Preliminary Outcomes Research Articles

Abstract WP105: Outcomes From the 1st 100 Stroke Survivors Served by a Novel Tech-Enabled Post-Acute Clinical Service

Introduction: This study evaluates the outcomes of a survivor-centric, navigator-driven, technology-enabled platform supporting survivors (SS) and care partners(CP) in post-stroke recovery. At current enrollment rates, the abstract will be updated to include 100 program participants and a propensity-matched analysis of readmission rates vs. a Medicare FFS claims set for appropriately matched subjects. Methods: An app-based, virtual care model was used to impact survivor quality of life and improve outcomes for stroke survivors. This mixed methods study utilizes focus group feedback, survey, app usage and patient-reported outcomes data. Participants (n=50) were facilitated by a clinical navigator (OT or LCSW). Clinicians worked through phone, messaging, and video calls with the SS/CP who had shared access within the app, with separate profiles. The average duration of participation was 12 weeks but tailored to individual needs based on post-stroke impairments, social determinants, health literacy, risk factors and lifestyle management, mental health, and other resource needs. The average participant had 10 Navigator touchpoints totaling 8 hours over the duration of the program. Results: Clinician-assessed mRS scores were captured at 90 days following hospital discharge for 96% of participants. Significant functional improvement was seen, with 84% achieving mRS scores of 0-2 at 90 days, compared to 60% of participants at the time of enrollment. The 30- and 90-day all-cause readmission rates for survivors were 5% and 10%, respectively, superior to recent publications reporting 30-day unplanned readmission rates after stroke ranging from 8.7%-12.5%, and 90-day readmissions ranging from 18.9% to 20.7%. Conclusion: These preliminary outcomes indicate that a tech-enabled healthcare services program can engage and impact the outcomes of individuals and care partners during stroke recovery.

The impact of measurement on clinical trials: Comparison of preliminary outcomes of a brief mobile intervention for autistic adults using multiple measurement approaches.

Initial studies of the emotional safety plan (ESP), a new, brief telehealth and mobile intervention to support autistic adults to cope with periods of distress, have reported feasibility and acceptability (Bal et al., 2023, Autism, 1-13). Herein we report the preliminary clinical outcomes of thirty-six autistic adults who developed a personalized ESP, with a specific interest in comparing "outcomes" demonstrated by different instruments and assessment frequencies in order to inform outcome measurement in future clinical trials. Comparison of pre-intervention baseline to post-monitoring outcome (pre-post) anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) revealed medium effect sizes for reduction in symptoms, though, low effect sizes were observed for pre-post Adult Self-report Anxiety and Depressive Problems scales and the Emotion Dysregulation Inventory Reactivity and Dysphoria scales. Weekly assessments showed an initial decrease in GAD-7 anxiety symptoms but no effect on weekly PHQ-9 depressive ratings. Ecological momentary assessment (EMA) data suggested that, when participants reported feeling sad or agitated and used the ESP, reduced negative feelings and increased positive states were reported in subsequent EMA. Perhaps not surprisingly, preliminary outcomes of these feasibility trials differed depending on measure chosen. Implications for the design of clinical trials are discussed.

Mindful awareness and resilience skills for adolescents (MARS-A): a mixed-methods study of a mindfulness-based intervention for a heterogeneous adolescent clinical population.

Mindful Awareness and Resilience Skills for Adolescents (MARS-A) is a mindfulness-based intervention adapted for the adolescent population. While previous studies have explored the benefits of MARS-A in various single-diagnosis populations, the aim of this study was to assess MARS-A for a heterogenous clinical adolescent population with mental health and/or chronic diagnoses, focusing on the underlying suffering present in all these conditions rather than its effects on a single diagnosis itself. Qualitative data was collected through interviews to understand post-intervention participant perspectives and experiences. Quantitative data was collected through measures to investigate preliminary secondary outcomes. After participating in MARS-A, participants reported qualitative benefits in enhanced well-being, including coping with difficult emotions and managing sleep and/or pain. Quantitative results showed a reduction in functional disability, psychological distress, perceived stress, and depressive symptoms; increase in positive affect; and benefit in coping with pain and chronic conditions. MARS-A shows great potential in a heterogeneous clinical adolescent population.

Teaching residents to teach: A pilot study for an innovative online curriculum.

