Primary Treatment Research Articles

Non-target lesion progression: Unveiling critical predictors and outcomes in patients with in-stent restenosis

BackgroundPercutaneous coronary intervention (PCI) has become the primary treatment for coronary artery disease. However, while PCI effectively addresses severe stenosis or occlusive lesions in target vessels, the progression of non-target vessel plaque remains a critical determinant of long-term patient prognosis. AimsThe purpose of this study was to investigate the impact of non-target vascular plaque progression on prognosis after PCI for ISR. MethodsThis study included 195 patients diagnosed with ISR and multivessel disease who underwent successful PCI with drug-eluting stent (DES) placement, along with intraoperative optical coherence tomography (OCT) assessment of the culprit stent. Subsequent rechecked coronary angiography categorized eligible patients into non-target lesion progression (N-TLP) and no-N-TLP groups. We evaluated the baseline morphological characteristics of N-TLP by OCT and investigated the relationship between N-TLP, non-culprit vessel-related major adverse cardiovascular events (NCV-MACE), and pan-vascular disease-related clinical events (PVD-CE) incidence. ResultsMultivariate logistic regression analysis revealed that diabetes mellitus (OR 3.616, 95% CI: 1.735–7.537; P = 0.001), uric acid level (OR 1.005, 95% CI: 1.001–1.009; P = 0.006), in-stent neoatherosclerosis (ISNA) (OR 1.334, 95% CI: 1.114–1.985; P = 0.047) and heterogeneous neointima morphology (OR 2.48, 95% CI: 1.18–5.43; P = 0.019) were independent predictors for N-TLP. Furthermore, N-TLP was associated with a high incidence of NCV-MACE (19.4% vs 6.9%, P = 0.009) and PVD-CE (83.9% [95% CI: 79.7%–88.3%] vs 93.1% [95% CI: 88.4%–98.0%], P = 0.038) after PCI in ISR patients. ConclusionDiabetes, uric acid levels, ISNA, and heterogeneous neointima are predictive factors for subsequent rapid plaque progression, with N-TLP exacerbating the incidence of NCV-MACE and PVD-CE after PCI.

Investigating the Therapeutic Effects of Curcumin Nanocapsules in Hydatid Cyst-Infected mice

Background/ObjectiveThe primary treatment for cysts is surgery, including removing the cyst and administering the appropriate chemical drugs. Herbal remedies have gained popularity as a viable and secure alternative to conventional pharmaceuticals. It may be advantageous to use nanocapsules to overcome the bioavailability challenges associated with herbal remedies like curcumin. The present study aims to provide insights into the effectiveness of curcumin nanocapsules in treating hydatid infections. MethodsCurcumin-loaded oil-in-water surfactant-based biocompatible nanomicelles were developed from dissolving Curcumin in 1% (w/w) solutions of ethyl butyrate oil by dissolving an amount of fatty acid sodium caprylate (SC, 0.09 g) and F127 (0.009 g), phosphate-buffered saline (PBS at pH 7.4) under vigorous stirring at a fixed ethyl butyrate-to-surfactant molar ratio of 10 and final total volume of 50 mL. The excess of free PHT was eliminated by dialysis for 24 h. Following five months after infection, 45 mice were divided into six groups. Groups 1, 2, and 3 were treated daily with curcumin nanocapsules (0.5, 0.25, 0.125 mg/ml) for one month. Group 4 was treated with curcumin (0.5 mg/ml), group 5 was treated with albendazole (150 mg/kg), and group 6 was the negative control group without treatments (only received saline). A detailed analysis of the cysts' physical characteristics, including their size and weight, has been conducted. ResultsThe mean zeta potential spectrum of the nanocapsules was -33.96 millivolts. Regarding the total cyst numbers, all three nanocapsule groups had significantly lower total cyst numbers than the curcumin, albendazole, and negative control groups. Regarding the total cyst weight, all three nanocapsule groups had a significantly lower total cyst weight than the curcumin and negative control groups. Regarding the cyst with the maximum size, nanocapsules groups 1 and 2 had a significantly smaller size than the curcumin, albendazole, and negative control groups. ConclusionThe current study found that encapsulation positively affects curcumin efficacy as a superior alternative to chemical drugs, offering both biological advantages and environmental benefits.

Neuro-regeneration or Repair: Cell Therapy of Neurological Disorders as A Way Forward.

