Significant Site Differences Research Articles

“Comprehensive Analysis of Factors Influencing Recurrence and Survival in Glioblastoma: Implications for Treatment Strategies”: A Single Center Study

Glioblastoma is a highly aggressive malignancy affecting the brain and central nervous system. It is the most common malignant primary brain tumor, yet its prognosis remains poor. Median survival typically ranges from around 13 months with standard treatment to up to 19.9 months in some recent clinical trials. Despite advances in treatment, the aggressive nature of glioblastoma continues to present significant challenges for improving patient outcomes. This study aimed to analyze various biological, radiological, and molecular factors associated with glioblastoma recurrence and to estimate survival outcomes. A total of 104 glioblastoma patients diagnosed between January 2017 and September 2022 were included. Patient demographics, treatment received, and molecular characteristics were obtained from the Electronic Patient Record (EPR). Tumor molecular characteristics were analyzed using the OnkoSight Advanced CNS NGS panel. Statistical analyses were performed to develop a prognostic model for glioblastoma recurrence and estimate survival rates. Among the patients, 65.4% had no recurrence, with a mean age of 63 years. No gender or BMI differences were observed, but ages <60 years were associated with recurrence. Radiological findings showed no significant differences in tumor size, necrosis, site, or focality. In multivariate analysis, the female gender, obesity, old age (>60 years), or bifocal tumors were associated with decreased glioblastoma recurrence. However, factors like tumor site, size, necrosis, MGMT promoter methylation, and EGFR alteration showed no significant association with recurrence. Median survival was 12 months, with older age significantly associated with shorter survival. Tumor sizes >4 cm showed shorter survival trends but not statistically significantly. Patients who lived longer experienced more tumor recurrence incidents. Standard or non-standard treatments were associated with longer median survival compared to no treatment. Our findings provide insights into factors influencing glioblastoma recurrence and survival. Age, gender, and tumor characteristics play pivotal roles in recurrence. Understanding these factors could aid in optimizing treatment strategies and improving patient outcomes. However, further multicentric investigations are needed to validate these findings. This study emphasizes the importance of considering biological and radiological factors in clinical decision-making for glioblastoma cases.

Association between placental site and successful induction of labor among postdate primiparous women.

This study aimed to determine the association between placental site and successful labor induction. This cross-sectional study recruited all postdate primiparous women undergoing induction of labor. Eligible women were subjected to proper history taking and clinical examination. Vaginal examination to determine the bishop score was done. Routine antenatal scan was done for fetal biometry and the placental site. Transvaginal ultrasound was done for cervical length assessment. Induction of labor was commenced and women were subdivided into those with successful induction (delivered vaginally) and those with failed induction (needed cesarean delivery). Successful induction was achieved in 73/91 (80.2%) participants. The bishop score was significantly increased among women with successful induction (4.6 ± 0.9 vs 3.9 ± 1.1, p value 0.014). In addition, the cervical length was significantly shorter among those who delivered vaginally (2.6 ± 0.5 vs 4.2 ± 0.5, p value 0.0001). There was no significant difference in the placental site among women with failed or successful induction. The cervical length was the only significant predictor for successful induction of labor (p value 0.0001). The placental site showed a non-significant role in the prediction of successful vaginal delivery (p value 0.280). The placental site is not associated with the outcome of labor induction. The cervical length was the significant predictor for successful induction of labor.

CT feature of irregular extensive ulceration as a predictor of liver metastasis in gastric gastrointestinal stromal tumours.

