Treatment Recommendations Research Articles

Artificial Intelligence for Healthcare and Diagnostics

Abstract: AI models are being applied to several components of healthcare including diagnostics, drug development, personalized healthcare plans and so on. The large datasets which rapidly rise in complexity and volume form part of big data, provide the potential for ML models to make significant progress in diagnostics, medical image interpretation and treatment recommendations. The introduction of AI across the various departments of the healthcare industry has already raised efficiency and dropped prices. Covid 19’s exponential growth rate completely overwhelmed the healthcare sector's capabilities. AI and robotics became paramount in boosting efforts to detect, identify the risk of and monitor the virus, and develop and deliver the vaccine throughout the planet. The systems that did well generally had large datasets, one modality and did well in testing with foreign data. Currently, low efficiency and high costs make research difficult. With big data being produced at astronomical rates, we should theoretically be making constant discoveries and advancements. However, only part of this data is currently being processed and studied. Attempts are being made to resolve this gap by leveraging AI tools

The role of bariatric surgery in the treatment of urinary incontinence in obese women

Obesity has become an epidemic in recent decades, affecting millions of people worldwide. Many studies proved a cause between obesity and urinary incontinence in women. Lifestyle modifications, low-calorie diet, and weight loss surgery can improve symptoms of urinary incontinence in obese patients. Studying the effect of bariatric surgery on urinary incontinence symptoms has shown positive results in the short term period. However, there is data on worsening due to regaining weight in the long term period. Contradictory study search findings emphasize the need for further research and development of new clinical recommendations for effective treatment of urinary incontinence in women with obesity.

UK guidelines for the management of bone sarcomas.

This document is an update of the British Sarcoma Group guidelines (2016) and provides a reference standard for the clinical care of UK patients with primary malignant bone tumours (PMBT) and giant cell tumours (GCTB) of bone. The guidelines recommend treatments that are effective and should be available in the UK, and support decisions about management and service delivery. The document represents a consensus amongst British Sarcoma Group members in 2024. Key recommendations are that bone pain, or a palpable mass should always lead to further investigation and that patients with clinical or radiological findings suggestive of a primary bone tumour at any anatomic site should be referred to a specialist centre and managed by an accredited bone sarcoma multidisciplinary team. Treatment recommendations are provided for the major tumour types and for localised, metastatic and recurrent disease. Follow-up schedules are suggested.

Misdiagnosis in breast imaging: a statement paper from European Society Breast Imaging (EUSOBI)-Part 1: The role of common errors in radiology in missed breast cancer and implications of misdiagnosis.

Misdiagnosis in breast imaging can have significant implications for patients, healthcare providers, and the healthcare system as a whole. Some of the potential implications of misdiagnosis in breast imaging include delayed diagnosis or false reassurance, which can result in a delay in treatment and potentially a worse prognosis. Misdiagnosis can also lead to unnecessary procedures, which can cause physical discomfort, anxiety, and emotional distress for patients, as well as increased healthcare costs. All these events can erode patient trust in the healthcare system and in individual healthcare providers. This can have negative implications for patient compliance with screening and treatment recommendations, as well as overall health outcomes. Moreover, misdiagnosis can also result in legal consequences for healthcare providers, including medical malpractice lawsuits and disciplinary action by licensing boards. To minimize the risk of misdiagnosis in breast imaging, it is important for healthcare providers to use appropriate imaging techniques and interpret images accurately and consistently. This requires ongoing training and education for radiologists and other healthcare providers, as well as collaboration and communication among healthcare providers to ensure that patients receive appropriate and timely care. If a misdiagnosis does occur, it is important for healthcare providers to communicate with patients and provide appropriate follow-up care to minimize the potential implications of the misdiagnosis. This may include repeat imaging, additional biopsies or other procedures, and referral to specialists for further evaluation and management. Question What factors most contribute to and what implications stem from misdiagnosis in breast imaging? Findings Ongoing training and education for radiologists and other healthcare providers, as well as interdisciplinary collaboration and communication, is paramount. Clinical relevance Misdiagnosis in breast imaging can have significant implications for patients, healthcare providers, and the entire healthcare system.