Resident-as-teacher (RAT) curricula have improved teaching behavior, ability, and confidence among resident participants. However, there are limited data on the appropriate format, length, and content. With teaching being a core residency competency and residents delivering one-third of student teaching in the clinical setting, properly training residents in clinical teaching is essential. We created a formal, scalable, asynchronous RAT curriculum. We report the pilot implementation of this curriculum along with feasibility, user acceptability, and preliminary knowledge outcomes. In this pilot pre-post interventional study, senior emergency medicine residents completed a formalized online education curriculum during their "teach month." The curriculum consisted of three online modules completed weekly over a 4-week rotation. Topics included adult learning, assessment and feedback, and group teaching. Several surveys were sent to residents before and after curriculum implementation. The surveys rated satisfaction and asked several education-specific knowledge questions to assess learning. Ratings were analyzed using means and confidence intervals (95%). Knowledge questions were graded and then analyzed by ANOVA and Fisher's LSD test. After the online modules were completed, the intervention group residents' mean score on knowledge questions was significantly higher than that prior to the curriculum and significantly higher than that the control group (previous graduated residents; 6.00 vs. 2.70, p = 0.0001; and 6.00 vs. 3.00, p = 0.0003, respectively). This score was maintained 3 months after completing the online modules. Intervention group residents were more satisfied with the online education resources than the control group (p = 0.048). Residents participating in a formalized online curriculum during their teach month demonstrate a high comprehension of education concepts and increased satisfaction with the provided educational resources and report high satisfaction with the teach month. Our pilot study suggests that a short online education-focused curriculum is an effective method of providing RAT training and may be applicable to clinical teachers across specialties and experience levels.

Endovascular Repair of Juxtarenal and Pararenal Abdominal Aortic Aneurysms Using a Novel Low-Profile Fenestrated Custom-Made Endograft: Technical Details and Short-Term Outcomes.

The aim of this study is to share preliminary experiences and outcomes with a novel custom-made fenestrated TREO® Abdominal Stent-Graft System to treat juxtarenal and pararenal abdominal aortic aneurysms (AAAs). Juxtarenal and pararenal AAA patients treated with the custom-made fenestrated TREO® Abdominal Stent-Graft System were included from 4 high-volume European academic medical centers from June 2021 to September 2023. Technical success and 30-day/in-hospital mortality and complications were analyzed. Technical success was defined as successful endovascular implantation of the stent graft with preservation of antegrade flow to the target vessels, and absence of type 1 or 2 endoleak (EL) at the first postoperative computed tomography angiography (CTA). Forty-two consecutive patients were included. The majority of the devices were constructed with 2 (N=4; 9.5%), 3 (N=9; 21.4%), or 4 (N=27; 64%) fenestrations. In 1 case, the device was constructed with a single fenestration (2.4%) and 1 device contained 5 fenestrations (2.4%); 17% had previous AAA repair. Target vessel cannulation with placement of a bridging stent was successful in all but 1 vessel (99, 3%). One aneurysm-related death occurred in the direct postoperative period and 2 limb occlusions necessitated reintervention during admission. In the median follow-up period of 101 (2-620) days, 3 more patients died due to non-aneurysm-related causes. Technical success was achieved in 90% of the cases. Nineteen ELs were seen on the first postoperative CT scan: 1 type 1b EL (N=1; 2%), 15 type 2 ELs (N=15; 36%), and 3 type 3 ELs (N=3%). Eleven patients received more than 1 CT scan during a median follow-up of 361 days (82-620): 3 type 2 ELs resolved and 1 type 3 EL was treated in this period. In the follow-up, 1 patient had a coagulation disorder that caused occlusions of the branches. The results of the first experiences using the custom-made fenestrated TREO® Abdominal Stent-Graft System in Europe are promising. There was a low short-term mortality and morbidity rate in these patients of which 17% had previous AAA repair. Mid-term and long-term follow-up data are needed to evaluate endograft durability and performance. This study shows the first experiences and short-term results of a novel low-profile custom-made device: the custom-made fenestrated TREO® Abdominal Stent-Graft System. Showing these results and experiences can help the physicians in clinical decision-making for their patients.

