Treatment Outcomes In Patients Research Articles

Clinical Profiles of Retinal Vasoproliferative Tumors

Purpose: To describe the clinical features and treatment outcomes of patients with retinal vasoproliferative tumors. Methods: This retrospective case series comprised patients diagnosed with a retinal vasoproliferative tumor. Electronic medical records were reviewed, and patients’ demographic details, clinical presentation, and treatment outcomes were analyzed. Results: Nineteen eyes of 19 patients with vasoproliferative tumors were included. The mean age (±SD) at presentation was 37.0 ± 16.95 years. No eye had bilateral tumors, and 1 eye had multiple tumors. Three eyes (15%) had primary tumors, while 16 (84%) had secondary tumors. Primary tumors mainly affected the inferotemporal quadrant (n = 3). Secondary tumors involved the inferior quadrant (n = 4), inferotemporal quadrant (n = 5), and inferonasal quadrant (n = 5). Secondary tumors were associated with Coats disease (n = 6), intermediate uveitis (n = 3), traumatic chorioretinopathy (n = 2), familial exudative vitreoretinopathy (n = 2), retinal vasculitis (n = 2), and retinal vascular occlusion (n = 1). Retinochoroidal features included intraretinal and subretinal exudates, subretinal fluid, intraretinal hemorrhaging, vitreous hemorrhaging, cystoid macular edema, vitritis, preretinal fibrosis, dilated feeding vessel, epiretinal membranes, and tractional retinal detachment. Treatment modalities included cryotherapy, laser photocoagulation, and local steroids. The mean follow-up was 25.3 months, during which 18 eyes had tumor regression and 1 had a worsening condition. Conclusions: Secondary vasoproliferative tumors were more frequently observed than primary tumors, often presenting as unilateral, unifocal tumors situated posterior to the equator in the inferior fundus. Conventional treatment approaches, such as cryotherapy and laser photocoagulation, were effective at tumor regression and often required multiple sessions.

EGS SO30 - Management of Iatrogenic Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass non-operative for early perforation without sepsis, endoscopic with endoclip/stent and surgical including primary repair, exclusion and diversion or oesophagectomy. Recently, Endoscopic Vacuum Therapy (EVT) has been introduced as safe and effective alternative approach. We sought to assess treatment outcomes in patients with IOPs prior to and during periods where EVT was available as treatment option. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=30) presented or transferred to our tertiary oesophagogastric unit for IOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or spontaneous perforation secondary to malignancy or benign pathology were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day and 1-year mortality. Results In 2009-2017 pre-EVT period, 11/30 patients were managed a) non-surgically 7/11, b) endoclip 3/11 and stenting 1/11. 30-day and 90-day mortality were 1/11, 90-day morbidity Clavien-Dindo >IIIa 3/11 (27.3%), 90-day reintervention 8/11 (72.7%), median LOS 27 days. In 2018-2023 EVT period, 19/30 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 5/19, b) non-surgical 7/19, c) IR NJT, stent or PEG in 6/19 d) EVT in 4/19. 30-day mortality was 0/19, 90-day mortality 1/19 (5.2%), 90-day morbidity Clavien-Dindo >IIIa 7/19 (36.8%), 90-day reintervention 9/19 (47.4%), median LOS 61 days. 1-year mortality was 0/19 for both. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of iatrogenic oesophageal perforations. Careful patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is a sine qua non.

OGC O03 - Clinical Outcomes of Routine Jejunostomy Feeding Following Oesophagectomy

