Retrospective Series Research Articles

GLP-1RA in the Real World: 1-year Compliance and Outcomes of Semaglutide use in Patients With or Without Previous History of Bariatric Surgery.

To investigate weight loss outcomes of semaglutide in a real-world setting, specifically in patients who have undergone metabolic/bariatric surgery (MBS). Despite excellent weight loss for semaglutide in clinical trials, actual results may be limited due to factors such as costs, drug availability, insurance coverage, and adverse events. A retrospective series of patients with obesity prescribed semaglutide at a large multidisciplinary weight management center in a tertiary academic institution. Primary endpoints were compliance and percentage total weight loss (%TWL) within 1 year of semaglutide prescription, with further evaluation of weight loss in those with previous history of MBS. The average [SD] %TWL at 1 year among all patients prescribed semaglutide was 8.8% [10.5]. Of 1,072 patients prescribed semaglutide, 199/1072 (18.6%) did not start semaglutide mainly due to access issues, and 268/1072 (25%) discontinued it within 1 year primarily due to patient factors and side effects. Among patients who completed 1 year of treatment, %TWL was 10.9% [9.8]. In those with history of MBS, %TWL was higher in patients who underwent Roux-en-Y Gastric Bypass (RYGB), but not sleeve gastrectomy, compared to no MBS history (13.6% [10.3] vs. 10.1% [9.6]; P=0.022). Furthermore, %TWL with semaglutide was less in those with BMI>40, than those with BMI<40. 1-year semaglutide compliance is low at 56.4%. 1-year TWL for all patients prescribed semaglutide was 8.8%, and 10.9% for those who took semaglutide for 1 complete year. Patients who underwent RYGB tended to lose more weight with semaglutide than naïve MBS patients.

1p and/or 19q polysomy is an adverse prognostic factor in oligodendrogliomas, and easy to detect by automated FISH.

To study the feasibility of automated analysis by FISH technique in the determination of the 1p and/or 19q polysomy in oligodendrogliomas (OGs) and to explore its prognostic value. We analyzed a retrospective monocentric series of 145 consecutive OGs with IDH mutation and 1p/19q codeletion. For all cases, automated FISH analyses were performed to determine 1p and/or 19q polysomy status and results were compared to manual analysis to verify the concordance of the two methods. Polysomic status was then compared to clinical and histological data, the CDKN2A deletion status when available, event free survival (EFS) and overall survival (OS). Our study comprised 79 grade 2 OGs (O2) and 66 grade 3 OGs (O3). Polysomy of 1p and/or 19q was observed in 58 cases (40% of whole cohort) with a significant enrichment in the high grade cohort (59% versus 24%; p < 0,0001) and recurrent cases (55%). A majority of polysomic cases were copolysomic for 1p and 19q (75% of the polysomic cohort) rather than 1p or 19q single polysomy (21% and 4% respectively). Polysomy was correlated to high grade histological criteria of high mitotic and Mib1 proliferative indices (p = 0,002 and p = 0,0005 respectively) and to vascular proliferation (p = 0,0003). Univariate and multivariate analysis showed a significant correlation betwen polysomy and a shorter EFS and OS (p = 0,02 and p = 0,016 respectively). Concordance between manual and automated analysis was almost perfect for both 1p and 19q analysis (96 and 98% respectively, κ = 0,92 and 0,95 respectively). Automated analysis revealed that the large majority of polysomic signatures are represented by a small number of R/G signals (mainly 7 signatures) allowing a very easy implementation to pre-existent FISH platforms analysis software. 1p and/ or 19q polysomy status represent a prognostic factor in OGs and can be easily determined by automated analysis. Our study supports the clinical interest to determine the polysomic status in all primitive or recurrent OGs and underline the benefits of automated analysis which offers a better archive storage and facilitates multicentric comparison.

