Treatment Sessions Research Articles

Impact of kV-cone beam computed tomography dose on DNA repair mechanisms: A pilot study

PurposeIn head and neck squamous cell carcinoma (HNSCC), early complications of the radiotherapy (RT) are observed from the beginning of the treatment to a few months after its end. During external radiotherapy treatment, several patient-dependent parameters can cause a modification of the dose distribution compared to the planned distribution due to variation in patient positioning, anatomy, or intra-fractional movements for example. To verify these parameters during treatment sessions, one of the most commonly used solutions is the cone-beam computed tomography (CBCT). Nowadays, the use of CBCT may constitutes a significant part of the total dose at the end of treatment (up to 10 cGy per session) and more often the volume irradiated by imaging is larger than the one irradiated by the treatment, leading to unintentional irradiation of nearby organs.In this study, we asked whether the imaging low dose added to a following fraction dose (2Gy) may affect the biological response in terms of DNA repair. Material and methodsUsing an IVInomad dosimeter and scintillating fiber probes specially designed for this exploratory study, we exposed fibroblasts cells from head and neck cancer (HNC) patients to a CBCT dose followed by a radiotherapy fraction dose. DNA double strand breaks and DNA repair were assessed by immunofluorescence using the biomarkers gamma H2AX (γH2AX) and pATM. ResultsThe median dose of CBCT was measured between 17 to 21 mGy per session. The kinetics of both biomarkers were found to be strongly dependent on the individual factor in radiosensitive patients. For HNC patients, a prior CBCT dose applied few minutes before the 2Gy dose may have a sublinear effect on the DNA repair mechanisms and potentially on observed health tissue toxicity. ConclusionThe preliminary results obtained highlight the importance of individual and tissue factors for recognizing and repairing DSB during a treatment by radiotherapy using CBCT.

Safety of the Immediate Reconstitution of Poly-l-Lactic Acid for Facial and Body Treatment-A Multicenter Retrospective Study.

Poly-l-lactic acid (PLLA-SCA; Sculptra) was approved in 1999 in Europe and 2004 in United States as a collagen biostimulator. It is a freeze-dried preparation containing 150 mg PLLA-SCA per vial and, since approval, has been recommended to be reconstituted 72 h before treatment, which can hinder its use in clinical practice. In 2021, the manufacturer authorized the reconstitution of PLLA-SCA immediately before use. To evaluate adverse events in patients treated with immediately reconstituted PLLA-SCA on the face, body, and scars. This was a retrospective analysis of medical records of patients treated with immediately reconstituted PLLA-SCA for aesthetic purposes from January 1, 2021, to December 31, 2021, at two medical centers. A total of 274 treatment sessions were conducted on 167 patients (ranging from 1 to 5 sessions per patient). Of these, 228 sessions (151 patients) targeted the face, 39 sessions (22 patients) addressed the body, and 7 sessions (5 patients) focused on scars. The mean final concentration of PLLA-SCA was 15.30 mg/mL for the face, 8.35 mg/mL for the body, and 10.53 mg/mL for scars. The majority of injections were administered with a blunt cannula (face: 87.3%, body: 100%, scars: 57%), and in 6 out of 7 scar treatments, PLLA-SCA was additionally applied topically after fractional treatment. One patient developed a PLLA-SCA nodule 30 days after facial treatment, which resolved after two saline injections. The most common adverse events were bruising (face: 6.57%, body: 7.69%) and mild pain (face: 3.07%). No events required further intervention. This study reports an adverse event profile with immediately reconstituted PLLA-SCA, used on the face, body, and scars, similar to that reported with PLLA-SCA reconstituted 72 h prior to use. This was a retrospective study of medical records at two medical centers, and trial registration was not required.

Increased Dose in Spine Stereotactic Radiosurgery for Metastatic Disease: Are We Underestimating the Risks?