Abstract Background Malnutrition negatively affects treatment outcomes of patients with oesophageal cancer post-oesophagectomy. Chemo(radio)therapy exacerbates nutritional deficits, and thus strategies to ensure adequate nutritional intake are necessary. Feeding jejunostomies are commonly used for nutritional support to maintain nutrition and reduce the effect of complications but may be associated with increased morbidity. This study examines the impact of routine post-operative jejunostomy feeding on postoperative weight loss in patients who have undergone oesophagectomy. Method A retrospective review of patients undergoing oesophagectomy between January 2012-December 2014 and January 2016-December 2019 at a single oesophagogastric unit was performed. Routine post operative feeding with overnight feeding on discharge was introduced in 2015. 507 patients were identified and separated into two groups (245 without routine post operative jejunostomy feeding, 262 with routine feeding). Primary outcomes measured included post operative weight loss (2 weeks, 6 weeks, 3 months and 6 months). Secondary outcomes investigated included length of hospital stay, complications and long-term survival. Subgroup analyses were performed on patients who have experienced complications and those receiving different treatments. Results Weight loss was less in patients discharged with jejunostomy feeding at 2 weeks, 6 weeks, 3 months, 6 months (2.92kg vs 5.49kg, 3.39kg vs 6.37kg, 4.81kg vs 7.96kg, 7.25kg vs 9.285kg, p<0.05). In those with complications, routine feeding resulted in less weight loss up to 3 months (p<0.05). Jejunostomy feeding experienced less weight loss in subgroups surgery alone (7.99kg vs 8.72kg, p<0.001), neoadjuvant therapy with surgery (8.02kg vs 9.90kg, p<0.05), and neoadjuvant therapy, surgery with adjuvant therapy (6.29kg vs 9.14kg, p<0.05). Average hospital stay was 16 days with feeding, 19 days without. Long-term survival was greater with jejunostomy feeding (P=0.04). Conclusion Post-operative jejunal feeding is associated with significantly reduced post operative weight loss. This is reflected in patients who received surgery alone, neoadjuvant therapy with surgery and neoadjuvant therapy with surgery and adjuvant therapy. Patients with complications who had routine jejunostomy feeding also experienced significantly less weight loss than those without routine jejunostomy feeding. Routine jejunostomy feeding is associated with a shorter length of hospital stay and is associated with a greater long-term survival.

Comprehensive data of 5085 patients newly diagnosed with colorectal liver metastasis between 2013 and 2017: Fourth report of a nationwide survey in Japan

AbstractThe Joint Committee for Nationwide Survey on colorectal liver metastasis (CRLM) was established to improve treatment outcomes in patients with CRLM. The aim of this study was to evaluate the transition in the characteristics and treatment strategies of patients with CRLM and to analyze the prognostic factors. The data of 5085 patients newly diagnosed between 2013 and 2017 were compared with those of 3820 patients from 2005 and 2007. In patients who underwent hepatectomy (n = 2759 and 2163), the number of CRLMs was significantly higher and in the 2013–2017 data than in the 2005–2007 data (median 2 vs. 1; p = .005). Overall survival (OS) rates after diagnosis of CRLM after hepatectomy were better in the 2013–2017 data than that in the 2005–2007 data (5‐year OS, 62.4% vs. 56.7%, p < .001). Recurrence‐free survival (RFS) after hepatectomy was comparable between the groups (5‐year RFS, 30.5% vs. 30.7%; p = .068). Multivariate analyses identified age at diagnosis of CRLM ≥70 years, lymph node metastasis of primary lesion, preoperative carbohydrate antigen (CA) 19–9 value >100 U/mL, number of CRLM 2–4, and R2 resection as independent predictors of OS. Synchronous CRLM, concomitant extrahepatic metastasis, lymphatic invasion, lymph node metastasis of primary lesion, preoperative CA19‐9 value >100 U/mL, number of CRLM 5–, and nonlaparoscopic approach were selected as that of RFS. Despite having a higher prevalence of advanced stage CRLM in the 2013–2017 patient population compared to the 2005–2007 cohort, prognostic outcomes demonstrably improved in the later period.

Survival and Treatment Outcomes in Gastric Cancer Patients with Brain Metastases: A Systematic Review and Meta-Analysis

Background: Brain metastases (BM) from gastric cancer (GC) are rare but associated with poor prognosis, significantly impacting patient survival and quality of life. The objective of this systematic review and meta-analysis is to consolidate existing research on BM from GC, evaluate the incidence and clinical outcomes, and explore the effectiveness of treatment options. Methods: A systematic search was conducted across the Medline, Web of Science, and Scopus databases, following PRISMA guidelines. Eighteen high-quality studies, as per the Newcastle–Ottawa Quality Assessment Scale, were included, encompassing 70,237 GC patients, of whom 621 developed BM. Data on progression-free survival (PFS), overall survival (OS), neurological symptoms, and HER2 status were analyzed using a random-effects model. Results: The incidence of BM in GC patients was found to be 2.29% (95% CI: 1.06–3.53%), with the range extending from 0.47% to 7.79% across studies. HER2-positive status was significantly associated with a higher likelihood of developing BM, with an odds ratio of 43.24 (95% CI: 2.05–913.39; p = 0.02), although this finding was based on limited data. The surgical resection of BM was linked to significantly improved survival outcomes, with a mean difference in OS of 12.39 months (95% CI: 2.03–22.75; p = 0.02) compared to non-surgical approaches. Conclusions: The surgical resection of brain metastases in GC patients significantly enhances overall survival, while HER2-positive patients may show a higher risk for developing BM. These findings underscore the importance of tailored therapeutic approaches for GC patients with BM.