Proning During Robot-assisted Bronchoscopy for Improved Access to Posterior Lung Lesions: A Retrospective Series

Proning During Robot-assisted Bronchoscopy for Improved Access to Posterior Lung Lesions: A Retrospective Series

Manuscript Title: Comparative Cost-Effectiveness Analysis between Navigated Robot-assisted platforms and O-arm navigation in Minimally Invasive Transforaminal Interbody Fusion (MIS-TLIF).

Manuscript Title: Comparative Cost-Effectiveness Analysis between Navigated Robot-assisted platforms and O-arm navigation in Minimally Invasive Transforaminal Interbody Fusion (MIS-TLIF).

Orbital mesenchymal chondrosarcoma and its specific fusion gene HEY1-NCOA2

BackgroundMesenchymal chondrosarcoma (MC) is an uncommon type of malignant soft tissue tumor. The skeleton is the most common site of MC. Extraosseous sarcoma is rare, especially that of the orbit. Fusion gene HEY1–NCOA2 has diagnostic significance for MC, but there is a lack of research on its related pathways. To analyze the characteristics of orbital mesenchymal chondrosarcoma (MC), and search for HEY1-NCOA2-related pathways in orbital MCs, four cases of orbital MC were included in the study.MethodsFrom January 2018 to December 2022, four MC patients hospitalized at Tianjin Medical University Eye Hospital were collected for a retrospective series of case studies. HEY1-NCOA2 of the assay specimens was detected by fluorescence in situ hybridization, and immunohistochemical staining was performed for representative proteins of the relevant pathways. For figure modification and statistical analysis, GraphPad Prism 8.0 (La Jolla, CA, USA) was utilized.ResultsFour orbital MC were reported. Among the 4 ligible MC specimens, two were HEY1-NCOA2-positive and two were HEY1-NCOA2-negative. Immunohistochemistry showed stronger expression of COL2A1, APC, CD99, and Bcl2 in HEY1-NCOA2-positive samples than in HEY1-NCOA2-negative MCs.ConclusionWe summarized the clinical features, treatments, and prognosis of orbital MC, including our cases and the literature. The expression of COL2A1 and Bcl2 is elevated in HEY1-NCOA2-positive tissues, and they promote tumor cell growth by regulating cell proliferation, apoptosis, epithelial–mesenchymal transition, and drug resistance. For HEY1-NCOA2-positive patients, given the high expression of CD99, drugs targeting the MAPK pathway may be an effective treatment.

Cartilage Resection in the Surgical Management of Ear Melanoma.

Melanoma of the ear accounts for approximately 1% of cutaneous melanomas. Management recommendations are based on small retrospective series and case reports. Resection of melanoma of the ear requires a delicate balance between disease clearance, preservation of function, and aesthetics. The role of cartilage resection in the wide excision of melanoma of the ear remains unclear. We aimed to compare outcomes in patients having wide excision of ear melanoma who had cartilage resected with those who had a cartilage-sparing approach. Data were obtained from the Melanoma Institute Australia (MIA) prospectively maintained database. All patients diagnosed with invasive melanoma involving the ear between 1990 and 2022 were included. Data analysis was performed to assess the association between cartilage resection and recurrence-free survival (RFS), melanoma-specific survival (MSS), and overall survival (OS). Overall, 411 patients were included in the study, of whom 330 (80%) had cartilage resected and 81 (20%) had a cartilage-sparing resection. The cartilage resection group had a higher mean Breslow thickness (1.9vs. 1.4mm; p=0.0002), whereas the cartilage-sparing group had a higher proportion of stage IA disease (60.5 vs. 39.7%; p=0.041). Five (1.2%) patients had melanoma invading into perichondrium but not deeper. Cartilage resection had no impact on RFS {hazard ratio [HR] 0.82 (0.52-1.29); p=0.39} or MSS (HR 0.89 (0.30-2.62); p=0.83). The decision to resect cartilage as part of the wide excision of invasive ear melanoma should be tailored to the needs of the individual patient, however a cartilage-sparing approach does not appear to compromise MSS outcomes, particularly in early-stage disease.