2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

Management of acute community-acquired bacterial meningitis : Leading symptoms of impaired consciousness and fever with/without headache

Simultaneous symptoms of impaired consciousness and fever are suspicious for acute bacterial meningitis. This is amedical emergency and prompt action is essential. The clinical workup for suspected bacterial meningitis as well as treatment recommendations and differential diagnosis for the main symptoms of decreased vigilance and fever are described. Evaluation of selective literature using PubMed (U.S. National Library of Medicine®, Bethesda, MD, USA), especially taking into account the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) guideline of community-acquired bacterial meningoencephalitis in adults. Bacterial meningoencephalitis presents with the main symptoms of impaired consciousness, nuchal rigidity, headache and fever, which may, however, be absent in some cases. The diagnosis is confirmed by investigation of the cerebrospinal fluid. Further diagnostics include emergency laboratory tests, blood cultures, microbiological examinations, and cranial computed tomography (CCT). Empirical treatment should be administered promptly. Acute bacterial meningitis must be considered in cases of loss of vigilance and fever, requiring arapid, structured approach in the emergency department.

Sepsis-associated liver injury: Mechanisms and potential therapeutic targets

In this editorial, we examined a recent article in the World Journal of Gastroenterology that focused on sepsis-associated liver injury (SLI) and its treatment. SLI is a serious complication of sepsis, primarily caused by microcirculatory disturbances, the gut-liver axis, and inflammatory responses. Specific treatment recommendations for SLI are lacking. The gut-liver axis represents a potential therapeutic target, with metformin showing promise in modulating the gut microbiome and enhancing intestinal barrier function. Although immunomodulatory therapies are being explored, anti-tumor necrosis factor agents and interleukin-1 receptor antagonists have not demonstrated significant clinical benefits. Statins may reduce liver inflammation and prevent injury in sepsis, but their clinical application is limited. Reduced D-related human leucocyte antigen expression on monocytes and lymphocytes suggests immune suppression in patients, indicating that corticosteroids could reverse clinical deterioration in severe infections and address adrenal cortical insufficiency. Current large-scale studies on glucocorticoid therapy for sepsis have yielded mixed results, likely due to inadequate assessment of the immune status of the host. Future research should prioritize the development of personalized immunotherapy tailored to patients’ immune profiles, focusing on identifying novel indicators of immune status and advancing immunomodulatory targets and therapeutics for septic patients.

2024 American Heart Association and American Red Cross Guidelines for First Aid.

Codeveloped by the American Heart Association and the American Red Cross, these guidelines represent the first comprehensive update of first aid treatment recommendations since 2010. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines cover first aid treatment for critical and common medical, traumatic, environmental, and toxicological conditions. This update emphasizes the continuous evolution of evidence evaluation and the necessity of adapting educational strategies to local needs and diverse community demographics. Existing guidelines remain relevant unless specifically updated in this publication. Key topics that are new, are substantially revised, or have significant new literature include opioid overdose, bleeding control, open chest wounds, spinal motion restriction, hypothermia, frostbite, presyncope, anaphylaxis, snakebite, oxygen administration, and the use of pulse oximetry in first aid, with the inclusion of pediatric-specific guidance as warranted.

Validity and reliability of the osteoporotic fracture treatment score (OF score) and outcomes across various treatments in osteoporosis vertebral compression fracture patients.