PECULIARITIES OF ORTHODONTIC TREATMENT FOR PATIENTS WITH GENERALIZED PERIODONTITIS AND PREDOMINANCE OF PARASYMPATHETIC NERVOUS SYSTEM ACTIVITY

The use of orthodontic treatment for patients with generalized periodontitis enhances the effectiveness of comprehensive care. However, it is important to consider the reduced capacity for alveolar bone regeneration in these patients. Therefore, as part of the complex treatment of generalized periodontitis, the inclusion of medications to support alveolar bone regeneration is essential. The course of various diseases can be influenced by the state of the patient’s autonomic nervous system. In this study, medications were administered to normalize parasympathetic nervous system activity in patients with generalized periodontitis undergoing orthodontic treatment. The objective of the study was to evaluate the effectiveness of orthodontic treatment in patients with generalized periodontitis, particularly those with a predominance of parasympathetic autonomic nervous system activity. This was assessed by the supplementary use of a combination of drugs designed to stimulate alveolar bone formation and regulate parasympathetic nervous system function. Materials and methods. This study involved 35 young patients (aged 18-35) with generalized periodontitis and a predominance of parasympathetic autonomic nervous system activity, all of whom presented with displacement of the maxillary frontal teeth. These patients underwent orthodontic treatment. To correct the state of the autonomic nervous system over the treatment of generalized periodontitis, patients were prescribed to take a complex of medicines including the preparation “Calcinova” for stimulating osteogenesis. A comprehensive periodontal examination, including the assessment of hygienic indices, was conducted to evaluate periodontal status throughout the treatment. Results. The periodontal examination revealed that almost all patients demonstated an improvement in oral health. Noticeable dynamics in the pathological process were observed as a result of the complex treatment. The analysis of these findings underscores the importance of orthodontic treatment for patients with generalized periodontitis, particularly when combined with methods to correct parasympathetic nervous system activity and promote osteogenesis. This approach was shown to positively affect periodontal tissues and enhance the effectiveness of generalized periodontitis treatment. Conclusions. Correction of parasympathetic autonomic nervous system function enhances the effectiveness of therapy. In this study, a complex of medications was used to improve parasympathetic nervous system activity. The addition of “Calcinova” to stimulate osteogenesis further contributed to achieving more stable treatment outcomes in patients with generalized periodontitis.

Clinical features, treatment options and outcomes in primary cutaneous B‐cell lymphomas: a real‐world, multicenter, retrospective study

AbstractBackgroundPrimary cutaneous B‐cell lymphomas (PCBCLs) are rare cutaneous neoplasms with limited literature regarding treatment options and associated treatment outcomes. This study aimed to investigate and present real‐world treatment outcomes in patients with PCBCLs.MethodsAll patients with PCBCL who were treated in five major referral centers for cutaneous lymphoma in Greece over 10 years were retrospectively included with their baseline characteristics and treatment‐associated outcomes collected and analyzed.ResultsIn total, 235 PCBCL patients, of whom 125 (53.2%) were females, were included. The median age at diagnosis was 60 years (IQR 47–72), and the median follow‐up duration was 3 years (IQR 1.3–6.4). The most common subtype was primary cutaneous marginal zone lymphoma (PCMZL) (52.3%), followed by primary cutaneous follicle center lymphoma (PCFCL) (40.9%), and primary cutaneous large B‐cell lymphoma, leg type (PCDLBCL, LT) with 16 (6.8%) cases. Complete responses (CRs) were observed in 77.3% after first‐line treatment. Both radiotherapy (RT) and surgical excision (SE) achieved superior outcomes, with 88.9% and 89% achieving CR, respectively. Relapses occurred in 22.6% of initial complete responders. The median time to the next treatment (TTNT) for the PCMZL and PCFCL was 349 days. RT and topical/intralesional steroids demonstrated longer TTNT compared to SE (445 and 359 vs. 154 days). For PCMZL and PCFCL, the 1‐year progression‐free survival (PFS) was 84.2% (75.7–89.9) and 85% (75.1–91.2), and the 5‐year PFS was 66.5% (55.2–75.5) and 58.8% (44.4–70.7), respectively.ConclusionsPCBCLs have favorable outcomes. RT demonstrates significantly increased TTNT compared to SE, suggesting RT as the preferable option. After careful evaluation, “watch and wait” may be a reasonable option for asymptomatic patients.