Reactive Bcl2-positive germinal centres in paediatric tonsils: expanding the spectrum of lymphoma mimickers in children and adolescents.

Bcl2-positive germinal centres (GCs) have never been documented in reactive lymphoid hyperplasia (RLH). Here we describe such phenomenon in paediatric chronic tonsillitis (PCT), addressing the differential diagnosis with paediatric lymphomas. Six PCT cases with Bcl2-positive GCs were retrieved from a retrospective series of 166 tonsillectomies from children and adolescents. Clinical-pathological data were collected, also considering the status of IG rearrangements and BCL2 translocations. PCT with Bcl2-positive GCs mostly occurred in males (5/6 cases; median age: 5 years). Histologically, tonsil architecture was preserved and Bcl2 positivity was documented in a minority of GCs. Bcl2-positive GCs expressed CD10 and Bcl6 and had a high proliferation index. All cases had polyclonal IG rearrangements without evidence of monotypic kappa and lambda chains by RNAscope. BCL2 translocations were lacking in all the cases. Bcl2-positive GCs in PCT are a rare and benign phenomenon, expanding the spectrum of lymphoma-mimicking paediatric RLH.

The Clinical Trial Landscape in Autoimmune Encephalitis: Challenges and Opportunities.

Autoimmune encephalitis (AE) is an important cause of neurologic morbidity and mortality. Treatment algorithms are primarily based on observational studies, retrospective series, and expert opinion. Despite clinical improvement with empiric therapy, recovery is often incomplete with a substantial burden of residual neurologic deficits and recurring symptoms. There is a pressing need for higher quality evidence-based therapies. However, designing and conducting clinical trials for patients with rare diseases such as AE has specific challenges, including slow recruitment, suboptimal outcome measures, and inclusivity vs exclusivity of the various disease subtypes. The anticipated knowledge gained from AE clinical trials emphasizes the need to overcome these challenges and support the development of the next generation of clinical trials. Yet, given these challenges, alternative approaches may be required. In this article, we review past and present clinical trials in AE with a focus on studies enrolling patients with neural surface antibodies. We discuss the potential challenges and opportunities inherent to clinical trials in rare diseases and provide an outlook for the field.

Intention-to-Treat Analysis of Hepatic Resection for Liver Metastases from Uveal Melanoma: A Single-Center Experience.

Uveal melanoma metastasizes to the liver in almost 50% of patients. The prognosis of liver metastases from uveal melanoma (LMUM) is dismal; however, results from retrospective monocentric series suggest that surgery may improve survival in selected patients. We report our results of surgical explorations and hepatic resections for LMUM. We retrospectively analyzed our prospectively collected institutional database of hepatic resections for LMUM between 2013 and 2023. In total, 22 patients underwent surgical exploration (median age 61 years, 41% female patients): 15 (68%) underwent curative-intent surgery (surgery group) while 7 (32%) had their resection aborted owing to intraoperatively unresectable disease (staging alone group). Patients in the surgery group had a longer interval between diagnosis of the primary tumor and LMUM (> 36 months in 64%, versus 29% in the staging alone group, p = 0.18). Preoperative imaging and intraoperative staging were concordant in ten (45%) cases, while five (23%) had more lesions, six (27%) had miliary disease, and one (4.5%) had peritoneal carcinomatosis. Minor postoperative complications occurred in 3 (14%) patients. All patients in the staging alone group underwent subsequent systemic or locoregional treatment. Median overall survival was 27 (15-47) months after surgery and 15 (8-21) months after staging alone. Recurrence after surgery occurred in 7/15 patients, with a median disease-free survival of 28 (4-38) months. More than 30% of patients with LMUM with preoperatively resectable disease are unresectable at explorative surgery. Acceptable recurrence rates and good survival outcomes are observed when radical surgery can be performed.