Background and Objectives: The recently published Spine Stereotactic Radiosurgery (SSRS) ESTRO guidelines advise against treating spinal metastatic disease with a single dose equal to or smaller than 18 Gy, prioritizing local control over the potential for complications. This study aims to assess the necessity and validity of these higher dose recommendations by evaluating the outcomes and experiences with lower radiation doses. Materials and Methods: A retrospective evaluation of SSRS patients treated at a single institute was conducted. The outcomes and complications of this cohort were compared to the current literature and the data supporting the new ESTRO guidelines. Results: A total of 149 treatment sessions involving 242 spinal levels were evaluated. The overall local control rate was 91.2%. The mean radiation dose for the local control group compared to the local failure group was similar (17.5 vs. 17.6 Gy, not significant). The overall complication rate was 6%. These results are consistent with previous publications evaluating SSRS for metastatic spinal disease. Conclusions: SSRS dose escalation may increase local control efficacy but comes with a higher risk of complications. The evidence supporting the strong recommendations in the recent ESTRO guidelines is not robust enough to justify a universal application. Given the palliative nature of treatment for metastatic patients, dose determination should be individualized based on patient conditions and preferences, with a detailed discussion about the risk-benefit ratio of increased doses and the level of evidence supporting these recommendations.

Intralesional immunotherapy of cutaneous warts using tuberculin purified protein derivative and vitamin D3 – A randomized comparative study

Objectives: Numerous studies have been conducted on the clinical efficacy of immunotherapeutic agents in the treatment of cutaneous warts showing variable results. The present study aimed to compare the clinical efficacy and safety of intralesional tuberculin purified protein derivative (PPD) and Vitamin D3 therapy in recurrent and recalcitrant extra-genital cutaneous warts. Material and Methods: This study was conducted as a prospective, randomized, comparative, and single-blind study. A total of 104 patients were randomly distributed into two treatment groups: Group A (Tuberculin PPD, n = 53) and Group B (Vitamin D3, n = 51). Each patient in Group A received an intralesional injection of 0.1 mL tuberculin PPD (5 Tuberculin Units), while each patient in Group B received an intralesional injection of 0.2 mL Vitamin D3 (Cholecalciferol containing 120,000 IU). The injections were given at the initial visit (week 0) and after every 2 weeks for a maximum of four sessions (weeks 2, 4, and 6). The largest wart was selected for intralesional therapy. The categorization of clinical response was done based on the percent reduction in the size of warts into complete (appearance of normal skin), marked (>50% reduction), moderate (<50% reduction), and inadequate (no change in warts) responses. Adverse effects (if any) were recorded during each patient visit. The final response was evaluated at 6 months follow-up from the last treatment session. Results: Regarding the response of patients to tuberculin PPD therapy, out of a total of 53 patients, 40 (75.5%) showed a complete response. Regarding the response of patients to Vitamin D3 therapy, out of a total of 51 patients, 36 (70.6%) showed a complete response. However, the difference in the response to the treatment between the two groups was statistically insignificant (P = 0.402). Conclusion: Both intralesional tuberculin PPD and Vitamin D3 are effective and safe in the treatment of all recurrent and recalcitrant extra-genital cutaneous warts.

Explicit information and practice type can affect the L2 acquisition of plural marking

Abstract Previous research has indicated that explicit information (EI) about either the first language (L1) or second language (L2) along with task-essential practice can facilitate L2 learning (e.g., Fernández, 2008; McManus, 2022). However, little research has examined L1–L2 contrastive EI with L1/L2 practice. Targeting plural-marking accuracy, the present study sought to fill this gap by exposing 127 Japanese intermediate learners of English to six online treatment sessions across four conditions: (1) non-contrastive EI (pluralization rule explanation) + L2 practice, (2) contrastive EI + L2 practice, (3) as per Condition 2 + additional L1 practice (application of L2 pluralization to L1 through the Japanese suffix –tachi), and (4) using prepositions as a control, non-contrastive EI (prepositional rule explanation) + L2 practice. Accuracy was tested at pre/post/delayed intervals using an acceptability judgement task (reading) and a picture description task (writing). Statistical analyses demonstrated greater gains from the contrastive variables in the immediate post-test, with L1 practice appearing especially beneficial, despite improvements diminishing in the delayed post-test. Supplementary data from retroactive interviews and questionnaire responses indicated favourable orientations towards the intervention. The study advances understanding of how EI and practice type can be used to maximize L2 learning through web-based practices tailored to the nature of the learning problem.

