Complete Rate Research Articles

Pathologic complete response rates of patients with ER-low/HER2-negative breast cancer treated with neoadjuvant pembrolizumab plus chemotherapy in the neo-real study.

Estrogen receptor-low (ER-low) breast cancer (BC) present clinicopathological features and disease behavior resembling triple-negative breast cancer, but have been frequently excluded from pivotal trials designed for the latter. Since neoadjuvant pembrolizumab plus chemotherapy (P + CT) is the new standard of care for stage II-III triple-negative breast cancer (TNBC), we aimed to access the effectiveness of this therapy for ER-low tumors. We evaluated patients with ER-low BC included in the Neo-Real/ GBECAM-0123 study, a real-world data study evaluating patients treated with neoadjuvant P + CT since July 2020 across ten cancer centers. The objective of this study was to evaluate the effectiveness of neoadjuvant P + CT through pathologic complete response (pCR). Twenty patients were included in this analysis. Median age was 40years (range 28-64). Most patients had grade 3 tumors (n = 18, 90%), with a median Ki67 index of 75% (range 30-95%), and 70% had stage II tumors. All the twenty patients were submitted to surgery, with a pCR observed in 12 cases (pCR rate of 60%). Receiving less than 6 cycles of pembrolizumab was associated with a trend towards worse pCR rates (20% vs 73.3%). The clinicopathological features and the response to neoadjuvant P + CT observed in this ER-low BC cohort are similar to that observed in TNBC. Patients with stage II-III ER-low/HER2- BC should be treated with neoadjuvant P + CT following the treatment standards for TNBC, and proper adherence to the regimen is relevant to improve effectiveness.

Perioperative chemotherapy with either S-1 or 5-fluorouracil plus oxaliplatin and docetaxel for locally advanced gastric or gastroesophageal junction adenocarcinoma: A prospective trial and matched comparison.

396 Background: Perioperative triplet chemotherapy improves the survival and surgical outcome of patients with locally advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma in addition to curative surgery. 5-fluorouracil (5-FU), docetaxel, oxaliplatin and leukovorin (FLOT) has been suggested as the treatment of choice. S-1, an oral fluoropyrimidine chemotherapeutic, also shows compelling efficacy as one of the triplet backbone and is exempt from a prolonged infusion time. However, a comparison over efficacy and tolerability between S-1 or 5-FU-containing triplet has not been investigated. Methods: The study contains two parts. The first part was a prospective single-arm multi-centered phase II trial with eight cycles of perioperative leucovorin, oxaliplatin, docetaxel and S-1 (LOTS) in patients with ≥T3 any N or ≥T2N(+) non-metastatic gastric/GEJ adenocarcinoma. The primary endpoint was the treatment response assessed by pathological tumor regression (TRG). After confirming the result passing the statistical threshold, we compared them with an identical and independent patient population who received perioperative FLOT under a prospective observation. A propensity score matching (PPSM) was used to balance the heterogeneity between the two groups. The efficacy, survival and tolerability were compared in a post-hoc manner. Results: From Feb 2017 to Jan 2024 with a comparable median follow-up time (LOTS, 18.7 ms; FLOT, 18.9 ms), a total of 45 and 154 patients were enrolled and received either LOTS or FLOT treatment. After a one-to-two PPSM procedure, the baseline characteristics of patients were comparable (LOTS, n=45; FLOT, n=90). Patients had similar curative resection rates (LOTS, 91%; FLOT, 86%; p=.359) and above nearly complete pathological regression rates (TRG 0-1: LOTS, 23%; FLOT, 27%; p=.669). The 24-ms recurrence-free (RFS) and overall survival (OS) rates were also comparable (LOTS vs. FLOT: 66 vs. 59% in RFS, p=.463; 73 vs. 68% in OS, p=.491). The toxicities were tolerable, except that more diarrhea and nausea events were reported in the LOTS group, whereas neutropenia, thrombocytopenia and mucositis were significantly prominent in the FLOT group. Conclusions: Perioperative LOTS shows reasonable therapeutic efficacy and survival as compared with FLOT in patients with locally advanced gastric/GEJ cancer. While the toxicity profile is distinctive from FLOT, it could be a potential alternative regimen with the convenience to save the prolonged infusion time. Clinical trial information: NCT04999332 . Pathological outcome. Prior to LOTS treatment (n=45) After LOTS treatment (n=43) Prior to FLOT treatment (n=90) After FLOT treatment (n=86) p in LOTS vs. FLOT CAP TRG, n (%) 0.669 0 - - 1 (2.3) - - 3 (3.5) 1 - - 9 (20.9) - - 20 (23.3) 2 - - 14 (32.6) - - 23 (26.7) 3 - - 19 (44.2) - - 40 (46.5)

Incidence of mediastinal lymph node positivity in patients undergoing robotic transthoracic esophagectomy.