Multicenter retrospective cohort study of the sequential use of the antibody-drug conjugates (ADCs) trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) in patients with HER2-low metastatic breast cancer (MBC)

Antibody drug conjugates (ADCs) have improved outcomes for patients with metastatic breast cancer (MBC), but there is little data about the sequential use of these agents. In this multicenter retrospective cohort study, we identified 84 patients with HER2-low MBC treated sequentially with trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) in either order at 5 institutions between 2020–2024. We evaluated clinical parameters associated with time to treatment failure (TTF) and real-world overall survival (rwOS). Median TTF was longer for ADC1 than ADC2, irrespective of HR-status, ADC sequence order, age ≤65 or >65 years, presence of visceral disease, or use of an intervening therapy. Younger age, longer time from MBC diagnosis to start of ADC1, and receipt of SG as ADC1 were associated with longer rwOS from start of ADC1. This cohort represents one of the first multicenter retrospective series of patients treated with sequential ADCs for HER2-low MBC, which may inform clinical practice.

Low vaccine coverage and absence of exacerbations after vaccination in a Myasthenia Gravis cohort: An observational retrospective series of 89 patients.

Low vaccine coverage and absence of exacerbations after vaccination in a Myasthenia Gravis cohort: An observational retrospective series of 89 patients.

Do we need a preventive stoma in surgery for colorectal endometriosis? A retrospective series of 97 patients treated at an expert centre.

Various surgical techniques for the treatment of colorectal endometriosis have been described, and the benefit of a preventive stoma remains unclear. The aim of our study is to evaluate the risk of complications in patients who underwent surgery for colorectal endometriosis without a policy of preventive stoma. Retrospective cohort study of 97 consecutive patients treated for colorectal endometriosis in an expert centre from January 2022 to January 2024. Complications after colorectal endometriosis surgery in patients without preventive stoma. Forty-three patients were managed by segmental resection, 20 patients by single-disc excision, 5 patients by double-disc excision and 29 patients by rectal shaving. 48 patients required vaginal suturing. We found complications in 14% of patients. Severe complications (Clavien-Dindo ≥3) were encountered in 8.24% of patients. 3.09% developed a rectovaginal fistula. Patients with a colorectal endometriosis nodule larger than 3 cm had more complications than patients with smaller nodules (57.1% vs. 42.9% of total complications), with a P-value close to the statistical significance. Surgery for colorectal endometriosis performed in high-volume centres by expert surgeons leads to a reduction in the risk of postoperative complications. In our study, we did not perform routine preventive stoma formation, and we did not find an increase in postoperative complications compared to the literature. This study provides data on the risk of postoperative complications in patients undergoing surgery for colorectal endometriosis without a preventive stoma policy.

The effect of isolated tumor cells on adjuvant treatment decisions for patients with endometrial cancer: A retrospective case series.

The effect of isolated tumor cells on adjuvant treatment decisions for patients with endometrial cancer: A retrospective case series.

Contraindication to surgery in primary retroperitoneal sarcoma: Retrospective series on 20years of practice in a high-volume sarcoma center.

Contraindication to surgery in primary retroperitoneal sarcoma: Retrospective series on 20years of practice in a high-volume sarcoma center.

Waterjet ablation therapy vs. urethral-sparing robot-assisted simple prostatectomy for large prostate volumes (>80 mL): results of a retrospective multicentric series according to the standardized BPH6 achievement.