DOP66 INSPIRE: Preliminary data from an observational post-marketing registry on the effectiveness and safety of darvadstrocel in patients with Crohn’s Disease and complex perianal fistulas

Abstract Background Darvadstrocel (DVS), a suspension of expanded allogeneic adipose-derived mesenchymal stem cells, is approved for the treatment of complex Crohn’s perianal fistulas (CPF). INSPIRE (EUPAS24267) is a European observational post-approval study evaluating real-world effectiveness and safety of DVS in patients with complex CPF for up to 36 months. Here we report preliminary clinical and safety outcomes from INSPIRE. Methods Patients with complex CPF who had received DVS according to local standard practice were eligible to enrol. Clinical response (closure of ≥50% of external openings [EOs]) and clinical remission (closure of all EOs) of DVS-treated fistulas that were draining at baseline, were evaluated in the all-treated (AT; received ≥1 dose of DVS with an evaluation for fistula response after 6 months) and per-protocol (PP; received DVS as per label-approved guidelines) cohorts. Treatment-emergent adverse events (TEAEs), serious TEAEs and AEs of special interest were reported for the safety cohort (all patients treated with DVS). Results As of April 2023, 652 patients had enrolled (Table 1). Complete data to evaluate 12-month clinical response and remission were available for 134 (AT cohort) and 124 (PP cohort) patients, of whom 79.9% (AT, n = 107) and 79.8% (PP, n = 99) had a clinical response and 76.1% (AT, n = 102) and 76.6% (PP, n = 95) had clinical remission (Figure 1). From baseline to Month 12, there was a decrease in the mean (standard deviation [SD]) Perianal Disease Activity Index score (–3.5 [3.3]; n/N = 96/302 and –3.7 [3.2]; n/N = 89/249) and a decrease in the mean (SD) Harvey–Bradshaw Index for Crohn’s disease activity (-0.3 [2.8]; n/N = 102/302 and -0.4 [2.9]; n/N = 95/249) in the AT and PP cohorts, respectively. Complete safety data were available for 619 patients (median [min–max] follow-up 480 [6–1595]) days. Overall, 26% (n = 162) had ≥1 TEAE and 10% (n = 63) ≥1 serious TEAE. The most frequent TEAEs were anal abscess (6.9%), COVID-19 (1.9%) and proctalgia (1.1%). No deaths were reported. One breast cancer lymph node metastasis and one ovarian epithelial cancer were reported; both events were confounded by immunosuppressant treatment and were not considered related to DVS treatment. Conclusion These preliminary data are consistent with the pivotal ADMIRE-CD study and demonstrate a single dose of DVS in patients with complex CPF is associated with positive clinical outcomes in up to 80% of patients, and a favourable safety profile, both of which are maintained after 12 months. The inherent limitations of registry-based studies mean these data should be interpreted with caution. However, the ongoing INSPIRE study will provide longer follow-up data to confirm these observations with respect to any study limitations.

Transpedicular Intravertebral Cage Augmentation Using Expandable Cage in Kummell Disease: Technical Note and Case Series

ObjectiveTo demonstrate the surgical techniques for transpedicular intravertebral cage augmentation (TPICA) using an expandable cage for Kummell disease, which requires posterior surgical stabilization, and provide the preliminary surgical outcomes. MethodsSix consecutive patients undergoing TPICA surgery using an expandable cage with a minimum 6-month follow-up were evaluated. Radiographic analysis to evaluate the local kyphosis angle (LKA), restoration ratio of anterior vertebral height (RAVH) of the index vertebra, and clinical outcomes including the Oswestry Disability Index (ODI), EuroQol 5-dimension instrument (EQ-5D), and visual analog scale (VAS) for back and leg pain, were compared between the preoperative and final follow-ups. ResultsAll patients showed improvements in all clinical outcomes and were able to walk independently without support at the last follow-up. In radiographic evaluation, the mean preoperative RAVH was 41.2 ± 15.6%, which increased postoperatively to 70.3 ± 20.5% (1.70 times) and 62.4 ± 20.0% at the last follow-up (1.51 times). The mean preoperative LKA was 10.5 ± 14.8 and was corrected to 6.0 ± 10.0 at the last follow-up. A slight loss of correction was observed between the postoperative period and the last follow-up; however, there was no clinical significance. ConclusionsExpandable cages in TPICA may allow easier surgical manipulation for cage insertion around the pedicle entrance, minimizing damage to the fractured vertebral body's endplates while achieving satisfactory height restoration compared to static cages, and may also provide wider indications for TPICA surgery.

Single incision robotic cystectomy and urinary diversion.