The human central nervous system (CNS) has a limited capacity for regeneration and repair, as many other organs do. Partly as a result, neurological diseases are the leading cause of medical burden globally. Most neurological disorders cannot be cured, and primary treatments focus on managing their symptoms and slowing down their progression. Cell therapy for neurological disorders offers several therapeutic potentials and provides hope for many patients. Here we provide a general overview of cell therapy in neurological disorders such as Parkinson's disease (PD), Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), Wilson's disease (WD), stroke and traumatic brain injury (TBI), involving many forms of stem cells, including embryonic stem cells and induced pluripotent stem cells. We also address the current concerns and perspectives for the future. Most studies for cell therapy in neurological diseases are in the pre-clinical stage, and there is still a great need for further research to translate neural replacement and regenerative therapies into clinical settings.

Current status of drug therapy for alveolar echinococcosis

Alveolar echinococcosis (AE) is a chronic zoonotic parasitic disease caused by infection with Echinococcus multilocularis . AE is associated with a high mortality rate and poses a significant threat to human health. The primary treatment for AE is surgical resection of the lesions; however, owing to its long incubation period and insidious disease progression, many patients are diagnosed only after the onset of complications such as liver cirrhosis, jaundice, and portal hypertension, which preclude curative surgical intervention. For patients who are unwilling or unable to undergo surgery, lifelong administration of anti-AE medications is necessary. Benzimidazole compounds, such as albendazole and mebendazole, are the current mainstays of treatment, offering good efficacy. Nevertheless, these medications primarily inhibit parasite proliferation rather than eradicate the infection, and their long-term use can lead to significant drug-related toxic effects. Consequently, there is an urgent need to develop new therapeutic strategies that convey better efficacy and reduce the adverse effects associated with current treatments. Recent advancements in AE therapy include novel synthetic compounds such as antiviral agents, antibiotics, antineoplastic agents, immunosuppressants, and antiangiogenic agents, as well as natural compounds derived from traditional Chinese and Tibetan medicine. These new drugs show promising clinical potential because they interfere with parasitic metabolic pathways and cellular structures. This review aims to discuss recent research on AE drug therapy, including mechanisms of action, dosing regimens, signalling pathways, and therapeutic outcomes, with a goal of providing new insights and directions for the development of anti-AE drugs and summarizing current advancements in AE pharmacotherapy.

The efficacy of wastewater treatment plant on removal of perfluoroalkyl substances and their impacts on the coastal environment of False Bay, South Africa

AbstractPer- and polyfluoroalkyl substances (PFASs), which have their origins in both industrial processes and consumer products, can be detected at all treatment stages in wastewater treatment plants (WWTPs). Quantifying the emissions of PFAS from WWTPs into the marine environment is crucial because of their potential impacts on receiving aquatic ecosystems. In this study, the levels of five PFAS were measured in both influent and effluent sewage water samples obtained from a municipal WWTP, the discharges of which flow into False Bay, on the Indian Ocean coast of Cape Town, South Africa. Additionally, seawater, sediment, and biota samples from eight sites along the False Bay coast were also analysed. Results showed high prevalence of PFAS in the different environmental matrices. Perfluorononanoic acid was most dominant in all these matrices with maximum concentration in wastewater, 10.50 ng/L; seawater, 18.76 ng/L; marine sediment, 239.65 ng/g dry weight (dw); invertebrates, 0.72–2.45 µg/g dw; seaweed, 0.36–2.01 µg/g dw. The study used the chemical fingerprint of five PFASs detected in WWTP effluents to track their dispersion across a large, previously pristine marine environment and examined how each chemical accumulated in different marine organisms. The study also demonstrates that primary and secondary wastewater treatment processes cannot fully remove such compounds. There is thus a need to improve effluent quality before its release into the environment and promote continuous monitoring focusing on the sources of PFAS, including their potential transformation products, their environmental fate and ecological risks, particularly in areas receiving effluents from WWTP.