Osteoporotic vertebral compression fractures (OVF) are prevalent and substantially impact healthcare systems and patients' quality of life. The osteoporotic fracture treatment score (OF score), developed by the German Society of Orthopedics and Trauma (DGOU), guides surgical decisions, but its reliability and validity are underexplored. This study assessed the OF score's inter- and intraobserver reliability, validated its treatment recommendations, and investigated intermediate outcomes of different DGOU-recommended surgical strategies for OVF. A retrospective cohort study was conducted. Inter- and intraobserver reliability of the OF score and its subcomponents were analyzed using clinical and radiographic data. Validity was assessed by comparing the OF score's recommended treatments with actual treatments received. Outcomes at the final follow-up were back pain visual analog scale, Oswestry Disability Index, EQ-VAS, EQ-5D-5L, adjacent fracture incidence, local kyphotic angle, and reoperation rates. Patients with at least 1-year follow-up were included. A total of 157 patients (84.7% female; mean age 74.2 ± 10.5 years) were evaluated. The most frequent osteoporotic fracture (OF) types were OF4 (49.0%) and OF3 (40.8%). The OF score demonstrated good interobserver reliability (ICC = 0.77, 95% CI: 0.65-0.86) and intraobserver reliability (ICC = 0.83, 95% CI: 0.72-0.90). Kappa values for subcomponents ranged from 0.57 to 0.89. Excluding patients with indeterminate recommendations (OF score = 6), 82.9% received treatments concordant with OF score recommendations. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 (95% CI: 0.67-0.86); an OF score cutoff > 6.5 predicted actual treatment with 87.9% sensitivity and 61.0% specificity. All surgical treatments showed comparable improvements in clinical outcomes. However, patients treated with stand-alone cement augmentation (CA) had less local kyphotic angle correction (P = 0.004) and greater postoperative kyphotic progression (P < 0.001) than those undergoing short-segment (SS-PI) or long-segment instrumentation (LS-PI). No significant differences in adjacent fractures or complications were observed. The OF score is a reliable and valid system with good discriminative ability for surgical decision-making in OVF patients. CA, SS-PI, and LS-PI are viable options with comparable functional outcomes. However, in OF3 or OF4 fractures, caution is advised due to lesser kyphosis correction and greater kyphotic progression with CA compared to SS-PI or LS-PI, as recommended by the DGOU.

Passive anti-amyloid β immunotherapy in Alzheimer's disease-opportunities and challenges.

With the advent of the first disease-modifying, anti-amyloid β-directed passive immunotherapy for Alzheimer's disease, questions arise who, when, and how to treat. This paper describes shortly the pathogenic basis of and preclinical data, which have, more than two decades ago, initiated the development of this vaccination therapy. We discuss clinical trial results of aducanumab, lecanemab, and donanemab. We also review appropriate use recommendations of these novel treatments on patient selection and safety monitoring. Furthermore, estimations of numbers of patient who will qualify for treatment regarding inclusion and exclusion criteria and estimations on readiness of health-care systems for identifying the right patients and for providing the treatment are reported. In our view, we are experiencing a fundamental shift from syndrome-based Alzheimer's dementia care to early, biomarker-guided treatment of Alzheimer's disease. This shift requires substantial adjustments of infrastructure and resources, but also holds promise of eventually achieving substantial slowing of disease progression and delaying dementia.

HPB SO50 - A comprehensive review of clinical practice guidelines for managing hepatic adenoma

Abstract Background Hepatic adenoma(HCA) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of Hepatic adenomas. Practice guidelines are needed, because of the many variation, diagnostic tools, and conservative and invasive management protocols. Therefore, our aim was to systematically search for available clinical practice guidelines on hepatic adenoma, critically appraise them, and compare management recommendations. Method Systematic literature search was performed by two investigators using appropriate prespecified search terms within the bibliographic databases of MEDLINE, EMBASE, and PubMed. All HCA guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on HCA were analysed, compared, and critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) 2020 checklist. Results The literature search yielded unique 199 papers, 187 were excluded after screening of title/abstract, and 9 after full-text screening. Guidelines included were: (EASL; 2016, (ACG; 2014), (SBH; 2015),). There were no set standards in the assessment methods for grading and gravity of recommendations between guidelines. Observed differences were: (1) indications for biopsy; (2) advices on contraceptive pills and follow-up; (3) use of an lesion centred approach to HCA; (4) lack of adequate treatment recommendations of HCA in male population ; and (5) approach to HCA depending on subtype varaition on magnetic resonance imaging. Conclusion Recognising differences in recommendations can assist in formulating practice standards and identify needs for research.

Update from d-uo: what can healthcare research contribute to renal cell carcinoma?