In this review, we aim to provide readers with a balanced understanding of all aspects of single incision robotic cystectomy (SIRC) and urinary diversion using the single-port (SP) robot. The review will trace the historical progression from open surgery to the introduction of minimally invasive approaches and present an in-depth description of the SIRC technique, offering a step-by-step guide for reference. Emphasis will be placed on indications and patient selection criteria to equip surgeons with well-rounded insights for decision-making. The review analyzes preliminary surgical outcomes by drawing from existing literature and clinical experiences, endeavoring to present a balanced view of the potential benefits and limitations. Addressing the learning curve and training prerequisites is paramount, and this review explores strategies and challenges in preparing surgeons for proficiency. Finally, the focus shifts to current challenges and future directions, identifying key issues and potential advancements in the field. By presenting historical context, technical insights, clinical evidence, and strategic foresight, the review aims to provide a comprehensive resource that engages surgeons, researchers, and trainees from diverse perspectives.

Percutaneous nephrolithotomy guided by 5G-powered robot-assisted teleultrasound diagnosis system: first clinical experience with a novel tele-assistance approach (IDEAL stage 1)

BackgroundTo demonstrate the technical feasibility of percutaneous nephrolithotomy (PCNL) guided by 5G-powered robot-assisted teleultrasound diagnosis system (RTDS) in a complex kidney-stone (CKS) cohort and present our preliminary outcomes. PCNL is highly skill-required, which hinders it popularization in primary medical units of remote regions. We designed an innovative tele-assistance approach to make PCNL easy to be operated by inexperienced surgeons.MethodsThis was a prospective proof-of-concept study (IDEAL phase 1) on intraoperative tele-assistance provided by online urological experts via a 5G-powered RTDS. Total 15 CKS patients accepted this technology. Online experts manipulated a simulated probe to assist unskilled local operators by driving a patient-side robot-probe to guide and monitor the steps of access establishment and finding residual stones.ResultsMedian total delay was 177ms despite one-way network-connecting distance > 5,800 km. No perceptible delay of audio-visual communication, driving robot-arm or dynamic ultrasound images was fed back. Successful tele-assistance was obtained in all cases. The first-puncture access-success rate was 78.6% with a one-session SF rate of 71.3% and without complications of grade III-V.ConclusionsThe current technology based on 5G-powered RTDS can provide high-quality intraoperative tele-assistance, which has preliminarily shown satisfactory outcomes and reliable safety. It will break down a personal competence-based barrier to endow PCNL with more popular utilization.Trial registrationThe study was approved by ethics committee of the Xinjiang Kezhou People’s Hospital and ethics committee of the First Affiliated Hospital of Nanjing Medical University and was registered on http://www.chictr.org.cn (ChiCTR2200065849, 16/11/2022).

Post-translational Modification of PD-1: Potential Targets for Cancer Immunotherapy.

Activation of effector T cells leads to upregulation of PD-1, which can inhibit T-cell activity following engagement with its ligand PD-L1. Post-translational modifications (PTM), including glycosylation, phosphorylation, ubiquitination, and palmitoylation, play a significant role in regulating PD-1 protein stability, localization, and interprotein interactions. Targeting PTM of PD-1 in T cells has emerged as a potential strategy to overcome PD-1-mediated immunosuppression in cancer and enhances antitumor immunity. The regulatory signaling pathways that induce PTM of PD-1 can be suppressed with small-molecule inhibitors, and mAbs can directly target PD-1 PTMs. Preliminary outcomes from exploratory studies suggest that focusing on the PTM of PD-1 has strong therapeutic potential and can enhance the response to anti-PD-1.

Preliminary Outcomes of a Staged Percutaneous Retrograde Prefabricated Gentamicin-coated Intramedullary Nail to Manage Complications after Ankle Fusion through Tibial Bone Transport.