Personal and Clinical Predictors of Voice Therapy Outcomes: A Machine Learning Analysis Using the Voice Handicap Index

In this study, we examine the predictive factors influencing the outcomes of voice treatment in patients with voice-related disorders, using the voice handicap index (VHI) as a key assessment tool. By analyzing various personal habits and clinical variables, we identify the primary factors associated with changes when comparing VHI scores before and after voice treatment. For this research, we employed binomial logistic regression, random forest (RF), and a multilayer perceptron (MLP) model to evaluate the effectiveness of voice treatment. The findings reveal that gender (with female patients showing greater improvements in VHI scores compared to male patients), surgical history, voice use status, and voice training status are significant predictors of therapy outcomes. The MLP model demonstrated high accuracy, sensitivity, and specificity, with an area under the curve (AUC) value of 0.87 indicating its potential as a valuable clinical predictive tool; however, the model’s relatively low specificity suggests the need for further refinement to enhance its predictive accuracy. The results of this study provide valuable insights for clinicians and speech–language pathologists in developing personalized treatment strategies to optimize the effectiveness of voice therapy. Future research should prioritize the validation of these findings in larger and more diverse population samples. Furthermore, it is essential to explore additional predictive variables in order to enhance the model’s accuracy across different types of voice disorders.

QLTI-20. BRIDGING THE GAP: UNDERSTANDING THE CURRENT TREATMENT RESPONSES TO ENHANCE THE STANDARD OF CARE AND OUTCOMES FOR MALIGNANT PERIPHERAL NERVE SHEATH TUMORS

Abstract Malignant peripheral nerve sheath tumor (MPNST) are a rare and aggressive cancer that make up 5-10% of all sarcomas. There is currently no effective targeted therapy to treat MPNST and surgical resection remains the mainstay of treatment, though often not feasible due to location, size of the tumor, or presence of metastases. Evaluation of MPNST treatment response to palliative chemotherapy regimens could serve as a reference point for target response rates in clinical trials going forward. We performed a retrospective electronic health record analysis of patients with biopsy-proven diagnoses of MPNST at Washington University and Johns Hopkins University. We evaluated tumor characteristics along with treatment response, overall survival (OS), and progression free survival (PFS) rates for different chemotherapeutic regimens. The cohort comprises 140 patients, with ages at diagnosis ranging from 21 to 40 years. Most patients had tumors located in the extremities, with sizes ranging from 5-10 cm at the time of diagnosis. We identified 66 patients who received adjuvant chemotherapy, 44 received neoadjuvant chemotherapy and 28 did not receive any chemotherapy. We will present objective response rate (ORR) and clinical benefit rate (CBR) for neoadjuvant chemotherapy. Among patients with metastatic disease (n=53), 12 chemotherapy regimens were assessed. All regimens other than gemcitabine-docetaxel chemotherapy regimen performed better than the median PFS of 1.77 months which has been observed in clinical trials of targeted agents to date with the most compelling response to vincristine-irinotecan-temozolomide regimen. Despite advancements in our understanding of MPNST pathogenesis, these tumors carry a poor prognosis. Our study has identified several systemic therapies which should be further evaluated prospectively to improve treatment options and outcomes for patients with this aggressive sarcoma. These results can serve as a benchmark for future clinical trials.

BIOM-34. INTRACRANIAL MANAGEMENT OF HER-2 OVEREXPRESSION BREAST CANCER WITH EXTENSIVE VOLUME OR SYMPTOMATIC BRAIN METASTASES