Stem Cells Rehabilitate Diabetic Neuropathy

To report the effectiveness of stem cell treatment in diabetic neuropathy. This study recruited 83 Iraqi females from 45 to 73 years old who had NIDDM between August 31, 2020 and June 30, 2023. All of them had a "Diabetic neuropathy symptom score (DNS)" (grade 3–4) and a "Diabetic foot sensory neuropathy score" (grade 1-2). They all had HbA1c (10-13%) from 7 to 10 years. The patient/family provided informed permission when they visited the "Al Zahrawy Center for Stem Cells in Baghdad". For four treatment sessions (once every three weeks), Hamad dispersed stem cells around the tibial and deep peroneal nerves. Among 83 Iraqi females, 49 (59.1%) had a grade 4 "Diabetic neuropathy symptom score" upon presentation, which decreased to 24.2% in 20 females after three months of medication. Their "Diabetic foot sensory neuropathy (DNS)" was (54.3%) in 45 females at presentation and decreased to (21.8%) in 18 females after three months of treatment. The satisfaction rate for therapy was 74.6% for the "Diabetic neuropathy symptom score" and 78.3% for "Diabetic foot sensory neuropathy (DNS)". Stem cell therapy is a good treatment option for diabetic neuropathy. The researchers supported it and suggested a greater sample size in other places.

Effects of the English language intervention as a foreign language for struggling elementary readers in South Korea: a meta-analysis

AbstractThis meta-analysis comprehensively examined the effects of English language interventions on struggling elementary school learners in South Korea learning English as a foreign language. A total of 22 studies of experimental and quasi-experimental studies were separately analyzed by the study design using a random-effects model, and the mean effect size was medium (g = 0.68, SE = 0.26, CI95 = 0.18, 1.18, p < 0.01) for the experimental studies while the mean effect size was large (g = 1.39, SE = 0.67, CI95 = 0.08, 2.69, p < 0.05) for the quasi-experimental studies. Due to the large homogeneity statistics, subgroup analyses were additionally conducted for possible moderator effects contributing to the mean. The subgroup analyses indicated large effects in the affective (e.g., student’s motivation) and achievement (e.g., reading comprehension) type of outcome measures and effective intervention components (e.g., shared reading). Other effective contextual characteristics including the total session numbers, intervention frequency, and classroom type are also discussed along with the study limitations and future directions for the struggling readers learning English as a foreign language.

Combination of trehalose and botulinum toxin type A in REVITOX skin treatment protocols

This article presents the REVITOX protocol, developed by the author, which includes the combination of REVI products (native hyaluronic acid + trehalose) and botulinum toxin type A (BTA) for the treatment of rosacea and correction of age-related changes. A plethora of studies has demonstrated that trehalose, an exceptional stabilizer of proteins, contributes to maintaining cellular integrity, exhibits antioxidant and angioprotective effects, and has been shown to induce autophagy. In combination with the proven effects of hyaluronic acid and BTA, these properties facilitate the optimal environment for cellular structure functioning, influencing the basic mechanisms of rosacea pathogenesis and mitigating the severity of age-related changes through the balanced elimination of dynamic and static rhytides, stimulation of neocollagenesis and improvement of the mechanical properties of the dermis. By targeting the multifactorial processes of facial aging, improving skin hydration and elasticity, the REVITOX Beauty protocol has ensured the balanced rejuvenation of the perioral and periorbital skin, resulting in a significant improvement in skin quality, as confirmed by the results of 3D diagnostics. After 3 treatment sessions of the REVITOX Derma program, the patients showed a general improvement of facial skin, a visible reduction in erythema and telangiectasia severity, regression of papulopustular elements, enhanced skin hydration and elasticity, and no recurrences at the follow-up. Further studies on the combined use of BTA and REVI will investigate the potential for using these protocols in the treatment of other dermatological conditions, including in combination with energy-based devices and beauty injections.

Factors associated with adherence to swallowing therapy among patients diagnosed with oropharyngeal dysphagia.