A Comprehensive Review of Advanced Treatment Technologies for the Enhanced Reuse of Produced Water

Produced water (PW) is considered to be the largest source of industrial wastewater associated with oil and gas extraction operations for industrial production. It is a mixture of organic and inorganic compounds that has high complexity in terms of various characteristics. Globally, the volume of PW is increasing along with the expansion of gas and oil fields, leading to major impacts on the environment. Existing treatment technologies involve partially treating the PW through removing the suspended solids, heavy metals, without removing organic components and re-injecting the water underground using water disposal injection wells. The treatment process consists of a primary treatment unit to remove the particles, followed a secondary biological or chemical processing treatment, while the final treatment stage involves the use of a tertiary treatment unit to improve the water quality and remove the remainder of the undesired components. Moreover, while PW is considered one of the available options to be utilized as a water source, no alternate advanced treatment options on a commercial scale are available at present due to the limitations of existing PW treatment technologies, associated with their maintainability, sustainability, cost, and level of quality improvement. As such, research focused on finding an optimal treatment approach to improve the overall process continues to be conducted, with the aim of reusing the water instead of injecting it underground. This literature review discusses the latest advanced technologies for PW treatment aimed at reusing the full stream capacity of PW and eliminating the need for wastewater disposal via injection. It is concluded that researchers should focus on hybrid treatment technologies in order to remove the pollutants from PW, effectively allowing for its reuse.

Intraoperative ultrasound for uterine septum resection: a systematic review and meta-analysis.

Septate uterus is one of the most common uterine malformations. Recent studies suggest that uterine septa may negatively affect fertility. In cases of recurrent pregnancy loss (RPL) or infertility, hysteroscopic metroplasty has been considered the primary treatment for septate uterus. This systematic review and meta-analysis aims to evaluate whether intraoperative ultrasound monitoring may improve the efficacy of hysteroscopic metroplasty compared to other types of intraoperative monitoring or to unguided resections. An electronic database search was performed to identify articles published until June 15, 2023. Five studies (two randomized clinical trials, two prospective studies and one retrospective cohort study) fulfilled the inclusion criteria. The primary outcome was the rate of residual septum > 10mm after hysteroscopic metroplasty in the ultrasound (US) monitoring group compared to the rate of residual septum using other types of intraoperative monitoring/no monitoring (control group). The secondary outcomes were any residual septa, surgical time, complications, uterine perforations and reproductive outcomes. Intraoperative ultrasound for uterine septum resection significantly reduced the rate of residual septum > 10mm and the rate of any residual septa compared to the control group. There was no statistically significant difference in the procedure time between women undergoing intraoperative US monitoring versus the control group. A trend toward reduction of surgical complications was observed in the intraoperative US group compared to the control group. In conclusion, intraoperative ultrasound during metroplasty may reduce the rate of the residual septum with no surgical time differences. Further studies are warranted to understand how this may improve reproductive outcomes.

Predicting the need for additional intervention in prostate abscess treatment: Insights from a multicenter study and proposal of a Prostate Abscess Complexity Score

Purpose: To evaluate prostate abscess outcomes and identify predictors for additional intervention. Additionally, assess a complexity score for clinical decision-making. Materials and methods: This is a retrospective, multicenter study including 62 consecutively admitted prostate abscess patients. Primary treatment involved antibiotics or a combination with transrectal ultrasound-guided aspiration (TRUS-GA) or transurethral resection of the prostate with abscess deroofing. Outcomes were assessed by comparing resolution with primary treatment to additional intervention. Additional intervention involved escalation to TRUS-GA, repeat TRUS-GA, or transurethral resection of the prostate with abscess deroofing. The sample was further categorized by Prostate Abscess Complexity Score (PACS) into complex and noncomplex. Risk factors, clinical features, abscess characteristics, and reintervention predictors were analyzed using logistic regression and receiver operating characteristic analysis. Results: Sixty-two patients were included, 47 (75.8%) responded well to primary treatment, while 15 (24.2%) needed additional intervention. Risk factors for additional intervention included multifocal abscess (P = 0.005), septa (P = 0.023), bilateral involvement (P = 0.008), abscess diameter ≥3 cm (P = 0.040), and volume ≥20 cc (P ≤ 0.001). The PACS, considering abscess focality, septa, laterality, polarity, abscess diameter, and volume, showed 73% sensitivity and 74% specificity in predicting additional intervention (P = 0.001) with a threshold of ≥6 points to classify as complex. Among complex cases, 80% required additional intervention, compared to 34% in noncomplex cases (P = 0.002). Conclusion: This study highlights personalized treatment for prostate abscess. Identified risk factors (multifocal abscess, septa, bilateral involvement, large abscess diameter, and increased volume) provide insights into predicting the need for additional interventions. The proposed PACS offers a valuable tool for clinical decision-making when ≥6 points are encountered.