Abstract BACKGROUND HER-2 overexpression in breast cancer often leads to brain metastases, necessitating effective intracranial control strategies. This study aimed to evaluate the correlation between intracranial disease volume, symptomatic presentation, and treatment outcomes in HER-2 overexpressing breast cancer patients with brain metastases. METHODS A retrospective analysis was conducted on cases of HER-2 overexpressing breast cancer patients with brain metastases. Clinical records were reviewed to extract patient demographics, treatment modalities, and intracranial disease characteristics. Intracranial tumor burden was quantified at diagnosis and post-initial treatment. High intracranial tumor burden was defined as either total metastatic volume >15 cc, or the largest lesion >3 cm. Responses were assessed using established criteria. The correlation between intracranial disease parameters and intracranial progression-free survival (PFS) and overall survival (OS) was determined. RESULTS The study comprised 65 patients with HER-2 overexpression breast cancer and brain metastases. Symptomatic presentation was observed in 69.2% of patients at the diagnosis of brain metastases. Treatment with HER-2 target therapy alone or in combination with other modalities resulted in substantial intracranial responses, with 81.5% achieving at least a partial response at 3 months from therapy initiation. Median intracranial PFS and OS for patients with high intracranial burden were 9 and 22 months, respectively. Patients with high intracranial burden and symptomatic presentation at diagnosis demonstrated worse PFS and OS to those with lower burden and absence of symptoms (p < 0.05 for each). CONCLUSION Intracranial control in HER-2 overexpressing breast cancer patients with large volume or symptomatic brain metastases appears promising with combination with HER-2 targeted therapy and radiotherapy. Despite the varying intracranial disease burdens and symptomatic presentations, the use of HER-2 targeted therapy combined with radiotherapy demonstrates favorable intracranial responses, highlighting their potential in managing such cases.

DNAR-11. INHIBITION OF RAD52 ACTIVITY INDUCES DNA DAMAGE BY ACCUMULATING R-LOOPS IN DIFFUSE MIDLINE GLIOMA

Abstract Diffuse midline glioma (DMG) is one of the most devastating childhood cancers with a median survival of < 1year from diagnosis. There is a critical need for new therapeutics for improving treatment outcomes for DMG patients. We performed genome-wide CRISPR/Cas9 screening and identified RAD52 as a potential therapeutic target in DMG cells. RAD52 inhibition, using shRNA-mediated RAD52 depletion and treatment with RAD52 inhibitor, D-I03, suppressed DMG cell proliferation. Western blotting revealed that RAD52 inhibition increased DNA double-starand breaks (DSBs) marker γH2AX while it decreased repair markers BRCA1 and RAD51. Also, RAD52 inhibition causes a sustained level of phosphorylated RAD50 and γH2AX in irradiated DMG cells over 24 hours. Immunocytochemistry (ICC) of γH2AX and repair marker 53BP1 showed that RAD52 inhibition sustained DNA damage with high levels of γH2AX at 24 hours following radiation while the level of 53BPI was decreased, thereby inhibiting DNA DSB repair. DNA repair assay showed that RAD52 inhibition suppressed DNA DSB repair through a homologous recombination pathway. RNA sequencing showed that RAD52 inhibition downregulated genes associated with the DNA repair pathway. Importantly, RAD52 inhibition increased the radiosensitivity of DMG cells. To understand the mechanism of RAD52 inhibition on DNA damage, we performed dot plot assay and ICC of S9.6 which recognizes DNA-RNA hybrids (also known as R-loops) and found accumulation of R-loop formation in DMG cells treated with RAD52 inhibitor. In addition, RAD52 inhibition decreased the expression of RNA polymerase II. Finally, the combination therapy of RAD52 inhibitor and radiation inhibited tumor growth and increased survival of mice bearing DMG patient-derived xenografts, outperforming either monotherapy. Together, our results highlight that RAD52 inhibition induces DNA damage by accumulating R-loops, results in reducing DMG cell proliferation, while also increase DMG radiosensitivty, and providing a rationale for developing combination therapy with radiation for the treatment of DMG.

RTID-02. PERSONALIZED PEPTIDE VACCINATION AMONG 173 PATIENTS WITH GLIOBLASTOMA

Abstract Current treatment outcome of patients with glioblastoma (GBM) remains poor. Following standard therapy, recurrence is universal with limited survival. GBM tumors from 173 patients were analyzed for somatic mutations to generate a personalized peptide vaccine targeting tumor-specific neoepitopes. In agreement with their treating physician, patients added a personalized peptide vaccine to their treatment as an individual healing attempt. Patients were monitored from October 2015 until August 2023. We retrospectively evaluated their clinical courses and the results of their immune monitoring data. Among all patients, including 70 treated prior to progression (primary) and 103 treated after progression (recurrent), the median overall survival from first diagnosis was 31.9 months (95% CI: 25.0-36.5). Adverse events were infrequent and were predominantly grade 1 or 2. An immune response to at least one of the vaccinated peptides was detected in blood samples of 87 of 97 (90%) monitored patients. T-cell responses to vaccinated neoepitope peptides were durable in most patients. Significantly prolonged survival was observed for patients with multiple vaccine-induced immune responses (53 months) compared to those with no/low induced responses (27 months; P=0.03). Altogether, our results highlight that the application of personalized neoantigen-targeting peptide vaccine is feasible and represents a promising potential treatment option for GBM patients. This is the largest real-world observation involving GBM patients safely treated with a personalized peptide vaccine to date. This real-world observation will be translated into a clinical trial to evaluate the specific contribution of the neoantigen vaccine.