The objective of this study is to assess disparities in adherence to swallowing therapy for clinically diagnosed oropharyngeal dysphagia (OD) patients. Analysis was conducted on data from 600 patients with OD and confirmed impairments in swallowing safety and/or efficiency on a videofluoroscopic swallow study. Patients were classified based on their adherence to treatment sessions, defined as the number of swallow treatment sessions attended. The outcome of treatment adherence was categorized into two groups: those who attended fewer than 50% of the prescribed treatment sessions and those who attended 50% or more of the sessions. Continuous variables were presented as mean ± standard deviation or median ± interquartile range. Categorical variables were compared using Pearson chi-square tests and Fisher's exact test when appropriate. Univariable and multivariable binary logistic regression models were employed to identify factors associated with successful adherence. Approximately 79% adhered to swallowing treatment. We found no significant relationship between adherence and age, sex, race, ethnicity, primary language, marital status, insurance status, occupation, median income, distance, education, OD severity, and diagnosis year (p > 0.05). We found no covariables to be significant predictors to swallowing treatment nonadherence in both univariable and multivariable binary regression models (p > 0.05). The variables analyzed in this study were not significantly associated with nonadherence to swallow therapy. Nevertheless, our study still addressed an important knowledge gap and future studies would benefit from exploring other relevant socioeconomic and disease-related factors. Level 4.

Effectiveness of monopolar diathermy by radiofrequency combined with exercise in patients with chronic low back pain: A randomized clinical trial.

Chronic low back pain can severely affect quality of life. While several treatments are available, the combination of therapies often results in better outcomes. This study delves into the comparative effectiveness of combining monopolar dielectric diathermy radiofrequency (MDR) with supervised therapeutic exercise against the latter treatment alone. A randomized single-blind controlled trial was conducted. The intervention group (n= 30) received MDR with supervised therapeutic exercises for eight weekly sessions for four weeks. The control group (n= 30) received only the same exercise protocol. The following self-report measures were assessed before the first treatment session, at four, and 12 weeks: disability, pain, kinesiophobia, quality of life, sleep quality, emotional distress, isometric trunk strength, and trunk flexion range. Repeated ANOVA measures revealed significant time*group interactions for the McQuade test (p= 0.003), the physical role (p= 0.011), vitality (p= 0.023), social function (p= 0.006), and mental health subscales (p= 0.042). Between-group analyses showed significant differences for all outcomes at each follow-up: RMDQ (post-treatment, p= 0.040), ODI (post-treatment and 12-week, p= 0.040), VAS (p< 0.001), TSK (p< 0.001), and McQuade Test (p< 0.020). The combination of diathermy radiofrequency with supervised therapeutic exercise significantly surpasses the efficacy of supervised therapeutic exercise alone, showcasing improvements in pain, disability, kinesiophobia, lumbar mobility in flexion, and overall quality of life in patients with chronic low back pain.

Safety, Tolerability, and Short-Term Efficacy of Low-Level Light Therapy for Dry Age-Related Macular Degeneration.

Photobiomodulation (PBM) has become a promising approach for slowing the progression of early and intermediate dry age-related macular degeneration (dAMD) to advanced AMD. This technique uses light to penetrate tissues and activate molecules that influence biochemical reactions and cellular metabolism. This preliminary analysis is aimed at assessing the safety, tolerability, and short-term effectiveness of the EYE-LIGHT®PBM treatment device in patients with dAMD. The EYE-LIGHT® device employs two wavelengths, 590nm (yellow) and 630nm (red), in both continuous and pulsed modes. Patients over 50years of age with a diagnosis of dAMD in any AREDS (Age-Related Eye Disease Study) category were randomly assigned to either the treatment group or the sham group. The treatment plan consisted of an initial cycle of two sessions per week for 4weeks. Safety, tolerability, and compliance outcomes, along with functional and anatomical outcomes, were assessed at the end of the fourth month. This preliminary analysis included data from 76 patients (152 eyes). All patients were fully compliant with treatment sessions, and only one fifth of patients treated with PBM reported mild ocular adverse events, highlighting exceptional results in terms of tolerability and adherence. Changes in best-corrected visual acuity (BCVA) from baseline to month 4 differed significantly between the sham and PBM-treated groups, favoring the latter, with a higher proportion achieving a gain of five or more letters post-treatment (8.9% vs. 20.3%, respectively; p = 0.043). No significant differences in central subfield thickness (CST) were observed between the two groups over the 4-month period. The study also found a statistically significant disparity in mean drusen volume changes from baseline to month 4 between the groups in favor of patients treated with PBM (p = 0.013). These preliminary results indicate that PBM treatment using the EYE-LIGHT® system is safe and well tolerated among patients with dAMD. Furthermore, both functional and anatomical data support the treatment's short-term efficacy. ClinicalTrials.gov identifier NCT06046118.