Renal cell carcinoma (RCC) accounts for about 13.5% of all urological tumors. Healthcare research analyzes whether treatment recommendations from controlled studies or guidelines are being implemented in routine care. Aprerequisite for the assessment and scientific study of the quality of care in the treatment of urological tumors is standardized documentation. This article illustrates healthcare research in RCC by presenting current data from the prospective of the VERSUS study (VERSorgUngsStudie) by d‑uo (Deutsche Uro-Onkologen). The VERSUS study is anoninterventional, prospective, multicentric study for the documentation and descriptive statistical analysis of the diagnosis, treatment, and aftercare of uro-oncological patients. Of 25,065 patients currently included in the VERSUS study, 1976 have a diagnosis of RCC. Data regarding stage distribution, reason leading to initial diagnosis, distribution of symptomatic vs. asymptomatic patients as well as surgical margins from surgical treatment of RCC are presented. Despite providing interesting results, the VERSUS study remains limited with regard to the depth of the data, since it relies on the same dataset as the German cancer registry. In order to provide more comprehensive healthcare research, organ-related cancer registries like the Urothelial Cancer National Registry (UroNAT) and the Prostate Cancer National Registry (ProNAT) by d‑uo are necessary. These national cancer registries by d‑uo are unique in that they comprise all tumor stages. The Renal Cancer National Registry (ReNAT) by d‑uo is in preparation and will be avaluable contribution to quality assurance of oncological care in Germany.

Abstract 4138494: Remote Blood Pressure Monitoring and Intervention as a better and cost-effective method of Hypertension control compared to Usual care: A Systematic Review

Introduction/Background: Hypertension is a leading cause of morbidity and mortality. Despite treatment recommendations and encouragement of lifestyle changes, the actual rate of blood pressure control is still not at par. Remote intervention methods have been shown to achieve better rates of blood pressure control utilising lesser resources and lower healthcare costs. We conducted a systematic review by qualitatively evaluating the potential impact of remote monitoring and interventions compared to usual care in controlling Hypertension. Research Question: Are remote monitoring techniques and interventions better than usual in-person blood pressure checks for hypertension control? Methods: We did a comprehensive literature search of Pubmed/MEDLINE, Google scholar, Cochrane central Library, PLOS ONE, ScienceDirect and Clinicaltrials.gov to identify eligible randomised control trials and clinical trials published between July 2013 and May 2025. A Risk of Bias assessment was conducted using Cochrane Risk of Bias tools such as ROB-2 for randomised control trials and ROBINS-1 for cohort studies. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 5,185 records analysed, 10 randomised control trials, 1 cohort study and 1 implementation study satisfied our inclusion criteria. Compared to usual care, remote monitoring methods showed significant difference in systolic blood pressure control at 6-12 months in 9 out of 12 studies, while 3 studies did not show any significant difference. Quality of life, physical health, mental health and drug compliance have also shown a significant positive difference in patients. Remote self monitoring interventions were found to be more cost-effective than usual care. They also reduced the load of patients seeking appointments for hypertension control thereby improving the quality of patient care. Conclusion: The management of clinical hypertension is a challenging entity. Conventional methods of regular in-office blood pressure checks are both tedious and resource consuming. Using remote monitoring methods have shown to significantly improve blood pressure control compared to routine methods. It also eliminates white-coat hypertension during follow-up blood pressure checks which leads to more appropriate interventions. Remote monitoring and intervention for hypertension control is time-effective, cost-effective and improves quality of life.

Diagnosis and Treatment of Renal ANCA Vasculitis: A Summary of the Consensus Document of the Catalan Group for the Study of Glomerular Diseases (GLOMCAT)

The document provides a comprehensive overview of the diagnosis, monitoring, and treatment of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) with renal involvement, focusing on granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). It outlines the definitions, clinical presentation, histopathological classification, monitoring strategies, induction and maintenance treatments, as well as special considerations for relapsing, refractory, and frail patients with renal AAV. The document was prepared by the Catalan Group for the Study of Glomerular Diseases (GLOMCAT), which comprises nephrologists with extensive experience in the diagnosis and treatment of AAV patients. Several virtual and face-to-face meetings were held for coordination, section assignments, and content discussion. An exhaustive and systematic search of the literature was carried out, which included, among others, the following databases: PubMed, EMBASE, Cochrane Library, Google Scholar, and ClinicalTrials.gov, as well as the abstract books of national and international congresses. Overall, the document provides a comprehensive guide for clinicians managing patients with renal AAV, offering evidence-based recommendations for diagnosis, monitoring, and treatment across various clinical scenarios.