Effect of modern red clover & nitrogen fertiliser on yield, quality and botanical composition of a hybrid ryegrass sward

The advantages to pasture quality and quantity through the use of red clover in New Zealand farm systems is becoming more recognised. However, the production interactions between nitrogen fertiliser use and its effect on red clover in pastures is not well understood across multiple regions. Within this study we look to quantify the advantages of utilising red clover in hybrid ryegrass systems and show the effects of nitrogen fertiliser on red clover composition within the sward. In 2019, three replicated plot trials were established in the Manawatu, Canterbury and Southland provinces of New Zealand. All sites were managed with a typical cut and carry system for plot trials for 3 years, with dry matter (DM) production, seasonal feed quality and botanical composition measured. The primary treatments of the trials were tetraploid hybrid ryegrass, with and without red clover, with a nitrogen fertiliser treatment (276 kg N/ha/yr) and without overlayed. The trial results showed that adding both legume and fertiliser increased total dry matter production, as well as increasing the nutritional value of the pasture. Compared to straight hybrid ryegrass without fertiliser, when red clover or nitrogen fertiliser was added to the pasture mix/sward separately, total yield over three years increased by 18,147 kg DM/ha & 14,802 kg DM/ha respectively. When both red clover and nitrogen fertiliser were added to the pasture mix/sward, yield was increased by 23,301 kg DM/ha over three years. Fertiliser use and season had a significant effect on the red clover percentage of the pasture. However, even in the nitrogen fertiliser treatments, red clover proportions remained in excess of 15% across spring, summer and autumn. During winter, clover growth was minimal and contributed very little to dry matter production. Overall, the addition of red clover in pasture can significantly increase overall production and potential profitability of a farming system regardless of fertiliser practice. Maintaining fertiliser contributed to a balanced pasture which benefited the autumn-winter production phase.

Treatment Experience Using a Stent Graft for Lumbar Artery Injury that Failed Coil Embolization

Transcatheter embolization currently constitutes the primary treatment for lumbar artery injury due to blunt trauma. We present a case where a stent graft effectively treated a lumbar artery injury after coil embolization failed to achieve hemostasis. Aortic stent graft implantation is a safe procedure that can prevent surgical morbidity and has minimal complications. It may serve as an effective alternative for achieving hemostasis when coil embolization is not feasible or is unsuccessful.

Comparison of Weight Loss Induced by Dietary and Pharmaceuticals in Individuals with Overweight and Obesity: A Retrospective Study.

This study aims to evaluate the impact of low-carbohydrate diet, balanced dietary guidance, and pharmacotherapy on weight loss among individuals with overweight or obesity over a period of three months. The study involves 339 individuals with overweight or obesity and received weight loss treatment at the Department of Clinical Nutrition at the Second Affiliated Hospital of Zhejiang University, School of Medicine, between January 1st, 2020 and December 31st, 2023. The primary outcome is the percentage weight loss. Among the studied patients, the majority chose low-carbohydrate diet as their primary treatment (168 [49.56%]), followed by balanced dietary guidance (139[41.00%]) and pharmacotherapy (32 [9.44%]). The total percentage weight loss for patients who were followed up for 1 month, 2 months, and 3 months was 4.98 (3.04,6.29) %,7.93 (5.42, 7.93) % and 10.71 (7.74,13.83) %, respectively. Multivariable logistic regression analysis identified low-carbohydrate diet as an independent factor associated with percentage weight loss of ≥3% and ≥5% at 1 month (OR [odds ratio] =0.461, P＜0.05; OR=0.349, P＜0.001). The results showed that a low-carbohydrate diet was an effective weight loss strategy in the short term. However, its long-term effects were comparable to those observed with balanced dietary guidance and pharmacotherapy.

Assisted reproductive technology, pregnancy and recurrent disease in melanoma patients: a 30-year single institution experience.