Presentation and outcome of Gastric Cancer at a Tertiary Care Center

Introduction: Gastric cancer is the fifth most common cancer globally and the fourth leading cause of cancer-related deaths. Early-stage disease can be managed with endoscopic therapy or surgery, while advanced gastric cancer requires a multimodal treatment approach, including extensive lymphadenectomy. This study aims to evaluate the clinicodemographic profile and treatment outcomes of gastric cancer patients and to establish an effective therapeutic strategy. Methods: This retrospective descriptive cross-sectional study was conducted in the Department of Surgery at Shree Birendra Hospital. It included patients with gastric malignancies who had complete medical records. Data on patient history, AJCC staging, operative details, and postoperative findings were analyzed. Surgical choices were based on the clinical indication in each case. Clinicopathological characteristics and surgical outcomes were compared across tumor stages. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24. Results: The study included 90 patients (62 males, 28 females) aged between 23 and 82 years. The most common clinical presentations were abdominal pain (58%), gastric outlet obstruction (18%), lump (5%), anemia (5%), and peritonitis (4%). Adenocarcinoma was the predominant histological type (87.78%). Curative surgery was performed on 73 patients (81.11%), while 17 patients (18.89%) underwent palliative procedures. Morbidity occurred in 16 patients (17.7%), primarily due to chest complications and sepsis, and mortality was recorded in 5 patients (5.5%). Conclusion: This study highlights the predominance of locally advanced gastric cancer in males, with distal gastric cancer and well-differentiated adenocarcinoma being the most common. Chest complications and sepsis were the leading causes of morbidity and mortality. No patients received perioperative chemotherapy, underscoring the need for updated treatment protocols to improve outcomes.

Lymphatic Disorder Management in Pediatric Patients With Congenital Heart Disease in European Pediatric Cardiology Centers: Current Status, Disparities, and Future Considerations.

Lymphatic disorders such as protein-losing enteropathy, plastic bronchitis, and chylothorax are important complications of the Fontan circulation and ultimately result in an increased risk of early death. Several European centers are now performing lymphatic procedures. The aim of this study is to map the extent of these lymphatic disorders and treatments provided across European pediatric cardiology centers. A survey was circulated to 49 European pediatric cardiology centers consisting of 37 questions including a mix of binary, categorical, and continuous variables. Thirty-one centers (63%) participated in the study, performing a median of 250 (interquartile range, 178 - 313) cardiopulmonary bypass procedures per year. Chylothorax emerged as the most prevalent lymphatic disorderfollowed by protein-losing enteropathy and plastic bronchitis. The most common diagnostic investigation method was noncontrast magnetic resonance lymphangiography (52%). Eleven centers (35%) conducted lymphatic interventions with a median of 3 (interquartile range, 1 - 4) procedures per year and 12 (interquartile range, 5 - 15) interventions in total per center. This study confirms the rarity of and variation in treatment approaches for lymphatic disorders across Europe. With at least 11 centers offering lymphatic interventions, the adoption of these procedures is on the rise in Europe. To improve the quality of care and treatment outcomes for these complex patients, it is crucial to consider evidence-based lymphatic diagnostics, interventional lymphatic procedures, and the centralization of services in Europe.

Treatment of local purulent postoperative soft tissue complications in patients of older age groups with fractures of the proximal femur

BACKGROUND: Surgical treatment of fractures of the proximal femur in elderly patients makes it possible to put patients on their feet early and improve their quality of life. Local purulent complications in the postoperative period after hip fractures surgical treatment occur in 5–10% of cases. AIM: To improve the treatment outcomes of patients with local postoperative purulent complications of soft tissues by a comparative analysis of treatment methods with various antibacterial, antiseptic hydrogels and physical methods of wound treatment. MATERIALS AND METHODS: The article presents the nature of local purulent complications, their clinical picture, and diagnostic features. All the patients are divided into 2 groups. The main group included 53 patients, and the control group included 48. The patients of the main group underwent comprehensive treatment of local purulent complications using modern technologies (plasma scalpel) and dressings with hydrogel Argacol. The control group was treated with traditional bandages with dioxomethyltetrahydropyrimidine and chloramphenicol. RESULTS: The use of surgical wound treatment using a plasma scalpel and dressings with multifunctional hydrogel allows to accelerate the wound healing process by 2–3 weeks compared with the use of traditional techniques. CONCLUSIONS: The application of the proposed tactics of providing specialized care to elderly patients with a fracture of the proximal femur allows for a significant (p 0.05) improvement in treatment results.