Comparative Analysis of LORETA Z Score Neurofeedback and Cognitive Rehabilitation on Quality of Life and Response Inhibition in Individuals with Opioid Addiction.

Background. Previous studies has shown that conventional neurofeedback and cognitive rehabilitation can improve psychological outcomes in people with opioid use disorders. However, the effectiveness of LORETA Z-score neurofeedback (LZNFB) and attention bias modification training on quality of life and inhibitory control of these people has not been investigated yet. LZNFB targets deeper brain structures with higher precision, compared to conventional neurofeedback that typically focuses on surface EEG activity. The present study aims to compare the effect of these two methods on quality of life and response inhibition in men with opioid use disorders under methadone maintenance therapy (MMT). Methods. In this randomized controlled clinical trial with a pre-test, post-test, follow-up design, 30 men with opioid use disorders under MMT were randomly assigned into three groups of LZNFB, attention bias modification training, and control (MMT alone). The LZNFB and Cognitive Rehabilitation groups received 20 and 15 sessions of treatment, respectively. The Persian versions WHO Quality of Life-BREEF questionnaire and the Go/No-Go test were completed by the participants before, immediately after, and one month after interventions. The collected data were analyzed in SPSS v.22 software. Results. Both intervention groups showed a significant improvement in quality-of-life score and a significant reduction in response time at the post-test phase (P < .05), where LZNFB group showed more improvement in quality of life and more reduction in response inhibition. After one month, the increase in quality of life continued in both groups, while the decrease in response time continued only in the LZNFB group. Conclusion. Both LZNFB and attention bias modification training are effective in improving quality of life and response inhibition of men with OUD under MMT, however, LZNFB is more effective.

Adherence of healthcare providers to Enhanced Adherence Counseling (EAC) intervention protocol in West Amhara Public Health Facilities, Northwest Ethiopia, 2023: mixed method evaluation

BackgroundIn Ethiopia, there were an estimated 670,906 people living with the Human Immune Virus (HIV). Implementing an HIV test and treat strategy and rapid scale-up of anti-retroviral treatment (ART) provided health facilities increased the number of the number of people living with HIV/AIDS. In the same way, the expansion of viral load monitoring in these health facilities and poor adherence to ART increase the number of high-viral load (HVL) patients. To alleviate this problem, the World Health Organization (WHO) recommended EAC intervention for HVL patients. Therefore, the aim of this research was to determine the level of healthcare providers’ adherence to the EAC intervention protocol and explore barriers and facilitators of the intervention in West Amhara, Northwest Ethiopia.MethodDescriptive cross-sectional study design with concurrent mixed-method evaluation was employed. The adherence dimension, with its sub-dimensions of content, coverage, frequency, and duration of the EAC intervention, was used with sixteen indicators. A total of 20 high-case-load public health facilities and 173 HVL patients were included in our study. Quantitative data was entered into Epi Info and exported to SPSS version 25 for analysis. Descriptive statistics are analyzed in terms of frequencies, percentages, variances, and means and presented as narrations, frequency tables, graphs, and charts. Qualitative data were transcribed, translated, coded, and analyzed thematically using Open Code version 4.0 software. The qualitative findings were used to triangulate the quantitative findings.ResultThe average adherence level of health care providers (HCPs) to the EAC intervention protocol was 55.3%, from which content, coverage, frequency, and duration of the intervention contributed 70.3%, 86.3%, 36.9%, and 27.7%, respectively. Most of the intervention contents were delivered during the session, but none of the providers developed a patient adherence plan at the end of the session. All HVL patients were linked and enrolled in the EAC intervention. But only 6% of them were tested for repeat VL.ConclusionThe average adherence level of HCPs to the EAC intervention protocol was very inadequate. The main gap identified was difficulties in completing the EAC intervention sessions based on schedules. Implementing adherence improvement strategies, assigning an adequate number of EAC providers in ART and Prevention of Mother-to-Child Transmission (PMTCT) clinics, and allowing sufficient time during EAC sessions are important.