Objectives The aim of this study is to assess differences in melanoma recurrence between patients conceiving spontaneously versus those undergoing assisted reproductive technology (ART), to determine use of ART in post-melanoma patients and to examine the impact of counseling of this specific patient group. Design This study is a 30-year analysis including data from a single center questionnaire and a retrospective cohort study. Participants/Materials Women of childbearing age with a history of melanoma were requested to participate in our study. We selected patients who underwent either primary melanoma treatment or treatment of local / distant recurrence at our institute between 1994 and 2021. Each participant received a questionnaire and informed consent form. The questions concerned general health, primary tumor characteristics, utilization of ART, subsequent pregnancies and development of recurrent melanoma. Additional information was collected from the medical files. Setting The research was conducted in a dedicated oncology center and tertiary referral center for melanoma in The Netherlands. Methods Participants received the questionnaires by mail. Six weeks later a reminder was sent to non-responders. Analysis was performed using descriptive statistics. For comparisons between groups Chi-square tests were used. P-value was considered significant when below 0.05. A clinically relevant difference in recurrence rate was defined as a 10% difference. Results A total of 498 questionnaires were available for analyses, 449 from living patients and 49 from relatives of diseased patients. One hundred and seventy-nine patients (36%) with a history of melanoma became pregnant following their diagnosis. In this group, 28 patients (16%) attempted to conceive using ART, and eight of them experienced disease recurrence. There was no difference in the recurrence rate between patients who became pregnant after the diagnosis of melanoma and those who never subsequently conceived (37% vs 35%, p=0.609). Limitations The main limitations of the study are its size, observational design and questionnaire methodology. Conclusions Pregnancy did not increase the risk of recurrent melanoma. The group of patients conceiving after ART was small and therefore it is difficult to confidently conclude that the recurrence risk is comparable to the other groups. Prospective international registration of these patients, their oncologic follow-up and possible use of assisted reproduction, will provide valuable information to determine any potential association between ART and risk of recurrent melanoma. This would enable health professionals to develop surveillance strategies and pre-conception counselling of patients wishing to conceive.

Clinicopathologic feature and treatment progress of high-grade ovarian neuroendocrine tumors.

High-grade Ovarian neuroendocrine tumors represent a rare subset of ovarian neoplasms characterized by aggressive behavior, poor prognosis, and early metastasis. Despite their clinical significance, the management of these tumors lacks consensus due to their low incidence. This comprehensive review encompasses literature spanning from 1991 to 2024, focusing on the clinical presentation, diagnostic criteria, differential diagnosis, prognostic indicators, treatment modalities, and recent advancements in the understanding of this condition. Notably, a substantial proportion of affected individuals present during the perimenopausal period with unilateral lesions displaying mixed histological components. Biomarkers such as CA125, CA199, and NSE hold promise for aiding in the diagnosis and screening of ovarian neuroendocrine tumors. Unfortunately, patients exhibit a dismal prognosis even diagnosed at an early stage. Primary treatment strategies predominantly involve surgical intervention coupled with etoposide-cisplatin combination chemotherapy. In cases of recurrence, second-line chemotherapeutic agents including paclitaxel, irinotecan, and doxorubicin are commonly employed alongside localized radiotherapy. While specific genetic mutations remain elusive, emerging evidence suggests potential therapeutic effect involving mTOR inhibitors, PD-1 monoclonal antibodies, and antiangiogenic agents based on isolated case reports. The exploration of representative set of mutations will help for precise targeted therapies and remains a focal point of our ongoing research efforts.

Moderate-Intensity Statin Plus Ezetimibe: Time to Rethink it as an Optimal Initial Lipid-Lowering Strategy.

Achievement of low-density lipoprotein cholesterol (LDL-C) targets is crucial for the prevention of cardiovascular disease (CVD) in individuals with dyslipidaemia who are at high risk. Current guidelines recommend high-intensity statins at the highest tolerated dose as initial treatment to achieve LDL-C goals. However, the real-world situation is dismal: high-intensity statins are underused and achievement of LDL-C goals is suboptimal. Various challenges exist in the implementation of the recommended initial treatment strategy, including hesitancy to use high-intensity statins, non-adherence, and side effects, and the response to high-intensity statins varies across individuals. Emerging studies have shown another line of lipid-lowering, moderate-intensity statins in combination with ezetimibe, presenting considerable efficacy/effectiveness, along with better safety and adherence compared to statin intensification alone. Here we review the clinical evidence, treatment guidelines and challenges associated with high-intensity statins, and summarise the evidence on the combination therapy, moderate-intensity statin plus ezetimibe, which is the core strategy recommended by the 2023 Chinese Guideline for Lipid Management, as a possible primary treatment to achieve the LDL-C targets across several populations. The upfront use of a moderate-intensity statin plus ezetimibe may improve LDL-C control and lead to the prevention of CVD in real-world settings.