379 Background: Esophageal cancer is increasing in incidence worldwide. Robotic approaches have quickly become mainstream due to the improved visualization and possible increase in nodal harvest. There remains significant debate on the utility of mediastinal lymph node dissection in esophageal cancer patients. We sought to analyze the incidence of mediastinal lymph node positivity and to evaluate its impact on survival in patients with esophageal cancer undergoing robotic assisted trans-thoracic esophagectomy (RATE). Methods: Utilizing a prospectively maintained esophageal database, we identified patients who were diagnosed with EC and underwent RATE between 2009-2024. We then identified patients with positive lymph nodes and stratified by location (celiac or mediastinal). Baseline univariate comparisons were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests. Pearson’s Chi-square test was used to compare categorical variables. Survival analysis was performed via Kaplain-Meier method. Results: We identified 201 patients who underwent RATE with a median age of 70 (41-91). There were 160 (79.6%) males and 41 (20.4%) females. The mean BMI was 26.5 ± 5.5 and mean ASA score was 3.1 ± 0.6. Adenocarcinoma was the predominate histology at 162(80.6%). Locally advanced T3/T4 tumors were identified in 53 (26.4%) patients and 63(31.3%) had clinical node + disease. Neoadjuvant therapy was utilized in 159(79.1%) patients. The median lymph nodes resected 18 (14 – 22), and length of hospitalization 8 (7 – 11) days. The 30 and 90-day mortality were 2.2% and 2.6% respectively. R0 resections was performed in 200 (99.5%) of patients and the pathologic complete response rates were 42.1%. The incidence of mediastinal lymph node positivewas 6.3% vs 76.3% abdominal. There were 17.6% of patients that had both mediastinal and abdominal lymph nodes positive. The median survival was 23 months for abdominal LN+, 19.5 months for mediastinal LN+ p=0.23. Multivariate analysis revealed that age, neoadjuvant radiation, nodal positivity were predictors of survival. Conclusions: The incidence of mediastinal positive lymph nodes are much higher than previously reported. Perhaps the improved visualization and manipulation of tissue with robotic approaches have enhanced our ability to resect these nodes. Mediastinal lymph node positivity is a poor prognostic factor for survival in patients undergoing robotic esophagectomy. Given these findings, we would continue to support aggressive nodal resection in patients diagnosed with esophageal cancer.

Biosynthesis of Zinc Oxide Nanoparticles by Origanum majorana Aqueous Leaves Extracts, Characterization and Evaluated Against to Schistosoma haematobium.

Schistosomiasis, caused by Schistosoma worms, is a major neglected tropical disease in Africa, this disease is ranked as second after malaria. Nanotechnology is important for treating schistosomiasis while minimizing chemotherapy side effects. The current investigate aimed to assess the effectiveness of biosynthesized zinc oxide nanoparticles (ZnO NPs), which were used for the first time in an attempt to find alternative treatment for schistosomiasis and synthesized by Origanum majorana, and to compare them with praziquantel (PZQ), the only chemical treatment approved by the World Health Organization. The study included evaluations both in the laboratory and invivo. In the laboratory experiment, adult worms exposed to ZnO nanoparticles at concentrations of 100, 50, 25, 12.5, 6.25, and 3.125 μg/mL showed the highest complete mortality rates at concentrations of 100 and 50 μg/mL after 6 and 12 h, respectively. Combinations of ZnO nanoparticles at concentrations of 12.5 + 0.4, 25 + 0.3, 50 + 0.2, and 75 + 0.1 μg/mL with PZQ were also tested. Invivo, four groups of hamsters infected with Schistosoma haematobium were treated. In hamsters, the number of eggs present in the tissues as well as the size and number of granulomas significantly decreased when ZnO nanoparticles combined with PZQ were administered. The properties of ZnO particles synthesized by Origanum majorana were consistent and confirmed by all previous studies. These results indicate that green ZnO nanoparticles with PZQ showed high activity against S. haematobium in laboratory experiments.

Utility of computed tomography (CT) –based staging of mismatch repair deficient (dMMR) colon cancer.