This study aimed to investigate whether the computed tomography (CT) finding of irregular extensive ulceration (IEU) can serve as a predictor of liver metastasis (LIM) in patients with gastric gastrointestinal stromal tumours (GISTs). This study retrospectively collected clinical and imaging data from 286 patients diagnosed with low-, intermediate-, or high-risk gastric GISTs, or primary lesions with LIM from three medical institutions. The patients were categorised into non-LIM and LIM groups according to whether they had synchronous or metachronous LIM. Multivariate logistic regression analyses were performed to identify significant predictors of LIM. Additionally, receiver operating characteristic (ROC) curve, subgroup, and pathologic-radiologic correlation analyses were conducted. A total of 124 patients were ultimately enroled. There were significant differences in sex, site, growth pattern, size, shape, ulceration and Ki-67 expression between LIM and non-LIM groups. ROC curve analysis demonstrated that IEU had the highest area under the curve for predicting LIM (AUC = 0.842; 95% CI: 0.760-0.924; p < 0.001). Multivariate analysis indicated that IEU was the most significant independent predictor of high LIM risk (OR = 88.62; 95% CI: 2.80-2803.54; p = 0.011). Subgroup analysis showed that IEU was more frequently associated with male sex, age ≤ 55 years, proximal sites, irregular shapes, mixed growth patterns, and a high Ki-67 expression. The CT feature of IEU serves as an independent predictor of LIM in gastric GISTs and is strongly associated with high Ki-67 expression. Question Accurate assessment of LIM risk in patients with gastric GISTs is crucial, yet current non-invasive predictors remain inadequate. Findings IEU on CT is an independent predictor of LIM, with high diagnostic accuracy and a significant association with elevated Ki-67 expression. Clinical relevance IEU on CT scans enables non-invasive risk stratification for LIM in gastric GISTs. Our study refined the assessment of ulceration types, highlighting significant heterogeneity, which may guide personalised treatment strategies.

Antigenicity and genetic properties of an Eurasian avian-like H1N1 swine influenza virus in Jiangsu Province, China

Pigs are vital genetic mixing vessels for human and avian influenza viruses because their tracheal epitheliums possess both sialic acid α-2,6-Gal and α-2,3-Gal receptors. Cross-species transmission of influenza A viruses from swine to humans occurs occasionally. The first case of human infection with the Eurasian avian-like H1N1 swine influenza virus (EAH1N1 SIVs) genotype G4 was detected in Jiangsu in February 2023, and backtracking epidemiological investigations did not reveal a clear source of the infection. The hemagglutination (HA) and neuraminidase (NA) amino acid variant sites, antiviral drug susceptibility, and antigenic variation of the isolated A/Jiangsu/27271/2023 (JS/27271/23) virus were analyzed, and we evaluated the protective effect of sera collected from occupationally exposed populations in 2024 against the virus. Compared with the vaccine strain, the nucleotide sequence similarities of JS/27271/23 HA and NA were 96.5 % and 95.2 %, respectively. JS/27271/23 was sensitive to polymerase inhibitors (favipiravir and baloxavir), and the antigenicity of its HA protein was 8-fold different from that of the vaccine strain. The percentage of occupationally exposed population with antibody titers of ≥ 40 against A/Hunan/42443/2015 (HN/42443/15) and A/Jiangsu/1/2011 (JS/1/11) were 7.25 % and 2.25 %, respectively, and the geometric mean titers (GMT) were 6.24 and 5.34, respectively. Out of 400 serum samples examined, none had antibody titers of ≥ 40 against JS/27271/23. This suggests that low serum levels of antibodies to EAH1N1 SIVs in occupationally exposed populations may not provide adequate protection because of significant differences in amino acid sites and antigenicity between this virus and the current vaccine strain of EAH1N1 SIVs. There is no evidence of human-to-human transmission of EAH1N1 SIVs. Therefore, surveillance for EAH1N1 SIVs and the development of new vaccine strains are required.

Geospatial Mapping and Seasonal Profiling of Urinary Schistosomiasis in Ase-Niger River Settlements: A Data-Driven Population-Base Study in Delta State, Nigeria.