Quantitative SPECT/CT Metrics in Early Prediction of [177Lu]Lu-DOTATATE Treatment Response in Gastroenteropancreatic Neuroendocrine Tumor Patients.

Our objective is to explore quantitative imaging markers for early prediction of treatment response in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) undergoing [177Lu]Lu-DOTATATE therapy. By doing so, we aim to enable timely switching to more effective therapies in order to prevent time-resource waste and minimize toxicities. Methods: Patients diagnosed with unresectable or metastatic, progressive, well-differentiated, receptor-positive GEP-NETs who received 4 sessions of [177Lu]Lu-DOTATATE were retrospectively selected. Using SPECT/CT images taken at the end of treatment sessions, we counted all visible tumors and measured their largest diameters to calculate the tumor burden score (TBS). Up to 4 target lesions were selected and semiautomatically segmented. Target lesion peak counts and spleen peak counts were measured, and normalized peak counts were calculated. Changes in TBS (ΔTBS) and changes in normalized peak count (ΔnPC) throughout treatment sessions in relation to the first treatment session were calculated. Treatment responses were evaluated using third-month CT and were binarized as progressive disease (PD) or non-PD. Results: Twenty-seven patients were included (7 PD, 20 non-PD). Significant differences were observed in ΔTBSsecond-first, ΔTBSthird-first, and ΔTBSfourth-first (where second-first, third-first, and fourth-first denote scan number between the second and first, third and first, and fourth and first [177Lu]Lu-DOTATATE treatment cycles), respectively) between the PD and non-PD groups (median, 0.043 vs. -0.049, 0.08 vs. -0.116, and 0.109 vs. -0.123 [P = 0.023, P = 0.002, and P < 0.001], respectively). ΔnPCsecond-first showed significant group differences (mean, -0.107 vs. -0.282; P = 0.033); ΔnPCthird-first and ΔnPCfourth-first did not reach statistical significance (mean, -0.122 vs. -0.312 and -0.183 vs. -0.405 [P = 0.117 and 0.067], respectively). At the optimal threshold, ΔTBSfourth-first exhibited an area under the curve (AUC) of 0.957, achieving 100% sensitivity and 80% specificity. ΔTBSsecond-first and ΔTBSthird-first reached AUCs of 0.793 and 0.893, sensitivities of 71.4%, and specificities of 85% and 95%, respectively. ΔnPCsecond-first, ΔnPCthird-first, and ΔnPCfourth-first showed AUCs of 0.764, 0.693, and 0.679; sensitivities of 71.4%, 71.4%, and 100%; and specificities of 75%, 70%, and 35%, respectively. Conclusion: ΔTBS and ΔnPC can predict [177Lu]Lu-DOTATATE response by the second treatment session.

The Pattern of Dissociative Symptoms Differs between Post-Traumatic Stress Disorder and First Esketamine Administration for Treatment-Resistant Depression

Abstract Objective Dissociative symptoms are commonly observed during the first administration of esketamine for the treatment of Treatment-Resistant Depression (TRD) and in a substantial minority of patients with Post-Traumatic Stress Disorder (PTSD). We examine differences in the number and pattern of dissociative symptoms (depersonalization, derealization, dissociative amnesia, identity fragmentation) reported by these two groups. Data Selection Data for patients diagnosed with PTSD (N = 134) were drawn from studies of individuals with exposure to civilian traumas, childhood abuse or combat trauma. Data for patients with TRD undergoing their first treatment session with ESK (N = 759) were drawn from published results detailing the presentation of dissociative symptoms during FDA registration trials. Data Synthesis Dissociative symptoms in general were more prevalent in the ESK group (P &amp;lt; 0.01). However, a significant (p &amp;lt; 0.0001) Group x Item Domain interaction revealed that dissociative amnesia and identity fragmentation were endorsed more frequently relative to the other domains in the PTSD group relative to the ESK group. Depersonalization and derealization were the most prominent dissociative symptoms endorsed by the ESK group, whereas items from the dissociative amnesia domain were endorsed most frequently in the PTSD group. Conclusions The pattern of dissociative symptoms endorsed by patients with PTSD differs from that reported by patients with TRD receiving esketamine for the first time, suggesting the possibility that the etiology of “dissociative symptoms” may vary to some degree across therapeutic conditions.

