK pathway inhibitor; BID M-F 1mg/kg PO Day 1-35) or Alpelisib (PI3K pathway inhibitor; QD M-F 50mg/kg PO: Mice were dosed Day 1-29, followed by a gap period, and then dosing re-initiated, Day 86-103). Trametinib therapy did not effectively attenuate PDX120 tumor growth. In contrast, the PI3K inhibitor Alpelisib was well tolerated and significantly decreased PDX120 growth and prolonged survival compared to the vehicle control (Two-way ANOVA, Holm-Sidak, p<0.05). At the end of the study, histological analyses indicated a complete lack of Ki67+ and tumorigenic cells in the Alpelisb-treated tumors compared to vehicle controls, indicating a dominant growth dependency on PI3K pathway activation. While efficacy data generated in PDX derived from patients is not used to guide clinical decisions at this time, it can validate therapeutic approaches and provide rationale for future clinical trials. In conclusion, these studies provide critical feasibility data that has high translational value and great potential to improve survival and quality of life for children suffering with progressive WT. Citation Format: Mohammad Reza Saadatzadeh, Khadijeh Bijangi Vishehsaraei, Erika A. Dobrota, Barbara J. Bailey, Lauren E. Hein, Kathryn L. Coy, Melissa A. Trowbridge, Anthony L. Sinn, Troy A. Markel, Michael J. Ferguson, Pankita H. Pandya, Karen E. Pollok. Effective anti-tumor effect in a rare metastatic Wilms tumor xenograft by inhibition of RAS/PI3K hyperactivation. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4487.

Multidisciplinary Therapeutic Management in Complex Cervical Trauma

Background and Objectives: In the current literature, mandatory surgical exploration is a controversial topic, with some advocating for it and others against it, proposing a selective conservative management. This multidisciplinary therapeutic approach is based on clinical examination and serial paraclinical explorations associated with supportive drug treatment. Materials and Methods: The study group consisted of 103 patients with complex cervical trauma pathology produced by various mechanisms such as car or domestic accidents, aggression, ballistic trauma, self-inflicted attempts, hanging or strangulation hospitalized in the Ear, Nose and Throat (E.N.T.) Clinic, at "St. Spiridon" Iași Hospital, between 2012 and 2016. Results: The universal clinical indication for urgent surgical exploration of the patient with complex cervical trauma is the presence of the following symptoms: unstable vital signs, significant pulsatile bleeding, hematoma with a substantial increase in size, shock, airway obstruction, open airway wound, hematemesis, or hemoptysis. In this context, we considered it worthwhile to research the management of complex cervical trauma in a reference university medical center, alongside the analysis of the patient's characteristics under different aspects (demographic, pathological aspects, therapeutic). Conclusions: Complex cervical trauma has a variety of clinical aspects, with a variable evolution, which involves multidisciplinary therapeutic management. The increasing trauma rate is one of the main public health problems, requiring epidemiological studies, and the implementation of control strategies.

Cancer-associated thrombosis: comparison of characteristics, treatment, and outcomes in oncologic and nononcologic patients followed by a pulmonary embolism response team.

The risk of venous thromboembolism (VTE) in patients with cancer is currently 12 times higher than in the general population, and even 23 times higher when they receive chemotherapy. The main goal of the pulmonary embolism response team at the Center for the Management of Pulmonary Embolism (PERT‑CELZAT) is to improve prognosis through interdisciplinary care, with a particular focus on patients with contraindications to standard pharmacologic treatment, requiring individual decision‑making, including a wider use of interventional therapeutic methods. The objectives of the study were to report and compare the characteristics and outcomes of pulmonary embolism (PE) in patients with and without cancer treated by the PERT‑CELZAT. The analysis included 235 patients diagnosed with VTE who were consulted by local PERT between September 2017 and December 2021. The study group was divided into 2 cohorts: oncologic patients (OP) and nononcologic patients (NOP). There were 81 patients in the OP group (mean [SD] age, 66.2 [14.1] years) and 154 patients in the NOP group (mean age, 57.4 [17.4] years). The OPs were older and more frequently diagnosed with incidental PE. In‑hospital mortality for all patients reached 6.4% (15/235), 3.7% in the OP and 7.8% in the NOP group (P = 0.27). In‑hospital events, such as major bleeding, minor bleeding, recurrent PE, and deep venous thrombosis occurred with similar frequency in both groups. Posthospital mortality up to 12 months after the PE diagnosis was 12.8% (10/78) in the OP and 4.2% (6/142) in the NOP group (P = 0.03). In a long‑term survival analysis, cancer was associated with increased risk of mortality (hazard ratio, 2.44 [95% CI, 1.51-3.95]; P <0.001) when adjusted for age. The multidisciplinary therapeutic approach may provide the OPs with VTE an in‑hospital survival rate noninferior to that of the NOPs. The OPs died more often in the following months, because of their underlying neoplastic disease.