This study is aimed to determine the geospatial, seasonal, age and gender prevalence and intensity of UgS; and to establish disease maps in the Ase-Niger River communities for effective drug administration. This study employed a 24 months longitudinal study design for parasitological investigations in 11 riparian communities of the Ase-Niger River basin, taking into cognizance their GPS locations imported into QGIS software for schistosomiasis mapping. A total of 7,219 urine samples with WHO structured questionnaires were retrieved and subjected to parasitological evaluation using swinnex urine filtration techniques. An overall prevalence of 48.10% was established. Geospatially, prevalence ranges from 34.27% (Ivrogbo) to 52.29% (Ase) with seasonal significant difference (p < 0.05) accounting for 76.19% of the total variance. Ashaka had the highest prevalence for both males (55.73%) and females (53.32%) with significant difference in the study sites (p < 0.05) accounting for 96.47% of the total variance. Age-group 11-20 years consistently maintain a high prevalence at all sites. The peak geometric mean intensity of 105.69 was obtained in the dry season at Lagos Iyede. Ashaka, Igbuku, Iyede-Ame, and Onogboko had heavy-intensity levels in both seasons. Overall, the intensity was lower during the wet season than the dry season, with significant variations (p < 0.05) at Awah and Itobi-Ige. Geospatial prevalence and intensity have a robust and strong positive correlation (r = 0.7178; p = 0.0129), with 51.53% of intensity variability being influenced by prevalence (R2 = 0.5153). UgS is a significant public health issue in the Ase-Niger River basin, with prevalences surpassing the national average of 29.0% which calls for MDA in these settlements.

321. ANASTOMOTIC LEAK WITH ENHANCED RECOVERY PROTOCOL VERSUS CONVENTIONAL CARE AFTER ESOPHAGECTOMY FOR CANCER: CLINICAL CHARACTERISTICS AND OUTCOMES

Abstract Objective The anastomotic leak (AL) is greatly concerned in the clinical pathway of enhanced recovery after surgery (ERAS) with esophagectomy. This retrospective study was to compare the clinical characteristics and outcomes of AL between the ERAS protocol and conventional care in patients undergoing esophagectomy for cancer. The strategy for improving the safety of ERAS was explored. Methods The clinical data and outcomes were retrospectively analyzed in patients with thoracic esophageal carcinoma who received esophagectomy with esophagogastric anastomosis and experienced a postoperative AL from January 2018 to August 2023. The “Non Tube Non Fasting” edition was implemented in the ERAS group. Results 33 ERAS and 141 conventional patients experienced an AL in 489 ERAS and 1424 conventional patients with esophagectomy. The incidence of AL was significantly lower in the ERAS group (6.7%, 33/489) than in the conventional group (9.9%, 141/1424) (P&amp;lt;0.05). AL rate had no significant differences in the anastomotic sites between the two groups: cervical region (7.0%, 31/443 vs. 10.1%, 126/1250) and intrathoracic region (4.3%, 2/46 vs. 8.6%, 15/174) (P&amp;gt;0.05). There were no significant differences in the time-related AL between the two groups: delayed AL (39.4%, 13/33 vs. 54.6%, 77/141) and AL after planned discharge (24.2%, 8/33 vs. 23.4%, 33/141) (P&amp;gt;0.05). 164 patients received endoscopy and presented no significant differences in the average length of leakage between the two groups (5.7±3.8mm vs. 6.1±4.6mm, P&amp;gt;0.05). The comparison of the incidence of the most common early clinical manifestations showed no significant differences between the two groups: cervical wound infection (24.2%, 8/33 vs. 23.4%, 33/141), tachyarrhythmia (93.9%, 31/33 vs. 87.2%, 123/141), fever beyond 38°C (87.9%, 29/33 vs. 91.7%, 135/141), leukocytosis (81.8%, 27/33 vs. 89.4%, 126/141), cervical subcutaneous emphysema (42.4%, 14/33 vs. 41.1%, 58/141), purulent drainage (6.1%, 2/33 vs. 19.1%, 27/141), dyspnea (21.2%, 7/33 vs. 31.9%, 45/141), and right pneumothorax (54.5%, 18/33 vs. 50.4%, 71/141) (P&amp;gt;0.05). The incidences of the time-related early alarm signals were not significantly different between the two groups: within 3 days after surgery (100%, 33/33 vs. 95.7%, 135/141), during postoperative 4 days to 7 days (0%, 0/33 vs. 3.5%, 5/141), and after postoperative 7 days (0%, 0/33 vs. 0.7%, 1/141) (P&amp;gt;0.05). The 30-day mortality was significantly higher in the ERAS group than in the conventional group, and there were no differences in the other outcomes between the two groups (Table). Conclusion The ERAS protocol does not deteriorate the clinical characteristics and outcomes of AL compared with conventional care in patients undergoing esophagectomy for cancer. Improving the identification of delayed AL and the AL-associated mortality can enhance the safety of ERAS.