45 Background: dMMR tumors are characterized by rapid primary tumor growth with reduced likelihood for nodal and distant metastases compared to MMR proficient (pMMR) tumors. Neoadjuvant immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy for localized colon cancer with high pathologic complete response rates and low relapse rates. This raises the question if surgical treatment could be avoided with accurate radiographic staging while avoiding overtreatment of early stage tumors. This study assesses the utility of radiographic staging by CT for dMMR tumors compared to pathologic staging. Methods: Patients with stage I-III colon cancer treated with upfront surgical resection were retrospectively reviewed from a single institution from 2012 to 2023 in two cohorts: 1) dMMR colon cancer and 2) pMMR colon cancer limited to similar sample size as matched controls. Clinical stage was determined based on CT scans prior to surgical resection by 2 independent radiologists blinded to pathologic stage, and the results were correlated to pathologic stage. Clinical characteristics were extracted from the electronic medical record. Statistical analysis was performed using SPSS. Results: We identified 80 patients with dMMR colon cancer and 66 with pMMR tumors. CT clinical tumor staging was discordant from pathologic staging for 68% of dMMR tumors and 61% for pMMR tumors. For T4 dMMR tumors, CT had a 74% sensitivity and 44% specificity. T4 tumors were understaged by radiology to less than T4 for 56% of cases. For dMMR nodal staging, CT had 89% sensitivity and 50% specificity (Table 1). For pathologic node positive tumors, 14% were understaged by radiologist CT read to node negative. For pathologic node negative tumors, 50% of tumors were overstaged to node positive by radiologist CT read. There was poor inter-rater reliability for both T stage and N stage for dMMR and pMMR tumors. The weakest agreement between radiologists was for T stage (dMMR kappa = 0.246, mMMR kappa = 0.145). Conclusions: Radiologic clinical staging of dMMR and pMMR colon cancer does not correlate well with pathologic staging. There were high rates of understaging by CT evaluation for patients who may be candidates for neoadjuvant treatment (T4, N+). Furthermore, there was poor inter-rater reliability between radiologists, indicating that CT staging alone may not be sufficient. Additional diagnostic modalities for nodal detection may be necessary to accurately clinically stage patients before neoadjuvant ICIs in patients with locally advanced disease. Comparing utility of pMMR versus dMMR tumors for T4 and node positive disease. pMMR (n = 66) dMMR (n = 80) T4 versus T3 or less Sensitivity (%) 92 74 Specificity (%) 51 47 PPV (%) 80 77 NPV (%) 82 63 Node positive versus node negative Sensitivity (%) 60 50 Specificity (%) 75 89 PPV (%) 81 89 NPV (%) 53 50 Abbreviations: PPV = positive predictive value; NPV = negative predictive value.

Impact of Lauren’s subtype in locally-advanced gastric cancer (LAGC) prognosis: A call for change.

497 Background: Patients with LAGC should undergo perioperative chemotherapy and surgery. Lauren’s diffuse subtype and signet-ring cell carcinoma have been linked to worse outcomes and chemoresistance in this setting. This study aimed to assess the impact of Lauren’s classification on response to neoadjuvant chemotherapy and prognosis in LAGC. Methods: This analysis involved adult patients from a prospectively collected gastric cancer database who had histologically confirmed LAGC and received curative-intent perioperative chemotherapy and surgery. Patients were classified into two groups according to Lauren’s classification: intestinal and non-intestinal subtypes (including diffuse, signet-ring cell carcinoma and mixed histologies). Clinicopathological and treatment characteristics (age, gender, primary site, HER-2 status, staging laparoscopy, neoadjuvant chemotherapy, surgery and pathological complete response) of the two groups were compared using chi-square tests. Survival curves were obtained using Kaplan-Meier, and log-rank and Cox proportional models used to compare survival between groups. Results: Between 2015 and 2022, 174 patients met the inclusion criteria, with a median follow-up of 62.2 months (95% CI: 57.9-66.9). The intestinal subtype comprised 72 patients (41.4%) and the non-intestinal subtype included 102 (58.6%). The median age of diagnosis was significantly higher for the intestinal subtype (63 years) compared to the non-intestinal subtype (56 years; p<0.001). Female patients represented 26.4% of the intestinal subtype and 46.1% of the non-intestinal subtype (p=0.013). The primary gastric site was more prevalent in the non-intestinal subtype (78.4%) compared to the intestinal subtype (51.4%; p<0.001). HER-2 positivity was observed in 12.5% of intestinal and 4.5% of non-intestinal subtypes (p=0.14). Staging laparoscopy was conducted in 67 out of 72 (93%) patients with the intestinal subtype and in 96 out of 102 (94.1%) patients with the non-intestinal subtype, p=1. FLOT and FOLFOX/CAPOX protocols were administered in 50% and 40.2% of intestinal subtype cases, and in 53.9% and 36.2% of non-intestinal subtype cases, respectively (p=0.14). Pathological complete response rates were 8.5% for intestinal and 11.5% for non-intestinal subtypes (p=0.46). Three-year recurrence-free survival rates were 67.1% for intestinal and 64.6% for non-intestinal subtypes (HR=0.99, 95% CI: 0.61-1.61, p=0.96), while five-year overall survival rates were 73.3% and 67.2%, respectively (HR=1.12, 95% CI: 0.63-1.97, p=0.70). Conclusions: Our findings demonstrate that the non-intestinal subtype is more common in younger, female patients with primary gastric sites. However, Lauren’s subtype did not significantly correlate with pathological staging post-neoadjuvant chemotherapy or prognosis in LAGC. Lauren’s subtype should not influence treatment decisions in LAGC.

Evaluation of the impact of lymph node ratio on survival in patients with pancreatic cancer undergoing neoadjuvant therapy.