Distal tibial injuries combining bone loss, articular destruction and infection can be treated through distraction osteogenesis combined with ankle fusion. Bone transport is not without complications. This study investigates our preliminary results using a retrograde prefabricated gentamicin-coated nail (ETN PROtect®) to treat complications after infected bone defects of the distal tibial were managed by ankle arthrodesis and distraction osteogenesis. This is a retrospective case series study. All consecutive patients with bone transport complications after ankle arthrodesis and distraction osteogenesis who were subsequently operated on using a retrograde ETN PROtect® nail were analysed. The cases occurred between 2017 and 2020. The primary objective was to report on the resolution of the clinical problem and the risk of deep infection after nail implantation. Five patients have included: two docking site non-unions, two regenerated bone fractures and one hypotrophic regenerated bone. These complications were resolved in all patients (5/5, 100%). A painless, stable and plantigrade ankle arthrodesis was achieved in all cases. No patient developed a local infection or required nail removal (mean follow-up: 35.2 months). The mean LEFS score was 46.8 ± 13.8 and the mean knee ROM was 112 ± 12.7°. All patients tolerated full weight-bearing. All patients were very satisfied with the procedure (mean SAPS score was 93.8 points). The staged retrograde nailing technique using the ETN PROtect® nail may represent an effective and safe treatment for bone transport complications in high-infection-risk patients. Furthermore, the technique allows simultaneous achievement of ankle arthrodesis. The patients had good functional outcomes and were satisfied with the procedure. This strategy of using retrograde gentamicin-coated tibial nails offers a solution to resolve bone transport complications while simultaneously achieving functional ankle arthrodesis. Pujol O, Vicente M, Castellanos S, et al. Preliminary Outcomes of a Staged Percutaneous Retrograde Prefabricated Gentamicin-coated Intramedullary Nail to Manage Complications after Ankle Fusion through Tibial Bone Transport. Strategies Trauma Limb Reconstr 2023;18(3):155-162.

Clinical efficacy of modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia

Objective: To investigate the clinical efficacy of the modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia. Methods: A retrospective case series study was conducted. Clinical data were collected from patients who underwent the modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia at Eye Hospital of Shandong First Medical University from February 2017 to February 2022. During the procedure, the superior rectus and lateral rectus muscles were fully separated. A longitudinal blunt incision was made in the central muscle belly extending posteriorly to 12-14 mm from the muscle insertion. The temporal half of the superior rectus muscle and the upper half of the lateral rectus muscle belly were transposed and secured to the contralateral muscle insertion. Simultaneously, medial rectus muscle recession was performed. Follow-up visits were conducted at 1 week, 1 month, 3 months, and 6 months postoperatively. Patients' ocular alignment, eye movements, improvement in compensatory head posture, objective degrees of strabismus using synoptophore, changes in extraocular muscles and globe position on orbital CT scan were recorded. Surgical complications were also documented. Results: Five patients (8 eyes) were included in this study, including 4 females (7 eyes) and 1 male (1 eye), with an average age of (63±11) years and an average axial length of (34.58±2.25) mm. The medial rectus muscle recession during surgery was (7.6±2.3) mm. Preoperatively, all patients had esotropia with a horizontal range of+15°to+45° and a vertical range of+15°to+45°. Significant limitations in lateral and upward gaze were observed, with a degree of restriction ranging from-3 (-4 to-1). Three patients with bilateral involvement and one patient with unilateral involvement exhibited significant compensatory head postures. One patient with unilateral involvement had no compensatory head posture. Preoperative orbital CT scans indicated nasal displacement of the superior rectus muscle and inferior displacement of the lateral rectus muscle, with the eyeball herniating from the muscle cone. At the 6-month follow-up, all patients achieved nearly orthophoric alignment. Objective degrees of horizontal strabismus ranged from-4°to+7°, and vertical strabismus ranged from 0°to +6°, as determined by synoptophore examination. Eye movements significantly improved, with a degree of restriction of-1 (-2 to-1) for lateral gaze and-2 (-3 to-1) for upward gaze. Compensatory head postures disappeared, and orbital CT scans indicated the eyeball was located within the muscle cone. There were no severe complications such as anterior segment ischemia, muscle adhesions, disease recurrence, secondary glaucoma, or globe penetration. Conclusion: The preliminary clinical outcomes of the modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia are promising.

EARLY STAGES OF COLORECTAL CANCER CHARACTERIZATION BY AUTOFLUORESCENCE 3D MICROSCOPY: A PRELIMINARY STUDY.