Parallel evolution of methyltransferases leads to vobasine biosynthesis in Tabernaemontana elegans and Catharanthus roseus.

Monoterpenoid indole alkaloids (MIA) are one of the largest and most complex alkaloid class in nature, boasting many clinically significant drugs such as anticancer vinblastine and antiarrhythmic ajmaline. Many MIAs undergo nitrogen N-methylation, altering their reactivity and affinity to the biological targets through a straightforward reaction. Remarkably, all known MIA N-methyltransferases (NMT) originate from the neofunctionalization of ancestral γ-tocopherol C-methyltransferases (γTMTs), a phenomenon seemingly unique to the Apocynaceae family. In this study, we unveil and characterize a new γTMT-like enzyme from the plant Tabernaemontana elegans (toad tree): perivine Nβ-methyltransferase (TePeNMT). TePeNMT and other homologs form a distinct clade in our phylogenetic study, setting them apart from other γTMTs and γTMT-like NMTs discovered to date. Enzyme kinetic experiments and enzyme homology modeling studies reveal the significant differences in enzyme active sites between TePeNMT and CrPeNMT, a previously characterized perivine Nβ-methyltransferase from Catharanthus roseus (Madagascar periwinkle). Collectively, our findings suggest that parallel evolution of ancestral γTMTs may be responsible for the occurrence of perivine N-methylation in T. elegans and C. roseus.

Exoscope and Supermicrosurgery: Pros and Cons of 3D Innovation in Lymphatic Surgery.

Background: The surgical treatment of lymphedema has seen advancements in recent years, with supramicrosurgical lymphaticovenular anastomosis (sLVA) gaining global acceptance. The integration of 3D exoscopes into microsurgery offers potential ergonomic and educational benefits. However, systematic evaluation of their efficacy in sLVA remains limited. Methods: A retrospective cross-sectional study was conducted comparing the use of 3D exoscopes to conventional operating microscopes (OM) in sLVA surgeries. Patient data from January 2019 to January 2024 were reviewed, with demographic, clinical, and surgical outcome variables analyzed. Ergonomic assessments were performed using Rapid Entire Body Assessment (REBA) and Rapid Upper Limb Assessment (RULA), while surgeon satisfaction was evaluated through the Microsurgical Intraoperative Satisfaction and Comfort questionnaire (MISCq). Results: An analysis of 25 patients (OM group: n = 14; exoscope group: n = 11) revealed no significant differences in age, sex, etiology, or surgical site between the two groups. Surgical time, number of incisions, and number of anastomoses showed nonsignificant variations between the OM and exoscope groups. Ergonomic assessments indicated potential benefits with exoscope use, particularly for the assistant surgeon. Survey results demonstrated comparable levels of surgeon satisfaction with both instruments, with no significant differences in image quality, contrast, illumination, magnification, visual field, ergonomic maintenance, or stereoscopic orientation. Conclusions: The study suggests that 3D exoscopes are a valuable tool for sLVA supermicrosurgery, offering comparable outcomes to traditional microscopes with potential ergonomic advantages. Their integration into microsurgical practice may contribute to improved surgical comfort and team performance. Further research is warranted to confirm these findings and explore additional factors such as cost-effectiveness and long-term patient outcomes.