702 Background: Pancreatic cancer continues to have a dismal prognosis despite improvements in surgical care. Resection status and lymph node status continues to be key factors impacting prognosis. There remains significant debate on the utility of increasing nodal harvest in patients undergoing surgery, while others report an improvement in survival. We sought to evaluate the impact of lymph node positivity to lymph nodes resected in patients with pancreatic cancer undergoing resection. Methods: Utilizing the National Cancer Database, we identified patients diagnosed with pancreatic cancer who underwent neoadjuvant chemotherapy (NCT) or neoadjuvant chemoradiation (NCR) followed by resection. We then stratified by nodal status and calculated a LN+/LNR (lymph node resected) ratio. Pearson’s Chi-square test was used to compare categorical variables. Survival analysis was estimated by the Kaplan-Meier method and associated log-rank test. Propensity score matching (PSM) was completed for variables of age, sex, tumor size, LN removed, LN positive, pathogenic T- stage and N-stage, grade, 30- and 90-day mortality, R0 resection, facility volume, response, adjuvant therapy, and LNR. Significance was considered at p-value ≤0.05. Results: We identified 4117 patients with a median age of 65 (25-90). There were 2323 patients who underwent NCT and 1794 who underwent NCR. The median LN resected in the NCT was 18 vs 15 in the NCR, p<0.001. However, there were more LN+ in the NCT vs NCR, 2.1 vs 0.9, p<0.001. The R0 resection rates were lower in the NCT vs NCR 81% vs 86%, p<0.001. Additionally, complete response rates were higher amongst the NCR, 9.2% vs 4.7%, p<0.001. Lymph node ratios were consistently higher in the NCT cohorts among all ratio strata, p<0.001. Patients with pN+ disease had a median and 5-year survival of 26.4mo and 17% compared to their pN- counterparts at 38.8mo and 36%, p<0.001. Patients treated with NCT demonstrating a LNR of 0.01-0.1 had median and 5-year survival of 32.8 and 27%, LNR 0.11-0.4 (25.5mo and 12%), and LNR>0.4 (19.1mo and 10%), p<0.001. Patients treated with NCR demonstrating a LNR of 0.01-0.1 had median and 5-year survival of 29.1 and 21%, LNR 0.11-0.4 (25.8mo and 17%), and LNR>0.4 (21.3mo and 5%), p<0.001. PSM confirmed a higher LNR in the NCT cohort compared to NCR, p<0.001, however survival was also longer in these patients among the LNR 0.01-0.1, and 0.11-0.4, p<0.001. Conclusions: Lymph node status in patients with pancreatic cancer continues to be a significant prognostic indicator of survival. Moreover, lymph node ratio may be a more accurate predicter of survival in patients undergoing neoadjuvant chemotherapy and neoadjuvant chemoradiation.

A multicenter prospective study to evaluate the efficacy of resection for initially unresectable hepatocellular carcinoma after atezolizumab combined with bevacizumab (the RACB study): Short-term outcomes.

521 Background: The IMbrave150 study showed that atezolizumab plus bevacizumab (atezo+bev) is superior to sorafenib in progression-free survival and overall survival, making it the recommended first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). The RACB study was scheduled to evaluate the efficacy of atezo+bev in achieving conversion surgery for initially unresectable HCC. This time, we report the short-term outcomes of the RACB study. Methods: This prospective, single-arm, multicenter Phase II trial evaluates atezo+bev to achieve conversion surgery in patients with technically or oncologically unresectable HCC. Eligible patients had unresectable HCC without prior systemic chemotherapy and at least one target lesion based on RECIST ver1.1. Patients received atezolizumab (1200 mg) plus bevacizumab (15 mg/kg) every three weeks. If resectable on radiological assessment at 12 weeks, atezolizumab monotherapy was given followed by surgery. The primary endpoint was the progression-free survival. The secondary endpoints included the overall response rate, overall survival, resection rate, curative resection rate, on-protocol resection rate, and ICG retention rate at 15 min after atezo+bev therapy. The study is registered with the Japan Registry of Clinical Trials (jRCTs051210148). Results: Between March 2022 and March 2024, 55 patients from 17 centers were enrolled. Four patients were excluded due to ineligible lesions or other reasons. A total of 50 patients were included in the efficacy evaluation set. Macrovascular invasion and extrahepatic metastases were observed in 38 (76.0%) and 6 patients (12.0%), respectively. Two patients (4.0%) had metachronous extrahepatic metastases without intrahepatic tumors. The complete and partial response rates were 0% and 13% based on RECIST, and 2.2% and 26.1% based on mRECIST. The overall resection rate was 48%, corresponding to 24 cases. R0, R1, and R2 resections were performed in 21 (87.5%), 1 (4.2%), and 2 (8.3%) patients, respectively. Complications ≥Grade III according to the Clavien-Dindo classification included 3 bile leakages, 2 infections, 1 anastomotic leakage, and 1 hemoptysis. There were no surgery-related deaths. Of the 51 patients included in the safety analysis set, adverse events occurred in 34 cases (66.7%), with 16 Grade 3 or higher instances with one Grade 4 upper gastrointestinal bleeding, 1 Grade 4 encephalopathy, and 1 unexpected death after 1 cycle of atezo+bev. Conclusions: The RACB study's short-term outcomes demonstrated the feasibility of conversion surgery after atezo+bev in patients with initially unresectable HCC. The response rate of atezo+bev, as measured by mRECIST, was similar to IMbrave150, with a 48% resection rate, though careful monitoring of severe adverse events is essential. Clinical trial information: 051210148.