The introduction of minimally invasive techniques for BPH treatment aimed to balance de-obstruction with maintenance of ejaculatory function. The aim of this multicentric series was to compare outcomes of waterjet ablation therapy (WAT) versus urethral-sparing robot assisted simple prostatectomy (us-RASP) for large prostate volumes (PV>80 mL) according to BPH-6 metric. Four institutional BPH datasets were matched and queried for "PV>80 mL" (N.=86), "WAT" (Group A; N.=42) and "us-RASP" (Group B; N.=44). Baseline, perioperative and functional data according to BPH6 composite endpoint were compared between groups. Differences between continuous variables were assessed with t-test or Mann-Whitney U-test depending on their normal or not normal distribution, while Chi-square Test was used for categorical data. A two-sided P<0.05 was considered significant. Patients treated with WAT showed lower preoperative PSA median values (3.5 vs. 7.07 ng/mL) (P<0.05). Regarding perioperative outcomes, patients treated with us-RASP revealed increased median operative time (110 vs. 70 mins), prolonged bladder irrigation time (24 vs. 37.2 hours), longer median hospital stay (5 vs. 4 days), respectively (all P<0.05). At a median follow-up of 43.7 months (IQR 33.8-49.7), the BPH6 achievement rate was comparable between groups (54.7% vs. 56.8%; P=0.964). In the WAT series 1-year ejaculatory dysfunction rate was 19.1% while in the us-RASP cohort was 13.6%, respectively (P=0.21). Retrospective design and the lack of a propensity-score matching represent main limitations of this study. Compared to us-RASP, WAT showed comparable symptom relief and ejaculatory function preservation for prostate gland >80 mL with benefit in terms of main perioperative outcomes at mid-term follow-up.

Clinical Outcomes of Arthroscopic Treatment of High-grade Partial Thickness Rotator Cuff Tears with Augmentation using Bioinductive Collagen Implants Are Comparable to Tear Completion and Repair.

Clinical Outcomes of Arthroscopic Treatment of High-grade Partial Thickness Rotator Cuff Tears with Augmentation using Bioinductive Collagen Implants Are Comparable to Tear Completion and Repair.

Distal Biceps Tendon Repair in Competitive Strength Athletes: A Retrospective Series of 183 Athletes

Background: Elbow injuries are common among strength athletes, particularly distal biceps tendon ruptures. These injuries can significantly affect athletes’ performance and require effective treatment strategies to ensure optimal recovery and return to sport. Purpose/Hypothesis: The purpose of this retrospective cohort study was to evaluate the patient-reported outcomes, return-to-sport rate, and postoperative strength of competitive strength athletes who underwent distal biceps tendon repair. It was hypothesized that patients would show excellent patient-reported outcomes on validated questionnaires and exhibit high rates of return to sport as well as high subjective strength levels. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed for cases of distal biceps tendon repair in athletes competing in strength sports, such as weightlifting and powerlifting, between August 2003 and July 2020. The preoperative and postoperative sporting activity, mechanism of injury, and complications were assessed. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Additionally, the athletes were asked to rate their elbow strength as a percentage compared with their uninjured side. Results: A total of 183 patients were included (88% follow-up rate), with a mean follow-up of 69.6 ± 61.0 months. Among them, 168 underwent primary repair, while 15 underwent revision procedures, of which 7 involved allograft augmentation. All athletes were able to return to sport, and 73% of patients achieved full subjective strength of their affected arm. The median MEPS score was 100 (interquartile range, 100-100), and the median SANE score was 100 (interquartile range, 95-100). Multivariate linear regression analysis showed that an increased time between injury and surgery was associated with a decrease in the MEPS score (standard error [SE] = 0.002; t = −2.113; P = .036) and self-assessed strength (SE = 0.053; t = −3.183; P = .002). Graft usage was associated with a nonsignificant decrease in the SANE score (SE = 1.538; t = −1.791; P = .075). There were 28 complications (15%) that occurred, including 5 tendon retears (3%) and 1 intraoperative brachial artery injury (1%). Conclusion: Distal biceps tendon repair in competitive strength athletes resulted in a high return-to-sport rate and excellent recovery. However, delayed surgery negatively affected outcomes, and 27% of patients experienced persistent subjective strength deficits. Future research is needed to further optimize treatment strategies for athletes.

Focal Cerebral Injury in Pediatric Extracorporeal Life Support: Timing in Relation to Cannulation or Other Circuit Events in a Single-Center Retrospective Series, 2015-2023.