Variations of the abductor pollicis longus tendon and its insertion in the Thai population: Cadaveric study with clinical relevance

BackgroundThe abductor pollicis longus (APL) tendon exhibits significant anatomical variability, which is crucial for understanding its clinical implications in surgeries involving the thumb. While several studies have documented these variations in different populations, a systematic classification providing insights for surgical interventions targeting the thumb and its associated anatomical structures is rare. MethodsThis cadaveric study involved the dissection of 87 upper extremities from 44 embalmed cadavers (22 males, 22 females). The APL tendons were meticulously dissected, and the number of tendons slips and their insertion sites were recorded. Data were analyzed using Chi-square and Fisher's exact tests to assess differences in insertion sites between sexes and sides. ResultsThe number of APL tendon slips distal to the first extensor compartment ranged from 1 to 5, with double slips being the most common configuration. The primary insertion site was consistently the base of the first metacarpal bone, observed in all specimens. Secondary insertion sites included the abductor pollicis brevis muscle (67.82 %), trapezium (17.24 %), opponens pollicis muscle (5.75 %), and proximal phalanx (2.30 %). Statistical analysis showed no significant differences in the insertion sites between sides and sexes. A new classification system for APL tendon slips was developed, categorizing them into three main types (Type I, II, III), and two minor types (Type IV and V), based on the number and insertion sites of the tendons. Type II with double tendon slips was the most prevalent (48.28 %). Symmetrical findings were found in 21 cases (48.84 %), with subtype IIb being the most common pattern. ConclusionThis study highlights significant anatomical variations of the APL tendon in the Thai population, with important clinical implications for surgical planning and treatment of thumb-related conditions. The proposed classification system provides a structured framework for understanding these variations, aiding in the diagnosis and surgical management.

Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb: A Systematic Review and Meta-analysis of Clinical Outcomes.

Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes from a donor site into a limb affected by lymphedema to restore the normal flow of lymphatic fluid. Despite the increasing clinical experience with VLNT, there remains insufficient data to support its routine use in clinical practice. Here, we aim to evaluate the effectiveness and safety of VLNTs for upper limb lymphedema and compare clinical outcomes when using different donor sites. We carried out a systematic search of the literature through PubMed and Scopus databases for studies on VLNT for upper limb lymphedema. Primary and secondary outcomes included circumference reduction rate (CRR) and infection reduction rate by postoperative cellulitis episodes for the efficacy and safety of VLNT. Pooled analysis was performed using the inverse variance weighting meta-analysis of single means using the meta package in R software. Subgroup analyses were performed for donor and recipient sites, age groups, follow-ups, and symptom durations. Quality assessment was performed using the Newcastle-Ottawa Scale for nonrandomized studies. A total of 1089 studies were retrieved from the literature, and 15 studies with 448 upper limb lymphedema patients who underwent VLNT were included after eligibility assessment. The mean CRR was 34.6 (18.8) and the mean postoperative cellulitis episodes per year was 0.71 (0.7). The pooled analysis of CRR was 28.4% (95% confidence interval, 19.7-41.1) and postoperative cellulitis episodes showed a mean of 0.59 (95% confidence interval, 0.36-0.95) using the random-effect model. Subgroup analyses showed significant group differences in recipient site for CRR and postoperative cellulitis episodes with the wrist comprising the highest weights, and patients younger than 50 years showing a lower postoperative infection. Vascularized lymph node transfer using gastroepiploic flaps at the wrists has shown a significant difference in reductions of limb circumference and cellulitis episodes in upper limb lymphedema patients when compared with other donor sites. However, further prospective studies are needed to consolidate this finding.

Bevacizumab as Adjuvant Therapy in the Treatment of Keloid: A Randomized Clinical Trial