Comparison of flow diverter alone versus flow diverter with coiling for large and giant intracranial aneurysms: systematic review and meta-analysis of observational studies

BackgroundLarge and giant intracranial aneurysms pose treatment challenges. The benefit–risk balance of flow diverters (FDs) alone versus FDs with coiling remains unclear. This study aimed to compare these two strategies.MethodsThis...

Autoimmune Hemolytic Anemia in Children: Clinical Profile and Outcome

Autoimmune Hemolytic Anemia (AIHA) is an idiopathic condition marked by red blood cell destruction. Objective: To compare the clinical features, laboratory parameters, treatment approaches, and responses between idiopathic and secondary AIHA in pediatric patients, with the aim of identifying key distinctions that can inform the development of tailored diagnostic and therapeutic strategies. Methods: This was cross sectional study and conducted for six months from April 2024 to September 2024 at Department of pediatrics at Khairpur medical college khairpur mirs. Data were collected on demographics, presenting symptoms, laboratory findings (hemoglobin, bilirubin, LDH levels), antibody profiles, and treatment outcomes. SPSS 23 was used for statistical analysis to compare treatment responses and clinical characteristics between idiopathic and secondary AIHA patients. Chi-square tests were used for categorical variables and t-tests for continuous variables. Results: The mean age of participants was 6.8 years, with 58% male. Patients with idiopathic AIHA had higher hemoglobin levels (7.5 g/dL versus 6.9 g/dL for secondary, p=0.03) and lower bilirubin (3.6 mg/dL versus 4.1 mg/dL, p=0.02). Treatment varied significantly: 89% of idiopathic patients received steroids compared to 86% of secondary patients. Secondary patients were more likely to receive IVIG (51% versus 34%, p=0.04) and rituximab (37% versus 11%, p<0.01). Complete response rates were higher in idiopathic AIHA (83% versus 63%, p=0.01). Conclusions: Significant differences exist in the clinical presentation and treatment responses of idiopathic versus secondary AIHA. Tailored treatment strategies on AIHA type are essential for improving patient outcomes, warranting further research into these distinctions and new therapies.

Fact-finding and risk factor analysis of chemotherapy-induced nausea and vomiting in children with solid tumors: a prospective observational study

ObjectiveThe aim of the study was to describe the control of acute chemotherapy-induced nausea and vomiting (CINV) in children with solid tumors receiving highly emetogenic chemotherapy (HEC) at our center. Additionally, the study aimed to explore the risk factors for chemotherapy-induced vomiting (CIV) with the ultimate goal of enhancing CINV management for children.MethodsChildren aged 1–18 years with solid tumors treated with HEC were enrolled. A structured diary was used to record CINV data, and the pediatric nausea assessment tool (PeNAT) was employed to assess the degree of nausea. The primary outcome was achieving complete CIV control in the acute phase for all children, and secondary outcomes included the control of acute phase CINV, CIV, and chemotherapy-induced nausea (CIN) in children aged ≥ 4 years. Data on children were prospectively collected, and univariate and multivariate logistic regression was used to explore risk factors for complete CIV control.ResultsA total of 181 children were included, with 52.5% (95/181) experiencing acute phase complete CIV control. Eighty-six children aged ≥ 4 years could be evaluated for acute phase CINV control, and complete CINV control was achieved in 27.9% (24/86), with CIV, CIN complete control rates were 41.9% (36/86) and 34.9% (30/86), respectively. The results of multivariate logistic regression showed age (< 2 years vs. >6 years: OR = 0.186, 95% CI 0.062 ~ 0.56; 2 ~ 6 years vs. >6 years: OR = 0.322, 95% CI 0.145 ~ 0.715), female (OR = 2.034, 95% CI 1.035 ~ 3.994), duration of chemotherapy block (OR = 1.611, 95%CI 1.039 ~ 2.499), and antiemetic regimen (5-hydroxytryptamine-3 receptor antagonists (5HT3RA) vs. 5HT3RA + dexamethasone: OR = 0.395, 95% CI 0.171 ~ 0.914) were statistically significant in complete CIV control (P < 0.05).ConclusionsChildren with solid tumors treated with HEC at our center experienced suboptimal control of CINV. Older age, female, and a longer duration of the chemotherapy block were identified as risk factors for complete CIV control. Receipt of 5HT3RA plus dexamethasone had a higher likelihood of acute phase complete CIV control versus 5HT3RA. In the future, individualized management of nausea and vomiting, based on existing CINV guidelines and the unique characteristics of children, will be necessary to reduce the incidence of CINV and improve the quality of life for these children.

Preventive clipping versus coiling in unruptured intracranial aneurysms: A comprehensive meta-analysis and systematic review to explore safety and efficacy.