Hepatosplenic schistosomiasis, treatment outcomes and associated factors among adult patients treated at public hospitals in the Harari Region of Ethiopia: retrospective cross-sectional study.

Schistosomiasis is one of the neglected tropical diseases that pose a significant burden in developing countries, particularly in sub-Saharan Africa. Hepatosplenic schistosomiasis (HSS) is a substantial cause of morbidity and mortality. This study aimed to determine clinical patterns, outcomes and factors associated with HSS in the Harari Region of Ethiopia. An institutional-based retrospective cross-sectional study was conducted among 93 adult patients diagnosed with HSS at public hospitals in the Harari Region from December 2018 to November 2022. Data were extracted from medical records using a standardized data extraction tool. EpiData version 4.2 and SPSS version 26.0 were used for data entry and analysis. Fisher's exact test was used to identify the association between dependent and independent variables, and statistical significance was declared at p<0.05. In the current study, HSS-related mortality was recorded in 7.5% of patients. Recurrent episodes of upper gastrointestinal (GI) bleeding (p=0.04), hypotension (p=0.02), altered mental status at admission (p=0.009) and antibiotic use for the treatment of spontaneous bacterial peritonitis (p=0.04) were significant factors associated with HSS-related mortality. The study found that treatment outcomes of HSS patients were strongly associated with recurrent upper GI bleeding, hypotension, altered mental status and antibiotic use for spontaneous bacterial peritonitis treatment. The use of antibiotics for spontaneous bacterial peritonitis treatment was strongly associated with the treatment outcome of patients with HSS and was unique to our study. Adequate recording of patient data, improving chart keeping, integration of preventive and curative programs, improvement of the diagnostic tools, comprehensive treatment guidelines, early diagnosis and treatment are strongly recommended. Rigorous prospective studies that can fully reflect cause-and-effect relationships are crucial to fill fundamental evidence gaps.

A Two-Stage Approach to Alveolar Clefts Repair with Combined Cortical and Cancellous Bone Grafting

Background: Achieving optimal efficacy in secondary alveolar bone grafting (SABG) poses a considerable challenge for patients with alveolar clefts post-canine eruption. This study introduces a novel technique called the "two-stage SABG" to improve the treatment outcomes for patients who have missed the optimal timing for bone grafting. Methods: Patients aged 12 and above, presenting with unilateral, complete alveolar clefts after canine eruption, were divided into two cohorts: conventional and two-stage groups. The two-stage group underwent oronasal fistula closure and mucoperiosteal sealing during the initial stage, followed by particulate cancellous bone marrow (PCBM) and mandibular cortical bone grafting in the second stage after a three-month interval. Six months after surgery, the SABG was evaluated quantitatively and qualitatively using computed tomography (CT). Results: A total of 81 patients (median age: 14 years; male/female: 49/32) were included in the conventional group, while the two-stage group consisted of 33 patients (19 years; 20/13). The two-stage group exhibited significantly superior outcomes (P &lt; 0.01) in terms of radiographic healing rate (&gt; 4 points) (96.97% vs. 55.56%), bone bridge height (12.17mm, IQRs=4.26mm), bone bridge width (9.09mm, IQRs=2.74mm), bone formation rate (69.73%, IQRs=22.73%), and bone resorption rate (48.85%, IQRs=22.57%). Additionally, the average three-dimensional deviations greater than 3.5mm at the affected piriform aperture margin. Conclusions: The novel two-stage SABG approach demonstrates significant benefits in the repair of alveolar clefts and pyriform foramen deformities through combined cortical and cancellous bone grafting.

Emapalumab Treatment in Patients With Rheumatologic Disease-Associated Hemophagocytic Lymphohistiocytosis in the United States: A Retrospective Medical Chart Review Study.