Background. Despite the availability of numerous therapies, keloid treatment remains a challenging clinical issue. Intralesional triamcinolone has been established as an effective corticosteroid treatment for keloids, while sporadic reports suggest the efficacy of intralesional verapamil. This study aimed to evaluate the safety and efficacy of bevacizumab as an adjuvant therapy for keloid treatment. Methods. This randomized controlled trial involved 38 patients diagnosed with keloid according to clinical criteria. The study compared the effects of intralesional triamcinolone combined with bevacizumab injections with intralesional triamcinolone alone. Patients were randomly assigned to either the combination treatment group, which received intralesional triamHEXAL® (20 mg/ml, every two weeks for three months) plus Avastin® (2.5 mg/ml, every two weeks for two months), or the single treatment group, which received intralesional triamHEXAL® alone. The Vancouver Scar Scale (VSS) was used for serial photographic records of scar evaluation, with differences in VSS scores considered the primary outcome, and changes in height and patient satisfaction visual analog score (VAS) were secondary outcomes. Results. A total of 38 patients participated, with a mean age (SD) of 35.32 (14.02) years and 50% male. No significant differences in age, BMI, disease duration, gender, causing, family history, or site were observed between the two groups. The single treatment group exhibited a mean reduction of 0.60 (95% CI: (−1.18, −0.01); P=0.045) in pigmentation score and a mean decrease of 1.37 (95% CI: (−2.68, −0.07); P=0.039) in total score compared to the combination treatment group after three months of treatment. There was a significant reduction in keloid height in the combination group after the end of the treatment (P=0.024). No significant differences in side effects were observed between the two groups. Conclusion. Our study demonstrates that bevacizumab can be considered an effective and safe adjuvant therapy option for keloid treatment, suggesting its potential as a promising treatment for the management of keloids. This trial is registered with IRCT20131119015455N5.

Abstract PO1-05-11: Efficacy of metformin as adjunctive therapy in patients with de novo metastatic breast cancer: a retrospective cohort study

Abstract Background: Metformin, an oral biguanide used for the treatment of type-2 diabetes mellitus (DM), has been shown in a considerable number of studies to have an anti-tumorigenic impact against breast cancer cells through several mechanisms,thereby improving breast cancer outcomes. However, the impact of metformin treatment on survival outcomes in patients with non-diabetic breast cancer is still under debate, with very few data available regarding metformin administration in de novo metastatic breast cancer (dnMBC). This study was conducted to investigate and evaluate the impact on survival outcomes of patients with dnMBC treated with metformin as adjunctive therapy at our institutes. Methods: All dnMBC women who received chemotherapy-based systemic therapy or combined with metformin administered orally in our hospitals between March 2007 and November 2016 were enrolled in the study. Data were retrospectively extracted from the patients’case records. Data were analyzed according the clinicopathological features and treatment outcomes. All specimens were rechecked for the purpose of the research. Overall survival (OS), as the study endpoint, was defined as the time from pathologically confirmed diagnosis to all-cause death or end of the follow-up time.Kaplan-Meier estimate was used to calculate the survival rates.The difference between metformin and non-metformin groups was compared by the log-rank method.Cox regression analysis (uni-and multivariate analysis) was used to assess the effect of variables on survival outcomes.Analyses were performed by Stata 17 software for windows version. Results: A total of 252 women with dnMBC were included with an average age of 54.41±11.61 years. Among them, 97 patients (including 11 DM patients) received chemotherapy-based systemic therapy plus oral administration of metformin 850-1000mg twice daily (metformin group), and 155 patients received chemotherapy-based systemic therapy (non-metformin group). There was no significant difference in body mass index, age, N-stage, P53 index, ER/PR status, HER-2 expression and initial metastatic sites between metformin group and non-metformin group. But there were differences in T-stage and Ki67 index between the two groups (Table 1). The median follow-up was 70 months.The median OS was 24 months.The 3-year and 5-year OS rates for all patients were 29.8% (95% CI:24.2% to 35.4%) and 11.6% (95% CI:7.5% to 16.7%),respectively; Log-rank test showed that the metformin group had a significant advantage over the non-metformin group in OS rates(p=0.0002).The 3-year and 5-year OS rates in the metformin group were 42.3% (95% CI:32.4% to 51.8%) and 21.2% (95% CI:12.8% to 31.1%), respectively; the same rates for non-metformin group were 21.9% (95% CI: 15.8% to 28.7%) and 5.6% (95% CI: 2.4% to 11.1%), respectively. Results of proportional hazards model, after adjustment for T-stage and Ki67 index, depicted an independent prognostic value of metformin use with multivariate hazard ratio of 0.61 (95% CI: 0.45 to 0.81) for OS compared to non-metformin group (p=0.001).No survival advantage was found for DM patients (0.59;95% CI:0.29 to 1.22; p=0.159). Conclusions: Our data support a favorable outcome for survival associated with metformin use in dnMBC patients. However, the retrospective nature and small sample size of the current study are major limitations to reliable conclusions about metformin's potential to improve OS in patients. Therefore, prospective evidence from phase-3 randomized controlled trials on the feasibility of metformin use in dnMBC is required before its routine use can be recommended. Keywords: Metformin; De novo metastatic breast cancer; Adjunctive therapy; Survival outcomes Citation Format: Ren Chongxi, Sun Jianna, Kong Lingjun, Hongjun Yu. Efficacy of metformin as adjunctive therapy in patients with de novo metastatic breast cancer: a retrospective cohort study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-05-11.