INNV-22. CEREBELLOPONTINE EPIDERMOID CYST TO SQUAMOUS CELL CARCINOMA: MALIGNANT TRANSFORMATION, LEPTOMENINGEAL CARCINOMATOSIS, AND MANAGEMENT

Abstract BACKGROUND Intracranial epidermoid cysts (EDC) are rare, slow-growing, congenital tumors, that generally follow a benign course. EDCs have a rare potential for transformation to squamous cell carcinoma (SCC). We present a case of a malignant EDC transformation to SCC with leptomeningeal (LM) dissemination. METHODS Case report and review of literature. CASE PRESENTATION A 44-year-old female presented for evaluation of left-sided tinnitus and sensorineural hearing loss, which revealed a left cerebellopontine angle (CPA) tumor. She underwent a subtotal resection at age 47. One year later, she had rapid symptomatic recurrence of the cyst, as well as LM deposits of the right internal acoustic canal bundle, the left trigeminal nerve, and along the lumbar and sacral spine. She underwent repeat resection of the CPA lesion, with pathology now consistent with SCC, with CDKN2A loss. She received focal radiation therapy at the posterior fossa and the lumbar spine. SCC-directed chemotherapy with pembrolizumab and carboplatin followed by 5 cycles of pembrolizumab monotherapy was given as adjuvant therapy, prior to her developing symptomatic LM disease. CONCLUSION Malignant transformation of intracranial EDC is a rare occurrence in these typically benign tumours. Prognosis is especially poor when there is associated LM involvement, with median survival noted to be 10 months. Awareness of this phenomenon amongst clinicians is needed to ensure appropriate surveillance and aggressive treatment if it remains within patient wishes, though there is no consensus on recommendations for treatment. The patient presented has maintained disease stability with LM dissemination for over 10 months and ongoing, with a regimen of chemoradiotherapy informed by therapeutic approach to systemic SCC. To our knowledge, this is the first reported case of EDC to SCC transformation and LM dissemination stabilized with chemoradiotherapy using an immune-checkpoint inhibitor.

CTNI-78. PNOC008: A PILOT TRIAL TESTING THE CLINICAL BENEFIT OF USING MOLECULAR PROFILING TO DETERMINE AN INDIVIDUALIZED TREATMENT PLAN IN CHILDREN AND YOUNG ADULTS WITH NEWLY DIAGNOSED HIGH-GRADE GLIOMA (EXCLUDING DIFFUSE INTRINSIC PONTINE GLIOMA)

Abstract BACKGROUND Despite multiple clinical trials in young patients with newly diagnosed high grade gliomas (HGG), survival remains poor. PNOC008 is a single-arm, multi-center pilot trial, investigating the feasibility, toxicity, and efficacy of a molecularly guided individualized treatment approach following radiotherapy. METHODS Patients aged ≤21 years with newly diagnosed, localized, hemispheric HGG (Stratum A) or non DIPG, diffuse midline glioma (DMG) (Stratum B) were eligible. Comprehensive molecular profiling (targeted gene panel, whole exome, and whole transcriptome sequencing) was performed on primary tumor tissue. The molecular data was reviewed by a dedicated tumor board that recommended an individualized treatment plan combining up to four FDA approved drugs. Patients were followed for toxicity and efficacy. Circulating tumor DNA (ctDNA), imaging, and quality of life (QOL) measures were collected at multiple timepoints. RESULTS Fifty-five HGG patients enrolled between 2018 and 2023 (median age 11 years [range 2-20], n=31 female, n=29 Stratum A), including H3K27-altered (n=17), H3/IDH-wildtype diffuse pediatric-type (n=16), and H3G34-mutant diffuse hemispheric glioma (n=12). In 44 patients that followed the recommended treatment, median overall survival (OS) from time of study enrollment was 26.5 months in Stratum A (lower 95% CI: 18.5) and 23.6 months in Stratum B (lower 95% CI: 16.8), and 30 months in H3G34-mutant patients (n=10, lower 95% CI:24.6) with median follow-up of 34.5 months for all patients (lower 95% CI: 32.2). The treatment recommendations most commonly included alkylator with targeted therapy combinations. The often novel drug combinations were generally well tolerated with grade 3 or 4 treatment-related adverse events being mostly hematologic. Central imaging, ctDNA, and QOL analyses are underway. CONCLUSIONS A personalized treatment approach using comprehensive transcriptomic and genomic analysis is feasible and well tolerated with encouraging survival data in children and young adults with HGG. Further analyses of molecular subgroups and correlatives are ongoing.