Exploring the feasibility of preoperative tumor-bed boost, oncoplastic surgery, and adjuvant radiotherapy schedule in early-stage breast cancer: A phase II clinical trial.

Oncoplastic breast-conserving surgery (OBCS) improves satisfaction in patients who would fare otherwise sub-optimal cosmetic outcome, while brings challenge in tumor-bed identification during adjuvant radiotherapy. The ultra-hypofractionated breast radiotherapy further shortens treatment sessions from moderately hypofractionated regimens. To circumscribe the difficulty in tumor-bed contouring and the additional toxicity from larger boost volumes, we propose to move forward the boost session preoperatively from the adjuvant radiation part. Thus, the present study aims to evaluate the feasibility of a new treatment paradigm of preoperative primary-tumor boost before breast-conserving surgery (BCS) or OBCS followed by adjuvant ultra-hypofractionated whole-breast irradiation (u-WBRT) for patients with early-stage breast cancer. There was a phase II study. Patients younger than 55 years old, with a biopsy confirmed mono-centric breast cancer, without lymph node involvement were enrolled. Preoperative primary-tumor boost was given by a single 10Gy in 1 fraction, and BCS or OBCS was conducted within two weeks afterwards. Adjuvant u-WBRT (26Gy/5.2Gy/5f) was given in 6 weeks postoperatively without any boost, after the full recovery from surgery. Surgical complications and patient-reported outcomes, as assessed via Breast-Q questionnaires, were documented. A propensity score matching approach was employed to identify a control group at a 1:1 ratio for BREAST-Q outcomes comparison. From May 2022 to September 2023, 36 patients were prospectively enrolled. Surgical complications were observed in 7 cases (19.4%), including 3 cases with Clavien-Dindo (CD) grade 1-2 and 4 cases with CD grade 3 complications. All but four patients (11.1%) started the planned u-WBRT within one week after the pre-defined due dates postoperatively (≤49d). Four patients (11.1%) developed grade 2 radiodermatitis after chemotherapy initiation. Compared to the study group, the control patients reported higher scores in chest physical well-being (P=0.045) and in their attitudes towards arm swelling (P=0.01). No significant difference was detected in the other of domains (Satisfaction with Breasts, Sexual and Psychosocial Well-Being, and Adverse Effects of Radiation). With a median follow-up period of 9.8 months (2.4-18.9mo), none had any sign of relapse. This Phase II clinical trial confirmed the technical and safety feasibility of novel radiation schedule in patients undergoing BCS or OBCS. According to the BREAST-Q questionnaire, patients who underwent novel radiation schedules reported lower satisfaction in chest physical well-being. A randomized controlled trial is necessary to further investigate these findings. Additionally, long-term follow-up is required to assess oncological outcomes.

A - 27 Case Study Approach to Initial Exploration of Adaptations of Cognitive Behavioral Therapy (CBT) for Non-Epileptic Seizures (NES) in the Context of Cognitive Impairment

Abstract Objective The following case study seeks to review implementation of CBT for NES, discuss psychotherapeutic adaptations and outcomes while balancing treatment fidelity, and offer preliminary recommendations for expansion of psychotherapeutic modalities for individuals with cognitive impairment. Methods 49-year-old Hispanic male with a history of mixed epileptic (non-lesional frontal lobe medically refractory) and non-epileptic events. Neurological workup included video EEG, which captured seven events without EEG correlate and an unremarkable brain MRI. Neuropsychological evaluation indicated mild cognitive impairment due to epilepsy with deficits in processing speed, executive functioning, and confrontation naming with borderline to low average core visual and verbal abilities. The patient participated in manualized CBT for PNES. Results Treatment adaptations included extending treatment sessions from 12–19 sessions and including the patient’s sister. They read the chapters together and practiced strategies outside of session. She participated in helping him notice patterns of manifestations of fear and anger and their influence on somatic symptoms. Omission of treatment elements with higher cognitive demand (i.e., thought chart). Outcomes included increased awareness of emotions, triggers, and warnings but not episode reduction in the context of increased epileptic seizures. Conclusions Feasibility of treatment may be limited for individuals with mixed epileptic and NES episodes, particularly if there is cognitive impairment and difficulty differentiating between the two. Psychotherapeutic techniques that are concrete and behaviorally based will = be beneficial for individuals with cognitive impairment. Episode reduction in isolation is likely reductionistic when considering treatment effectiveness. Ability to self-manage episodes, quality of life, functional status, and self-efficacy are valuable markers of improvement.