To review the timing of extracorporeal life support (ECLS)-related focal cerebral injury (FCI) in relation to circuit interruptions in children and young adults. Retrospective study from January 1, 2015, to December 31, 2023. Single-center academic children's hospital. Children and young adults younger than 21 years old who had neuroimaging during or after ECLS. Multiple ECLS runs in individual patients were analyzed as distinct runs. None. FCI was radiographically defined as lateralized ischemia or hemorrhagic parenchymal brain injury greater than 1 cm3 or as subdural hemorrhage causing midline shift. Timing of clinical FCI documentation was abstracted from chart review and based on times of new-onset focal neurologic examination findings, focal electroencephalography findings, or incidental discovery on imaging. In instances of FCI, electroencephalography reports and inpatient progress notes were reviewed to identify electroencephalography-related timing of FCI. Institutional ECLS registry data were used to identify times of circuit events (i.e., cannulation, decannulation, and circuit interruptions). The probable time course of FCI after circuit events was evaluated in the ECLS runs with an imaging diagnosis of FCI, and summarized using cumulative distribution with 95% CI. In 101 ECLS runs in 94 patients with brain imaging, 20 had FCI: ischemic stroke in 12, intraparenchymal hemorrhage in six, and subdural hemorrhage with midline shift in two. Eighteen FCIs were documented within 48 hours of a circuit event. Among 13 FCIs with electroencephalography recording at the time of FCIs, eight had new-onset subclinical electroencephalography abnormality as the initial documented sign of FCI. The presence of FCI vs. not was associated with lower survival to decannulation (p = 0.007). In this single-center retrospective series, 2015-2023, the majority of ECLS-related FCIs were evident within 48 hours of ECLS cannulation, decannulation, or circuit interruption. These events warrant increased surveillance for neurologic complications.

Arthroscopic treatment of scaphoid nonunion with distal radius bone graft: A retrospective series of 31 cases.

Arthroscopic treatment of scaphoid nonunion with distal radius bone graft: A retrospective series of 31 cases.

Primary ovarian leiomyosarcoma: results from an analysis by the French Sarcoma Group (Ovarian SArcoma MAnagement - OSAMA Study).

Primary ovarian leiomyosarcomas are exceptionally rare, constituting less than 1% of ovarian tumors, and they typically have a poor prognosis. The available data on the management of these tumors are sparse, with limited publications mainly comprising small retrospective series that include multiple histologic types. The aim is to evaluate the clinical, surgical, pathologic characteristics and clinical outcome of patient affected by primary ovarian leiomyosarcomas. Using the national database (NetSarc), we conducted a retrospective study of the outcomes of primary ovarian leiomyosarcomas at 18 French Sarcoma Group centers. Patients with any International Federation of Gynecology and Obstetrics stage of primary ovarian leiomyosarcoma at first diagnosis and available follow-up were included. A total of 39 patients with primary ovarian leiomyosarcomas were included: 35 had localized disease and 4 had metastatic disease. The median tumor size was 134 mm. Radical and wide surgery was performed on 21 (62%) and 13 patients (38%), respectively. Tumor grade 3, presence of necrosis, mitoses ≥20 high-power field, and high Ki-67 expression >30% were reported in 17 of 34 (50%), 29 of 34 (85%), 17 of 34 (50%), and 17 of 27 patients (63%), respectively. Positive estrogen receptor expression was reported in 14 of 27 patients (52%), whereas progesterone receptor expression was observed in 10 of 27 patients (37%). Adjuvant chemotherapy was administered in 12 of 34 patients (35%), whereas pelvic adjuvant radiotherapy in 8 of 34 (23%). Of the early-stage primary ovarian leiomyosarcomas, 9 had isolated pelvic recurrence, whereas 18had parenchymal distant metastases. A total of 15 patients (44%) died of disease. In early-stage primary ovarian leiomyosarcomas, high mitotic counts and progesterone receptor negativity were variables associated with worse survival. Surgery is the cornerstone of treatment for early-stage primary ovarian leiomyosarcoma, whereas the role of adjuvant treatment remains unclear. Some pathologic features were associated with poorer survival. Owing to the rarity of ovarian leiomyosarcomas, referring patients to expert sarcoma centers is highly recommended.