Modification and Validation of the System Causability Scale Using AI-Based Therapeutic Recommendations for Urological Cancer Patients: A Basis for the Development of a Prospective Comparative Study

The integration of artificial intelligence, particularly Large Language Models (LLMs), has the potential to significantly enhance therapeutic decision-making in clinical oncology. Initial studies across various disciplines have demonstrated that LLM-based treatment recommendations can rival those of multidisciplinary tumor boards (MTBs); however, such data are currently lacking for urological cancers. This preparatory study establishes a robust methodological foundation for the forthcoming CONCORDIA trial, including the validation of the System Causability Scale (SCS) and its modified version (mSCS), as well as the selection of LLMs for urological cancer treatment recommendations based on recommendations from ChatGPT-4 and an MTB for 40 urological cancer scenarios. Both scales demonstrated strong validity, reliability (all aggregated Cohen’s K &gt; 0.74), and internal consistency (all Cronbach’s Alpha &gt; 0.9), with the mSCS showing superior reliability, internal consistency, and clinical applicability (p &lt; 0.01). Two Delphi processes were used to define the LLMs to be tested in the CONCORDIA study (ChatGPT-4 and Claude 3.5 Sonnet) and to establish the acceptable non-inferiority margin for LLM recommendations compared to MTB recommendations. The forthcoming ethics-approved and registered CONCORDIA non-inferiority trial will require 110 urological cancer scenarios, with an mSCS difference threshold of 0.15, a Bonferroni corrected alpha of 0.025, and a beta of 0.1. Blinded mSCS assessments of MTB recommendations will then be compared to those of the LLMs. In summary, this work establishes the necessary prerequisites prior to initiating the CONCORDIA study and validates a modified score with high applicability and reliability for this and future trials.

CTIM-33. IMMUNE BIOMARKERS OF TREATMENT RELATED IMAGING CHANGES IN GLIOBLASTOMA PATIENTS TREATED WITH STANDARD OF CARE PLUS PEMBROLIZUMAB

Abstract Pseudoprogression is a post-treatment imaging phenomenon in glioblastoma (GBM) that mimics true progression. Immune checkpoint inhibition with pembrolizumab has shown clinical benefits in multiple cancers and is a burgeoning treatment in GBM. Discerning pseudoprogression, or treatment-related imaging changes, from true progression is essential for appropriate treatment recommendations. However, there are no reliable biomarkers that can differentiate between pseudoprogression and true progression. Our prospective single-arm study (NCT 03347617) evaluated immune cell sub-populations (B-cells, T-cells, NK cells, monocytes, and myeloid cells) in newly diagnosed GBM patients who received standard-of-care chemoradiation plus concurrent pembrolizumab after maximal safe resection. Flow cytometry was performed on blood collected at predetermined timepoints (pre-treatment, post-radiation, suspected progression, and confirmed progression) and immune cell sub-populations were evaluated as covariates in univariable and multivariable logistic regression analysis. Of the 56 patients enrolled in this trial, 51 completed blood collection. Median survival was 13.84 months. Fifteen (29%) patients had pseudoprogression by modified RANO criteria and 36 (70.5%) had suspected or confirmed progression. Univariable analysis identified the following serum derived immune populations as being significantly associated with pseudoprogression: cytotoxic T-cell percentage (CD3+CD8+; HR: 1.10; p=0.045); total NK Cells percentage (CD3+CD56+; HR:0.912; p=0.0.053); IGD+CD27-naïve B-cells of B-cell percentage (HR: 0.976; p=0.014); IGD+CD27+non-switched B of B-cell percentage (HR:1.07; p=0.036). Backward selection multivariable logistic regression analysis confirmed the significant association of cytotoxic T-cell percentage (CD3+CD8+; HR:1.02; p=0.049) with pseudoprogression while controlling for IGD+CD27+non-switched B of B-cell percentage (HR:1.01, p=0.116). Increasing levels of serum cytotoxic T-cells in GBM patients treated with standard-of-care plus pembrolizumab is associated with pseudoprogression and may be used to differentiate between true progression. Validation of results is needed in a control population treated with standard-of-care prior to clinical implementation. Future studies will utilize serum immune biomarkers coupled with radiomic features to better characterize the pseudoprogression signature in GBM.