The Effects of the COVID-19 Pandemic on the Pattern of Fractures in Taif City, Saudi Arabia.

The COVID-19 pandemic forced the world to take restricted orders to control the spread of SARS-CoV-2 by limiting and controlling people's movement inside their countries. According to previous studies, the shutdown and quarantine affected orthopedic trauma presentations and patterns in many countries. This study aimed to show the change in the pattern of fractures in Taif City, Saudi Arabia, during the curfew period during the COVID-19 pandemic in 2020 and compare it with the same period in 2019. A retrospective study of all patients with fractures who came to the emergency room and were treated by the orthopedic department at Alhada Armed Forces Hospital, King Abdulaziz Specialist Hospital, and King Faisal Medical Complex, Taif City. During partial and total lockdowns between March 23 and June 21, 2020, Data was collected from this period during September 2023. Demographics, fracture type and site, mechanism of injury, length of admission, if admitted, and the management plan were documented. These fracture cases were compared with those within the same period of March-June from the previous year. All statistical analysis was done using two-tailed tests. There was a decrease in the number of fractures at the time of quarantine, with 69 cases in the three months of curfew in 2020, compared to 184 cases in the same three months in 2019. There was a significant difference in the anatomical site of fractures between the two years, with decreased radius/ulna fractures (P= 0.035) and foot fractures (P=0.010). Most fractures during the lockdown were due to home accidents, with a significant decrease in motor vehicle accidents (P=0.009). The pattern of fractures in Taif City was affected by the movement restriction during the COVID-19 pandemic. The number of fractures decreased by 62.5% during the quarantine compared with the pre-pandemic period. A significant decrease was noted in the number of hospitalized patients (33%) during the COVID-19 lockdown compared to 65.8% in the pre-pandemic period.

Abstract 5774: Are 19del and L858R really not the same disease entities

Abstract IntroductionThe similarities and differences between the two subtypes of common epidermal growth factor receptor (EGFR) mutations have been recognized by clinicians, but actual treatment strategies remain unchanged. The L858R mutation can be explained by the pharmacological conformational plasticity of the receptor protein and other co-occurring mutations, which may be subtypes of EGFR mutations or non-EGFR mutations, and differences in downstream signaling pathways. As long as we know that molecular differences lead to biological differences, it is a challenge for all of us that our treatment strategies must changeWe investigated the RWD, conformational structure and RNA expression profile about two types of common mutations in the mEGFR+ NSCLC patients.MethodWe collected the medical information for stage I-IIIA mEGFR+ NSCLC patients and explored the conformational structure by crystalized radiologic technique. And we performed RNA expression assay using multiplex IF and High-through-output Profiling. ResultOverall, the static structures of wild type (WT), L858R, and 19del (ΔL747-E749) EGFR did not show any significant differences. However, the difference in the static structure between WT-19del and L858R-19del was subtly greater than that of WT-L858R. In addition, further analyses demonstrated no significant structural differences in the phosphorylation sites. However, it should be noted that proteins do not exist as static structures in vivo, and they have a dynamic, flexible structure that changes over time, i.e., plasticity of proteins. Therefore, we investigated the X-ray B-factor value, which is an indicator of flexibility, dynamics, and plasticity of proteins. As expected, the loop or disordered regions mainly shows higher B-factor values, which indicates an active structure, highly changeable and dynamic. Together, the three types of the EGFR protein manifest wholly similar B-factor values, while several local regions present appreciably distinct B-factors. Physical properties such as the dynamic structure may affect intermolecular recognition of EGFR proteins and their function Recent biochemical and biophysical evidence suggests that oncogenic mutations have an impact on the conformational dynamics of enzymesConclusionIn conclusion, our results suggest that Patients with 19del and L858R mutations demonstrated a different clinical course. It is necessary to consider the dynamic structural characteristics and functional differences of EGFR membrane proteins. Citation Format: Yunseok Heo, Joo Ri Kim, Yeoun Eun Sung, Seoree Kim, Chan Kwon Jung, Jeong-Oh Kim, Jeong-yeon Shin, Guk Jin Lee, Sang hoon Chun, Seong Hyeon Bu, Young Ho Lee, Jin Hyoung Kang. Are 19del and L858R really not the same disease entities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5774.