In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression

BackgroundDepression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial.MethodsWe recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could ‘enrol’ a family member/ ‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement.ResultsStudy 1Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention.Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome.Study 2Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention.Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward.

Approach Bias and Tobacco Craving as Mechanisms of the Effect of Approach Bias Retraining on Smoking Cessation.

Approach bias, the automatic tendency to advance toward, rather than move away from appetitive cues, has been associated with greater tobacco cravings, dependence, and likelihood of smoking relapse. Approach bias retraining (ABR) has emerged as one way to reduce approach bias and promote avoidance toward smoking cues. Yet, additional research is needed to identify the mechanisms that may help explain the effect of ABR on smoking cessation. The current study uses data collected as part of a randomized controlled trial to test two unique mechanisms of action ([1] approach bias and [2] tobacco craving) for the efficacy of standard smoking cessation treatment (ST) augmented by ABR on smoking abstinence. Participants were 96 adult daily smokers (Mage=43.1, SD=10.7) motivated to quit smoking. Results showed that lower approach bias and lower cravings at a treatment session were significantly related to next session smoking abstinence (p's<.018). Further, deviations in approach bias partially mediated the effect of ABR on smoking abstinence (ab=-12.17, 95%CI: [-29.67, -0.53]). However, deviations in tobacco craving did not mediate this relation (ab=.40, 95%CI: [-.27, 1.34]). The current findings add to extant literature by identifying approach bias as a mechanism of action of the effect of ABR on smoking abstinence during smoking cessation treatment. The current study adds to our knowledge on the effectiveness of approach bias retraining (ABR) as a part of smoking cessation treatment. Results indicate that reductions in approach bias partially mediate the effect of ABR on smoking abstinence. These findings are consistent with previous research on alcohol-dependent adults and underline the potential of ABR to reduce approach bias and promote smoking cessation among smokers. Such findings could inform the development of future research exploring more targeted and effective smoking cessation interventions, ultimately improving outcomes for individuals attempting to quit smoking.

The cervico-ocular reflex changes following treatment in individuals with subclinical neck pain: a randomized control trial.

Individuals with subclinical neck pain (SCNP) exhibit altered cerebellar processing, likely due to disordered sensorimotor integration of inaccurate proprioceptive input. This association between proprioceptive feedback and SMI has been captured in cervico-ocular reflex (COR) differences where SCNP showed higher gain than healthy participants. Previous neurophysiological research demonstrated improved cerebellar processing in SCNP participants following a single treatment session, but it is unknown whether these neurophysiological changes transfer to cerebellar function. In a parallel group, randomized control trial conducted at Ontario Tech University, 27 right-hand dominant SCNP participants were allocated to the 8-week chiropractic care (n = 15; 7M & 8F) or 8-week control (n = 12; 6M & 6F) group. COR gain (ratio of eye movement to trunk movement) was assessed using an eye-tracking device at baseline and at post 8-weeks (treatment vs. no treatment). COR gain (10 trials): participants gazed at a circular target that disappeared after 3s, while a motorized chair rotated their trunk at a frequency of 0.04Hz, with an amplitude of 5º, for 2 minutes. A 2 × 2 repeated measures ANOVA was performed. COR gain was significantly reduced following 8-weeks of chiropractic care compared to the SCNP control (8-weeks of no treatment) group (p = 0.012, ηp2 = 0.237). The decrease in COR gain following treatment is likely due to normalized proprioceptive feedback from the neck, enabling improved processing and integration within the flocculonodular lobe of the cerebellum.