Characteristics of Breast Cancer Patients Who Refused Conventional Treatment in a Teaching Hospital in Southwestern Nigeria

Background Patients’ adherence to treatment recommendations is in the form of a spectrum: complete adherence or total rejection of the offered standard treatments. The aim of this study was to describe the characteristics of breast cancer patients who refused standard treatments in order to engender a focused intervention. Methods This was a retrospective study of breast cancer patients from 2017-2022. Data generated were analyzed using SPSS version 23.0. The results were presented using descriptive statistics. Inferential statistics for subgroup analysis was by chi-square test or risk difference with confidence intervals Results Among 343 patients, 86 (25% (95% CI 21-30) did not initiate conventional oncologic treatment. All were females and their age range was 33–83 years (mean, 49.9±12.0 years). The majority of the women were married (73%), educated (79%), low-income earners (69%), rural dwellers (63%) with advanced disease (81%). None of the patients had government insurance. The mean duration of symptoms was 11.9±9.7 months. Among 71patients with vital information, 50 (70% (95%CI 58-71) were confirmed dead in the last 3 years. The probability of death within 3 years was 38% (95%CI 8.0-68%) and was higher among those diagnosed as late-stage disease. Conclusions A large number of patients still fail to accept conventional treatments after breast cancer diagnosis. Understanding the patients’ characteristics may be necessary to recognize situations where active education and support can help patients accept standard treatment thereby prolonging survival.

The effects of conventional treatment in addition to Pilates on biopsychosocial status in chronic neck pain: A randomized clinical trial.

Although guidelines and systematic reviews recommend the use of exercise in the treatment of chronic pain and neck pain, there are no clear recommendations for conservative treatments frequently used in clinics. The effect of supporting clinical Pilates exercises with passive physiotherapy methods on biopsychosocial status is still unknown. The objective was to investigate the effects of conventional treatment (CT) in addition to clinical Pilates on pain levels, physical condition, functional status, and psychosocial status in individuals with chronic neck pain. Fifty women were randomly divided into 2groups, the clinical Pilates group (Pilates, n= 25), and the group receiving CT in addition to clinical Pilates (Pilates-CT, n= 25). Both groups received treatment 3days a week for 6weeks. The CT program involved the implementation of hot pack (HP) application, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound (US) to the cervical area. CT in addition to Pilates was more effective in reducing the Visual Analog Scale (at rest and during activity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, NeckPix Scale, Hospital Anxiety and Depression Scale-depression, and Cognitive Exercise Therapy Approach-Biopsychosocial questionnaire scores (p< 0.05) and in increasing the degree of change in the extension range of motion (ROM) and cervical flexor endurance values and scores in the energy parameter of Short Form-36 (p< 0.05). CT provided in addition to Pilates was more effective in reducing pain levels, disability, fear of movement, depression levels, and negative biopsychosocial status and improving extension ROM and cervical flexor endurance, neck awareness, and the energy/vitality parameter of quality of life in individuals with chronic neck pain.