Performance of an AI-powered visualization software platform for precision surgery in breast cancer patients.

Surgery remains the primary treatment modality in the management of early-stage invasive breast cancer. Artificial intelligence (AI)-powered visualization platforms offer the compelling potential to aid surgeons in evaluating the tumor's location and morphology within the breast and accordingly optimize their surgical approach. We sought to validate an AI platform that employs dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to render three-dimensional (3D) representations of the tumor and 5 additional chest tissues, offering clear visualizations as well as functionalities for quantifying tumor morphology, tumor-to-landmark structure distances, excision volumes, and approximate surgical margins. This retrospective study assessed the visualization platform's performance on 100 cases with ground-truth labels vetted by 2 breast-specialized radiologists. We assessed features including automatic AI-generated clinical metrics (e.g., tumor dimensions) as well as visualization tools including convex hulls at desired margins around the tumor to help visualize lumpectomy volume. The statistical performance of the platform's automated features was robust and within the range of inter-radiologist variability. These detailed 3D tumor and surrounding multi-tissue depictions offer both qualitative and quantitative comprehension of cancer topology and may aid in formulating an optimal surgical approach for breast cancer treatment. We further establish the framework for broader data integration into the platform to enhance precision cancer care.

How I approach the treatment of thrombotic complications in patients with myeloproliferative neoplasms.

Arterial and venous thromboses are the most significant complications in patients with myeloproliferative neoplasms (MPN), with the primary treatment goal being thrombotic risk reduction. In MPN with no history of thrombosis, primary prevention mainly involves the use of aspirin and cytoreduction is added in high-risk patients. However, thrombotic complications can unveil an MPN in approximately 20% of cases, necessitating the initiation of both antithrombotic therapy for the thrombosis and cytoreductive treatment for the MPN. The duration of anticoagulant therapy following an initial venous thromboembolic event (VTE) is subject to discussion. Furthermore, the occurrence of a thrombotic complication in patients with a known diagnosis of MPN prompts a reconsideration of both antithrombotic and hematological management. This review employs case-based discussions to explore the management of thrombotic complications in MPN patients. It addresses the nature and duration of antithrombotic treatments, as well as the approach to cytoreduction. Special attention is given to the place of direct oral anticoagulants and to the management of MPN patients with splanchnic vein thrombosis, which is disproportionately common in this group.

Effect of performance status on the therapeutic effect of nivolumab in recurrent or metastatic squamous cell carcinoma of the head and neck.

Systemic chemotherapy is the primary treatment strategy for recurrent or metastatic squamous cell carcinoma of the head and neck (RM-SCCHN). Therapeutic strategies are changing considerably with the introduction of molecular-targeted and immune checkpoint inhibitor (ICI) therapies in addition to conventional cytotoxic therapy. The CheckMate-141 and KEYNOTE-048 trials have enabled the use of ICIs as first-line treatment to improve the overall prognosis of RM-SCCHN. However, background factors affecting treatment responses, including performance status (PS), remain poorly defined. Therefore, we investigated the effect of PS in patients treated with nivolumab. We retrospectively reviewed the treatment outcomes and backgrounds of 31 patients with RM-SCCHN who received nivolumab monotherapy between April 2017 and March 2023. The patient background was male/female = 29/2, median age was 68years (range 39-85), PS0/1/2 = 14/15/2, and oral/oropharynx/hypopharynx/larynx = 2/12/12/5. Median overall survival was 8.0months (95% confidence interval [CI]: 4.3-30.6months), median progression-free survival was 3.0months (95% CI 1.7-9.1months), and objective response rate was 22.6% (95% CI 11.1-40.1%). Immune-related adverse events of grade 3 or higher were observed in three patients (9.7%). Eight (29.6%) of the 27 patients (excluding four patients who maintained complete response for over 2 years) were successfully transferred to post-treatment. In the multivariate analysis, Eastern Cooperative Oncology Group (ECOG) PS (Hazard Ratio: 9.87, 95% CI 1.79-54.56) was associated with poor survival. The efficacy of nivolumab is reduced in patients with poor PS.