Surgical clipping and endovascular coiling are both effective in preventing aneurysmal subarachnoid hemorrhage, but the choice between these interventions remains controversial, leading to treatment disparities across medical centers. A systematic review and meta-analysis were conducted, including relevant two-arm clinical trials up to September 2023, sourced from Scopus, PubMed, Web of Science, and the Cochrane Library. Our primary outcomes were complete occlusion rates during mid-term and long-term follow-ups. Standard mean differences and risk ratios were used to analyze variations in outcomes. Python meta-analysis with sensitivity testing and regional subgroup analysis was used to resolve heterogeneity. The analysis included 139,485 participants. Clipping demonstrated significantly higher complete occlusion rates in midterm follow-up (RR = 0.83, 95% CI [0.75, 0.91], p = 0.0001) but was associated with a higher risk of procedural complications such as bleeding and ischemic stroke. Coiling showed a higher risk of retreatment (RR = 3.46, 95% CI [1.21, 9.86], p = 0.02), yet it had lower procedural complications (RR = 0.54, 95% CI [0.38, 0.78], p < 0.0009), shorter hospital stays (MD 4.36, 95% CI [2.96, 5.77], p = 0.0001), and better post-procedural outcomes as indicated by lower modified Rankin Scale scores (RR = 0.73, 95% CI [0.55, 0.97], p = 0.03). Long-term occlusion rates were comparable between the two methods. While clipping achieves higher mid-term occlusion rates, coiling is associated with fewer complication rates, shorter hospital stays, and potentially better long-term outcomes. Treatment decisions should be individualized, considering patient-specific characteristics and procedural feasibility.

Review of Endosaccular Flow Disrupters for Wide-Neck Aneurysm Treatment.

Endosaccular flow disruption has emerged as a transformative approach for treating wide-neck intracranial aneurysms, which are characterized by neck diameters exceeding 4 millimeters or dome-to-neck ratios below 2. This review examines the technical specifications and clinical outcomes of major endosaccular devices, including the Woven EndoBridge (WEB) device, the Artisse embolization device, the Medina embolization device, the neck bridging device for bifurcation aneurysms, the polycarbonate urethane membrane-assisted device, the Galaxy saccular endovascular aneurysm lattice, and the Contour Neurovascular System. Analysis of pivotal trials reveals varying degrees of efficacy and safety across platforms. The WEB device demonstrated complete occlusion rates of 51.7% to 56.1% at 1 year, with adequate occlusion reaching 84.6% in the WEB Intrasaccular Therapy Study trial and sustained improvement in 76.8% of cases at 5 years. The Artisse system showed initial promise but concerning declines in adequate occlusion from 66.7% at 6 months to 57.1% at 36 months. More recent innovations such as the Galaxy SEAL device achieved complete occlusion in 76.9% of cases in preliminary studies in 1 year. Thromboembolic complications occurred in 12.9% to 17.7% of cases across devices though procedure-related mortality remained below 2%. While the WEB device has established a robust safety and efficacy profile through long-term follow-up data, newer technologies demonstrate promising early results but require extended surveillance. Current challenges focus on optimizing device sizing, improving delivery systems, and enhancing material properties to maximize occlusion rates while minimizing complications. The evolution of these technologies continues to expand treatment options for complex aneurysms previously challenging to address through conventional endovascular or surgical approaches.

Real-World Outcomes of Anti-CD19 Chimeric Antigen Receptor (CAR) T-Cell Therapy for Third-Line Relapsed or Refractory Diffuse Large B-Cell Lymphoma: A Single-Center Study

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common diagnosed aggressive B-cell lymphoma, with poor outcomes in those who experience relapsed or refractory (R/R) disease. Landmark clinical trials have demonstrated the efficacy and safety of anti-CD19 chimeric antigen receptor (CAR) T-cell therapy for patients with R/R DLBCL, though further exploration of real-world outcomes (RWOs) and safety data is warranted. Methods: A retrospective chart review was performed to collect patient and disease characteristics from patients with R/R DLBCL receiving CAR T-cell therapy for third-line treatment or beyond at the John Theurer Cancer Center as the standard of care. Results: We report on 82 patients with R/R DLBCL that successfully completed an infusion of an anti-CD19 CAR T-cell product at our institution. Best overall and complete response rates were 74.4% (95% CI, 64.9 to 83.8) and 67.1% (95% CI, 56.9 to 77.2), respectively. From the time of CAR T-cell infusion, median PFS was 26.5 months (95% CI, 8.6 months could not be estimated) and OS was not reached. Subgroup analyses revealed no statistical differences in outcomes by use of bridging therapy, Karnofsky performance status, transformed DLBCL status, and the type of CAR T-cell product used for this study. CAR T-cell therapy was well tolerated, with 58 patients (70.7%) experiencing cytokine-release syndrome and 17 patients (20.7%) experiencing immune effector cell-associated neurotoxicity syndrome. Conclusions: These results of RWOs in third-line patients with R/R DLBCL receiving anti-CD19 CAR T-cell therapy are comparable or superior to prior clinical trials and studies of RWOs, validating the strong efficacy and manageable toxicities of CAR T-cell therapy.

Clinical Outcomes of the PAUL® Glaucoma Implant for secondary glaucoma after vitreoretinal surgery.