Colorectal cancer is one of the most prevalent pathologies worldwide whose prognosis is linked to early detection. Colonoscopy is the gold standard for screening, and diagnosis is usually made histologically from biopsies. Aiming to reduce the inspection and diagnostic time as well as the biopsies and resources involved, other techniques are being promoted to conduct accurate in vivo colonoscopy assessments. Optical biopsy aims to detect normal and neoplastic tissues analysing the autofluorescence spectrum based on the changes in the distribution and concentration of autofluorescent molecules caused by colorectal cancer. Therefore, the autofluorescence contribution analysed by image processing techniques could be an approach to a faster characterization of the target tissue. Quantify intensity parameters through digital processing of two data sets of three-dimensional widefield autofluorescence microscopy images, acquired by fresh colon tissue samples from a colorectal cancer murine model. Additionally, analyse the autofluorescence data to provide a characterization over a volume of approximately 50 µm of the colon mucosa for each image, at second (2nd), fourth (4th) and eighth (8th) weeks after colorectal cancer induction. Development of a colorectal cancer murine model using azoxymethane/dextran sodium sulphate induction, and data sets acquisition of Z-stack images by widefield autofluorescence microscopy, from control and colorectal cancer induced animals. Pre-processing steps of intensity value adjustments followed by quantification and characterization procedures using image processing workflow automation by Fiji's macros, and statistical data analysis. The effectiveness of the colorectal cancer induction model was corroborated by a histological assessment to correlate and validate the link between histological and autofluorescence changes. The image digital processing methodology proposed was then performed on the three-dimensional images from control mice and from the 2nd, 4th, and 8th weeks after colorectal cancer chemical induction, for each data set. Statistical analyses found significant differences in the mean, standard deviation, and minimum parameters between control samples and those of the 2nd week after induction with respect to the 4th week of the first experimental study. This suggests that the characteristics of colorectal cancer can be detected after the 2nd week post-induction. The use of autofluorescence still exhibits levels of variability that prevent greater systematization of the data obtained during the progression of colorectal cancer. However, these preliminary outcomes could be considered an approach to the three-dimensional characterization of the autofluorescence of colorectal tissue, describing the autofluorescence features of samples coming from dysplasia to colorectal cancer. • A new digital image processing method was developed to measure intensity in 3D autofluorescence images of colorectal samples using a CRC mouse model. • This method showed that autofluorescence intensity in colon mucosa is similar in healthy tissue but changes significantly in tumor development. • Statistical analysis revealed CRC traits detectable from the second week post-induction, aiding in early CRC detection. • The study provides a basis for 3D autofluorescence characterization in colorectal tissue from dysplasia to cancer, although variability in autofluorescence limits data systematization during cancer progression.

Targeted Therapy in Non-Muscle Invasive Bladder Cancer-Clinical Updates

Non muscle invasive bladder cancer (NMIBC) comprises almost 75% of all bladder cancer (BC) diagnoses. Longstanding intravesical treatment options include chemotherapy or Bacillus Calmette-Guerin (BCG). However, despite these treatment options, there is a high rate of relapse for NMIBC patients, reaching up to 40-50% for patients with high risk disease. Radical cystectomy is recommended by guideline committees for patients with high risk NMIBC and for patients who fail intravesical treatment options however this is a procedure with high morbidity and many patients are not good candidates or prefer more conservative treatment approaches. Given this and the high failure rates of current therapies, much ongoing research in NMIBC is focused on other bladder sparing treatment modalities. There have been new advances in molecular features of BC with findings of genetic alterations in NMIBC leading way to a rise in precision medicine targeting a patient’s individual gene mutation. While data surrounding these targeted therapies in NMIBC specifically are all preliminary, many trials are currently underway derived from success in targeted treatments for locally advanced or metastatic BC. Preliminary results are promising and the targeted therapies for NMIBC are increasing. We performed a PubMed and Medline (OVID) literature review assessing recently published studies on targeted therapy on NMIBC, and an additional search on clinicaltrials.gov for active clinical trials. We report on preliminary outcomes and ongoing later stage trials for targeted therapies in NMIBC and anticipate upcoming promising changes to the treatment landscape.

Investigating the tolerance of different strawberry cultivars to Botrytis cinerea infection and its relation with fruit quality

BACKGROUND: Strawberries are a delicate, high nutritional value fruit with an extremely short shelf life and high susceptibility to tissue infection, mainly by Botrytis cinerea. Control of the disease requires an extensive amount of fungicide that is applied in varying complexes because the pathogen easily develops resistance against the active compounds. Planting tolerant cultivars seems to be a promising alternative for fruit growers, but there are currently no cultivars available combining tolerance to B. cinerea with attractive horticultural traits. OBJECTIVE: In this study, four well-defined strawberry cultivars (‘Romina’, ‘Cristina’, ‘Silvia’, and ‘Sibilla’) were selected and tested under treatment with Botrytis cinerea to determine the tolerance of each cultivar and its association with fruit quality. METHODS: Fruits were harvested and then stored for four days after inoculation (treatment) or not (control) with spores of B. cinerea; then, every day the level of decay was detected, and fruits were frozen for successive evaluation of fruit quality. RESULTS: The ‘Silvia’ cultivar is the one that demonstrated a higher level of tolerance to Botrytis infection during the treatment, and the ‘Romina’ cultivar was the cultivar most susceptible to the treatment. The results of the study also highlighted qualitative changes in all strawberry cultivars infected with Botrytis cinerea, by a decrease in the soluble solids content and an increase of acids. Generally, in all cultivars, phenolic acids, and vitamin C decreased in both control and infected but there was a strong decrease in infected fruit compared to control. Anthocyanin content increased in control fruits but strongly decreased in infected. CONCLUSION: As a preliminary outcome, a positive correlation was obtained between fruit nutritional quality and tolerance to decay, as a high amount of nutritional compound content provides lower susceptibility of fruits to Botrytis cinerea. To confirm this result more studies need to be done.