Outcomes of adjuvant radiation treatment following subtotal resection of world health organization grade II meningiomas.

Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs. re-treatment, or grade II and III meningiomas, all of which have different expected outcomes. Tumor control estimates in a large homogenous patient cohort are needed to accurately counsel patients. A retrospective review of patients that had immediate post-operative imaging-confirmed residual WHO grade II meningioma followed by either adjuvant intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS) between 1996 and 2020 was conducted. Kaplan-Meier survival analysis and log-rank test was used to assess progression-free survival (PFS). Thirty-nine patients met inclusion criteria (IMRT = 32; SRS = 7). Overall, the 3-, 5-, and 10-year PFS was 81.1%, 61.2%, and 44.6%, respectively. Median follow-up time was 37 months. When comparing IMRT and SRS cohorts, baseline characteristics did not differ significantly between groups, but significantly larger residual tumor volumes were treated with IMRT (22.2 cm3 vs. 6.3 cm3, p = 0.004). PFS was not significantly different between IMRT and SRS at 3 years (81.1% vs. 80.0%) or 5 years (65.5% vs. 40%) (p = 0.19). There was no significant difference in radiation necrosis between groups (IMRT = 3/32 patients vs. SRS = 0/7 patients, p = 0.32). Our homogenous patient cohort displayed acceptable control rates at 3 years using SRS or IMRT as adjuvant therapy. No significant difference in PFS or radiation necrosis was noted between patients treated with adjuvant IMRT versus SRS.

HPB SO79 - Dropped Gallstones After Laparoscopic Cholecystectomy: An Umbrella Review

Abstract Background The enduring presence of gallstones after laparoscopic cholecystectomy (LC) presents a substantial clinical obstacle, potentially resulting in morbidity and diagnostic intricacies, frequently leading to delayed identification. This umbrella systematic review aims to investigate the available body of literature regarding the symptoms, signs, etiology, management strategies, and associated complications of retained gallstones. Method We performed an extensive search of the academic literature spanning several databases, namely PubMed, Embase, Scopus, Web of Science, and Google Scholar. Inclusion criteria for this research encompassed systematic reviews, with or without meta-analysis, focusing on the examination of spilled gallstones in terms of signs, symptoms, diagnosis, imaging, and management. The assessment of potential bias in the final study selection was undertaken utilizing the R-AMSTAR and Risk of Bias in Systematic Reviews (ROBIS) assessment tools. Results The most sites for lost gallstones were the subhepatic, perihepatic, retroperitoneal, right flank and pelvic regions. A higher proportion of patients underwent emergency laparoscopic cholecystectomy compared to those who underwent elective procedures. complications included intra-abdominal abscesses, foreign body granulomas, parietal wall abscesses or pelvic abscesses. Multiple stones more common than single stones. Various clinical presentations have been documented, including the presence of abdominal masses simulating malignancy, intestinal obstruction, pelvic pain or fistula formation. Surgical intervention emerged as the primary treatment approach. Computed tomography was the most frequently employed diagnostic modality for stone identification (70.2%), ultrasonography (US) (63.2%) and X-ray (42.9%). Conclusion Our study highlights the overlooked issue of spilled gallstones post-laparoscopic cholecystectomy, posing diagnostic challenges and potential complications. Surgeons and patient education regarding this is lacking, stressing the need for increased awareness. Comprehensive studies with larger cohorts are essential for understanding risk factors and developing effective interventions.

Basic Study on Gene Biology of Bladder Cancer Metastasis

Bladder cancer is a complex disease with distinct treatment approaches based on its progression. For non-muscle invasive bladder cancer, the primary treatment method involves complete tumor resection, followed by immunotherapy, intravesical chemotherapy, and regular monitoring. In cases of muscle-invasive bladder cancer, a multimodal approach-including radical cystectomy and neoadjuvant chemotherapy offers the best chance of cure; though some tumors still progress to metastatic disease, which is associated with high mortality rate. Metastasis remains the primary cause of bladder cancer mortality. Since research on tumor metastasis began in 1889, discoveries like the seed and soil hypothesis and the role of host factors have shaped the treatment strategies and contributed to our understanding of metastatic behavior. Advancing our knowledge of tumor biology, particulary in relation to metastasis, remains essential, and summarizing current findings in this area will support further progress in bladder cancer metastasis research.