To report clinical outcomes from a single-center cohort undergoing PAUL® Glaucoma Implant (PGI) surgery for secondary glaucoma after vitreoretinal surgery (VR). Retrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from 04/2021 to 05/2023. 33 eyes of 33 patients were included. Mean number of preoperative VR surgeries was 2 (1-4), the majority following retinal detachment (23 eyes, 69.7%). 18 eyes had previous silicone oil tamponade (54.4%). Complete (without drops) and qualified (with or without drops) success rates (95% CI) after one year were 69.7% (54.5-84.8) and 97% (90.9-100) for Criterion A (IOP≤21mmHg), 66.7% (51.5-81.8) and 87.9% (51.5-81.8) for Criterion B (IOP≤18mmHg), 54.5% (39.4-72.7) and 72.7% (54.5-87.9%) for Criterion C (IOP≤15mmHg) and 24.2% (9.1-39.4) and 30.3% (15.2-48.4) for Criterion D (IOP≤12mmHg) respectively. Mean IOP decreased from 25.64 mmHg (14-49 mmHg) to 13.59 mmHg (8-20 mmHg) (reduction of 41.1%) after 12 months with a reduction of IOP-lowering agents from 3.21 (1 - 5) to 0.38 (0 - 3). Seven eyes (21.2%) developed postoperative complications, most of which eventually resolved. Two eyes had a tube flushing because of high postoperative IOP with silicone oil obstruction. Postoperative non-glaucoma related procedures were performed in 10 eyes (24.4%). None of these led to high IOP or further complications in the postoperative phase. PGI surgery is an effective procedure for reducing both IOP and topical therapy in patients with uncontrolled secondary glaucoma following vitreoretinal surgery. Non-glaucoma related procedures can be safely performed after PGI implantation with good IOP control.

Two-year randomized controlled trial of circumferential versus segmental ab externo angle surgery in patients with primary open angle glaucoma.

To compare the surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe segmental viscotrabeculotomy (VT) in primary open-angle glaucoma (POAG). A prospective randomized controlled study. Patients presenting with POAG and operated upon in Mansoura Ophthalmic Center in Mansoura, Egypt between February 2017 and September 2021 were enrolled. Study eyes were randomized to either VCST or VT and follow up extended for 24 months. Success was defined as an intra ocular pressure (IOP)≤18 mmHg with a 40% reduction from baseline. Complications were noted. The study enrolled 166 (82 in the circumferential group) eyes of 107 patients. There were no statistically significant differences between both groups in any demographic or preoperative clinical characteristics. The IOP trend demonstrated marked initial reduction (from 32.3±2.4 and 31.8±2.6 mmHg preoperatively in VCST and VT groups respectively) followed by a slow gradual rise over subsequent follow-up settling at lower IOP values in the circumferential (12.4±1.2 mmHg) than in the segmental group (15.5±0.9 mmHg) (p<0.001), both settling at significantly lower levels than preoperative values. The survival curve demonstrates complete success rates at 12, 15, 18, and 24 months were 98.8%, 96.4%, 95.1%, and 85.4% in the circumferential group and 98.8%, 92.9%, 91.7%, 79.8% in the segmental group respectively. Minimal self-limiting hyphema was universal in all study eyes. Angle procedures -segmental and circumferential- are effective in lowering the IOP for at least 2 years in eyes with POAG, with circumferential angle surgery providing a greater reduction of IOP and requiring fewer subsequent glaucoma procedures.

What is veteran suicide prevention really about? Questions from the community to researchers.

Military veterans are one of the most researched groups in healthcare in the United States. This population has extremely high rates of suicide attempts and completions. Despite increasing research focus, millions of dollars in funding, and being designated as a high clinical priority, rates of suicidal behavior continue to rise among veterans. Veterans are extremely concerned about this trend and critical of some suicide prevention projects. This study engaged 20 veterans who are connected to individuals within the military community who have attempted or completed suicide. Through semi-structured interviews, participants expressed a profound sense of disconnection from existing policies, treatments, and strategies aimed at preventing veteran suicide. During the course of the interviews, participants posed their own questions: Why is the public really concerned about veteran suicide? Why won't the public recognize its part in the veteran suicide epidemic? Why won't the medical industry listen and collaborate with us? This study underscores the critical need for all stakeholders involved in veteran suicide prevention to reflect on these concerns and to incorporate veterans' insights into future prevention strategies, creating a more responsive and effective approach.

P1066 Effectiveness and safety of vedolizumab in real-world studies in Asian patients with inflammatory bowel disease: a systematic review and meta-analysis