A novel modified penile disassembly procedure for isolated male epispadias repair: preliminary outcomes.

This study aimed to evaluate the preliminary outcome of a novel modification of a penile disassembly procedure. We retrospectively reviewed the data of 15 patients with isolated male epispadias (IME) who underwent a modified penile disassembly procedure. This modification involved leaving the glans connected while dissecting the urethral plate from the corpus cavernosum. This approach reserves the bundles of the anastomosis at the glans, which can prevent ischemic changes. One of the first two patients experienced glans ischemic changes on the first day after the operation, which ultimately resulted in the loss of half of the hemiglans. Urethral plate shortening was observed in two patients and was addressed with a transverse preputial island flap. Two patients developed a penopubic urethral fistula, which was repaired 6 months postoperatively. Of the 15 patients, 10 (66%) were continent or social continent, while 4 were incontinent and needed bladder neck reconstruction. One patient had not yet reached the age for continence evaluation. Additionally, Two patients had a residual dorsal curvature of approximately 10-15° and were advised to undergo continuous follow-up. The modified penile disassembly procedure is a simple, effective, and safe method for IME repair with an acceptable penile appearance and complication rate.

Модернизация китайского типа: эволюция концепции

The concept of “Chinese-style modernization” formulated in the end of the 1970s has been at the center of attention of the Chinese leadership and researchers since the beginning of this decade. The notion of primacy of national characteristics was transformed from a former reference to China’s weakness and backwardness to current focus on development success. Explanations of plans for China’s “basic socialist modernization” by 2035 formed the channel of influence of official policy on the academic discussions. The article analyzes contemporary Chinese comparisons of Chinese and Western paths of modernization along with theoretical reflections on the patterns of “Chinese-style modernization”. The determination to make China’s experience a reference point for policy decisions in developing countries is connected with studies in modernization theory. The question of the correlation between the general patterns of modernization and the specifics of the Chinese path of development has come to the fore. The emphasis on the differences between Chinese-style modernization and Western and Soviet models substantiates the theoretical possibility of a new development perspective for other countries, and encourages them to develop independent modernization strategies based on their own national specifics. Chinese researchers consider attempts by backward countries to copy the advanced institutions of developed nations as useless and even dangerous. China’s modernization is not complete, in the field of economic development there are mounting difficulties related to lagging behind in science and technology, deteriorating external environment, slowing growth, ageing population. While examining Chinese studies of Chinese-style modernization, it is appropriate to focus on the development of academic concepts, quantitative evaluation system and discursive system. Explorations in theory will be determined by practical achievements, first of all, by China’s ability to maintain sustainable balanced growth of the economy. The preliminary outcome can be assessed in the middle of the next decade, when China plans to build the foundations of modernization. The final judgement on the effectiveness of Chinese-style modernization will be made only after the results of China’s plans to become a world leader are known in the middle of this century.

Empowering Women: Pilates as a Holistic Approach to Alleviate Dysmenorrhea Symptoms: A Systemic Review

Introduction: Dysmenorrhea, characterised by painful menstrual cramps, is a prevalent condition affecting a significant portion of the female population worldwide. Despite its common occurrence, the management of dysmenorrhea often remains inadequate, with reliance on pharmacological interventions that may offer temporary relief but come with potential side effects and long-term consequences. Aim: To evaluate the effectiveness of pilates as a holistic approach to alleviate dysmenorrhea symptoms, with the goal of empowering women in managing their menstrual health more effectively. Materials and Methods: The study’s literature review spanned several databases—PubMed, Scopus, Web of Science, and Google Scholar—complemented by manual reference list searches. The search strategy incorporated keywords such as “Pilates,” “dysmenorrhea,” “menstrual pain management,” and “nonpharmacological interventions for dysmenorrhea.” This approach yielded 98 articles, from which six full-text available articles, published from 2014 to January 2024, were selected for their insights into the pilates-dysmenorrhea nexus. This research engaged women diagnosed with dysmenorrhea, with pre- and post-intervention assessments measuring pain levels and physical function using standardised tools. Results: Preliminary outcomes indicate a marked reduction in menstrual pain and an enhancement in physical function among participants undertaking pilates exercises, compared to those in the control group. Conclusion: Pilates exercises offer a holistic and comprehensive management strategy for dysmenorrhea, addressing both its physical and psychological dimensions. The study affirms pilates as an effective, non invasive way to ease dysmenorrhea symptoms.