Rheumatologic disease-associated hemophagocytic lymphohistiocytosis (HLH), a rare, life-threatening, systemic hyperinflammatory syndrome, occurs as a complication of underlying rheumatologic disease. Real-world evidence is lacking on emapalumab, a fully human monoclonal antibody that neutralizes the proinflammatory cytokine interferon-γ, approved for treating patients with primary HLH. REAL-HLH, a retrospective medical chart review study conducted across 33 US hospitals, assessed real-world treatment patterns and outcomes in patients with HLH treated with one or more dose of emapalumab between November 20, 2018, and October 31, 2021. Data are presented for the subset of patients with rheumatologic disease-associated HLH. Fifteen of 105 patients (14.3%) had rheumatologic disease-associated HLH. Of these, nine (60.0%) had systemic juvenile idiopathic arthritis, and one (6.7%) had adult-onset Still disease. Median (range) age at HLH diagnosis was 5 (0.9-39) years. Most patients (9 of 15; 60.0%) initiated emapalumab in an intensive care unit. Emapalumab was most frequently initiated for treating refractory or recurrent (10 of 15; 66.7%) disease. Most patients received HLH-related therapies before (10 of 15; 66.7%) and concurrently with (15 of 15; 100.0%) emapalumab. Emapalumab-containing regimens stabilized or achieved physician-determined normalization of most laboratory parameters, including absolute neutrophil count and absolute lymphocyte count (13 of 14; 92.9%), chemokine ligand 9 (9 of 11; 81.8%), and platelets and alanine transaminase (11 of 14; 78.6%), and reduced glucocorticoid dose by 80%. Overall survival and 12-month survival probability from emapalumab initiation were 86.7%. Emapalumab-containing regimens stabilized or normalized most key laboratory parameters, reduced glucocorticoid dose, and were associated with low disease-related mortality, thereby demonstrating potential benefits in patients with rheumatologic disease-associated HLH.

Pressure-Mediated Biofeedback With Pelvic Floor Muscle Training for Urinary Incontinence

Supervised pelvic floor muscle training (PFMT) has been recommended as the first-line treatment for women with stress urinary incontinence (SUI), but more evidence on whether adjunctive methods would provide additional benefits is needed. To compare the efficacy of PFMT with or without a home-based pressure-mediated biofeedback (BF) device. This multicenter assessor-blinded randomized clinical trial was conducted in the obstetric clinics of 5 participating tertiary hospitals in China. Participants included eligible women with new-onset postpartum SUI who were enrolled from March 28, 2022, to October 13, 2023. All participants received 3 months of supervised PFMT and were randomized to either the intervention (PFMT with a home-based pressure-mediated BF device) or the control group (home-based PFMT). The primary outcome was the severity of urinary incontinence evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form after 3 months of supervised PFMT. The secondary outcomes included the cure and improvement rates, PFM strength, quality of life, self-efficacy, and adherence. A total of 452 participants (median age, 34 [IQR, 31-36] years; median body mass index [calculated as the weight in kilograms divided by the height in square meters], 23.71 [IQR, 21.37-25.97]; median time since delivery, 50 [IQR, 43-61] days) were included in the analysis, with 223 in the intervention group and 229 in the control group. Compared with the control group, the intervention group achieved a significantly greater reduction in incontinence severity (median, 3.00 [IQR, 1.00-6.00] vs 2.00 [IQR, 0-4.00] points; z = -3.05; P = .002), significantly increased cure rate (45 of 223 [20.2%] vs 20 of 229 [8.7%]; z = 12.02; P = .001) and improvement (132 of 223 [59.2%] vs 102 of 229 [44.5%]; z = 9.71; P = .002), significantly greater pelvic floor muscle strength (median, 26.00 [IQR, 17.00-38.00] vs 21.00 [IQR, 13.50-33.50] cm H2O; z = -2.28; P = .02), and a significantly greater correlation between subjective and objective adherence (r = 0.825 vs r = 0.627). In this randomized clinical trial, the efficacy of pressure-mediated BF combined with PFMT was superior to that of PFMT alone. These findings support the use of pressure-mediated BF devices for improving treatment outcomes for patients with SUI. ClinicalTrials.gov Identifier: NCT05115864.

To Assess the Effect of Dyslipidemia on Treatment Outcome of Drug Sensitive TB Patients at a Tertiary Health Care Centre of North India

To Assess the Effect of Dyslipidemia on Treatment Outcome of Drug Sensitive TB Patients at a Tertiary Health Care Centre of North India