Abstract Background Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic gastrointestinal disorders with rising prevalence in Asia. Vedolizumab (VDZ) is a humanized monoclonal antibody targeting α4β7 integrin, selectively blocking gut lymphocyte trafficking. Despite numerous real-world studies on VDZ use in Asian patients with IBD over recent years, a comprehensive analysis summarizing its effectiveness and safety is still lacking. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of VDZ in Asian patients with IBD. Methods A literature search was conducted to identify real-world studies evaluating intravenous VDZ in Asian patients with IBD from inception to 20th December 2023. Meta-analyses were performed separately for CD and UC patients to pool clinical and endoscopic remission and response rates across induction (6-14 weeks), medium term (22-30 weeks), and long term (over 48 or 52 weeks) using a random-effects model in R software. The incidence of adverse events (AE), serious AE (SAE), and serious infection were assessed for safety. Results Twenty-nine studies (15 CD and 25 UC) with 2,395 patients (827 CD, 1,568 UC) were analysed (Figure 1). In the induction phase, clinical response and remission were achieved in 57.48% and 61.15% of CD patients, and 64.72% and 40.07% of UC patients. In the medium term, clinical response and remission were 64.32% and 60.72% for CD, and 64.87% and 43.51% for UC. In the long term, the clinical response and clinical remission rate were 44.55% and 45.83% in CD patients, 61.35% and 56.14% in UC patients. Moreover, corticosteroid-free clinical remission was achieved by 36.58% of that in CD and 49.03% of that in UC for the long-term observation. Endoscopic response was achieved by 41.37% of CD patients and 48.57% of UC patients during induction phase. Endoscopic remission rates for CD were 11.11%, 18.41%, and 36.42%, and for UC 43.19%, 54.27%, and 66.72% in induction, medium, and long term, respectively. The pooled complete endoscopic remission rates for UC were 27.98% (induction), 47.87% (medium term), and 50.61% (long term) (Table 1). AEs occurred in 6.67% to 61.54% of CD patients and 29.69% to 75.38% of UC patients. SAEs and serious infection rates were 0.00% to 1.56% and 0.00% to 2.70% in UC patients, and 0.00% to 0.75% for serious infections in CD, with no SAEs reported in CD studies. Conclusion VDZ demonstrated effective clinical outcomes with a favourable safety profile in Asian patients with IBD.

Mechanism of engineered macrophage membrane bionic gene-carrying nanospheres for targeted drug delivery to promote wound repair in deep second-degree burns

Hepatocyte growth factor (HGF) is a substance that stimulates the proliferation of hepatocytes which promote healing. We developed a macrophage membrane-encapsulated nanosphere drug delivery system containing HGF for the study of burn wound healing. Twenty-seven Sprague–Dawley rats were randomly divided into three groups: a saline control (NS) group, an engineered macrophage membrane-encapsulated nanospheres (ETMM@NPS) group, and an engineered macrophage membrane-encapsulated nanospheres treatment with HGF-loaded gene (HGF@ETMM@NPS) group.The wound tissue sections were examined histologically using hematoxylin and eosin (H&E) and Masson trichrome staining. Immunohistochemistry and Western blotting were performed to determine the expression of relevant proteins. The wound-healing, blood flow and complete epithelialization rates were significantly better in the HGF@ETMM@NPS group compared to the NS and ETMM@NPS groups. Expression of B-cell lymphoma 2-associated X-protein was significantly lower, and B-cell lymphoma 2, cluster of differentiation 31, HGF, alpha smooth muscle actin, and PCNA expression was significantly higher in the HGF@ETMM@NPS group compared with the other two groups. PCNA and HGF expression was significantly up-regulated in the HGF@ETMM@NPS group. The HGF@ETMM@NPS complex drug delivery system used in this research promoted wound healing via effective delivery of HGF to burn wounds, thereby accelerating skin cell growth and migration.

P0482 Diagnostic yield of Small Bowel Capsule endoscopy and Double Balloon Enteroscopy for Small bowel Crohn’s disease

Abstract Background Small Bowel Capsule Endoscopy (SBCE) a valuable tool in visualizing the small bowel (SB) SBCE paired with Double Balloon Enteroscopy (DBE) can obtain histology to investigate Crohn’s disease (CD). Diagnostic yield was assessed using SBCE &amp; DBE. Methods A retrospective analysis of patients referred to SBCE service with suspected CD. PillCam SB3 was used in this study with one reporting gastroenterologist. Previous colonoscopy, histology, faecal calprotectin (FC) &amp; MR enterography (MRE) analysed. Linear regression statistical analysis performed. Results 94 patients (50% female, median age = 44). No prior diagnosis of CD. 99% completed study rate. Pre-referral, 46 had Colonoscopy, 26 elevated FC (median = 160) &amp; 8 had abnormal MRE. Abnormal MRE findings: mural thickening of SB, strictures and terminal ileitis. Raised FC was not statistically significant for a SBCE finding in keeping with CD p = 0.357 however, an abnormal MRE was p=0.034. 64.8% of SBCE had an abnormal report, 35.1% had findings in keeping with CD i.e. 54% of abnormal findings on SBCE were indicative of CD. Further investigations: repeat SBCE (10.7%), repeat ileocolonoscopy (1.96%) RDBE (16.6%) &amp; ADBE (10.7%). Repeat SBCE was performed to assess healing. No further diagnosis of CD made with DBE. Conclusion SBCE and DBE are useful adjunct diagnostic tools rather than the primary investigations. A positive yield on SBCE did not correlate to diagnosis of CD. FC did not show significant correlation to a positive diagnosis. MRE showed to be significant precursor to SBCE. Similar research including intestinal ultrasound should be conducted.