Technique and Outcomes of Posterior Cruciate Ligament Repair With Augmentation.

Posterior cruciate ligament (PCL) injuries to the knee are uncommon, and ideal surgical management of these injuries is unclear. Current surgical techniques include PCL reconstruction with remnant debridement, remnant-preserving techniques, and primary PCL repair. Augmentation of PCL repairs and reconstructions has been proposed to protect repairs or grafts in the postoperative period. To describe PCL repair with the hamstring autograft augmentation technique and examine our preliminary midterm outcomes from a sequential cohort of patients. Case series; Level of evidence, 4. The authors identified patients at their institution who underwent remnant-preserving primary PCL repair with hamstring autograft augmentation for both isolated tears and tears associated with multiligament knee injury (MLKI). Patient-reported outcomes were evaluated at a minimum 2-year follow-up using the International Knee Documentation Committee (IKDC) subjective knee form, the 12-item Short Form Survey, and a custom return-to-play questionnaire. Patient-reported outcomes data were summarized, and the predictors of outcomes from the descriptive data and clinical measures were further examined. A total of 23 patients with a mean follow-up of 5.3 years met the inclusion criteria. Of these patients, 87% were associated with MLKI. The mean IKDC score was 87.7. Approximately 83% of patients were able to successfully return to their sport or occupation. Among 19 athletes, only 2 reported being unable to return to their preinjury level of sport because of limitations from their PCL surgery. Patient-reported outcome scores and return to sport or occupation did not have a statistically significant association with age, sex, body mass index, time from injury to surgery, or follow-up time. Outcomes of our cohort with remnant-preserving primary PCL repairs with hamstring autograft augmentation demonstrated comparable clinical outcomes to previously published PCL data. The advantages of remnant preservation, primary repair, and augmentation with an independent hamstring autograft reconstruction are combined within this technique.

Rapid brain MRI for image-guided ventricular catheter placement in pediatric patients: protocol and preliminary clinical outcomes.

Neuronavigation is a useful adjunct for catheter placement during neurosurgical procedures for hydrocephalus or ventricular access. MRI protocols for navigation are lengthy and require sedation for young children. CT involves ionizing radiation. In this study, the authors introduce the clinical application of a 1-minute rapid MRI sequence that does not require sedation in young children and report their preliminary clinical experience using this technique in their pediatric population. All patients who underwent ventricular catheter placement at a children's hospital using a rapid noncontrast MRI protocol, standard MRI, or head CT from July 2021 to August 2023 were included. Type of procedure, etiology of hydrocephalus, ventricle configuration and size, morphology of ventricles, need for adjunctive intraoperative ultrasound, duration of procedure, accuracy of catheter placement, and need for proximal revision within 90 days were retrospectively recorded and compared across imaging modalities. Sixty-eight patients underwent 83 procedures: 21 underwent CT navigation, 29 standard MRI, and 33 rapid MRI. Patients who received standard MRI more often had tumor etiology, while those who underwent CT and rapid MRI had posthemorrhagic etiology (χ2 = 13.04, p = 0.042). Intraoperative ultrasound was required for 1 patient in the standard MRI group and 1 patient in the CT group. There was no difference in procedure time across groups (p = 0.831). On multivariable analysis, procedure time differed by procedure type, where external ventricular drain placement and proximal revision were faster (p < 0.001 and p < 0.028, respectively). Proximal revision due to obstruction within 90 days occurred in 3 cases (in the same patient with complex loculated hydrocephalus) in the rapid MRI group and 2 cases in the CT group. Although this study was not powered for statistical inference, the authors report on the clinical use of a 1-minute rapid MRI sequence for neuronavigation in hydrocephalus or ventricular access surgery. There were no instances in which intraoperative ultrasound was required as an adjunct for procedures navigated with rapid MRI, and intraoperative time did not differ from that of standard navigation protocols.