Expression and clinical value of CXCR4 in high grade gastroenteropancreatic neuroendocrine neoplasms.

CXC chemokine receptor 4 (CXCR4) is associated with the progression and metastasis of numerous malignant tumors. However, its relationship with Gastroenteropancreatic Neuroendocrine Neoplasms Grade 3 (GEP-NENs G3) is unclear. The aim of this study was to characterize the expression of CXCR4 in GEP-NENS and to explore the clinical and prognostic value of CXCR4. This study retrospectively collected clinical and pathological data from patients with GEP-NENs who receiving surgery in Qilu Hospital of Shandong University from January 2013 to April 2021, and obtained the overall survival of the patients based on follow-up. Immunohistochemistry (IHC) was performed on pathological paraffin sections to observe CXCR4 staining. Groups were made according to pathological findings. Kaplan-Meier (K-M) curve was used to evaluate prognosis. SPSS 26.0 was used for statistical analysis. 100 GEP-NENs G3 patients were enrolled in this study. There was a significant difference in primary sites (P=0.002), Ki-67 index (P<0.001), and Carcinoembryonic Antigen (CEA) elevation (P=0.008) between neuroendocrine tumor (NET) G3 and neuroendocrine carcinoma (NEC). CXCR4 was highly expressed only in tumors, low or no expressed in adjacent tissues (P<0.001). The expression level of CXCR4 in NEC was significantly higher than that in NET G3 (P=0.038). The K-M curves showed that there was no significant difference in overall survival between patients with high CXCR4 expression and patients with low CXCR4 expression, either in GEP-NEN G3 or NEC (P=0.920, P=0.842. respectively). Differential expression of CXCR4 was found between tumor and adjacent tissues and between NET G3 and NEC. Our results demonstrated that CXCR4 can be served as a new IHC diagnostic indicator in the diagnosis and differential diagnosis of GEP-NENs G3. Further studies with multi-center, large sample size and longer follow-up are needed to confirm the correlation between CXCR4 expression level and prognosis.

Innovative Clinical Scenario Simulator for Step-by-Step Microsurgical Training.

Microsurgical training should be implemented with consideration of operative difficulties that occur in actual clinical situations. We evaluated the effectiveness of a novel clinical scenario simulator for step-by-step microsurgical training that progressed from conventional training to escalated training with additional obstacles. A training device was designed according to multiple and intricate clinical microsurgery scenarios. Twenty surgical residents with no experience in microsurgery were randomly assigned to either the control group (conventional training curricula, n = 10) or the experimental group (step-by-step training courses, n = 10). After 4 weeks of laboratory practice, the participants were scheduled to perform their first microvascular anastomoses on patients in an operating room. The Global Rating Scale (GRS) scores and operative duration were used to compare microsurgical skills between the two groups. There were no significant differences in the participants' baseline characteristics before microsurgical training between the groups with respect to age, sex, postgraduate year, surgical specialty, or mean GRS score (p < 0.05). There were also no significant differences in recipient sites between the two groups (p = 0.735). After training, the GRS scores in both groups were significantly improved (p = 0.000). However, in the actual microsurgical situations, the GRS scores were significantly higher in the experimental than control group (p < 0.05). There was no significant difference in the operative duration between the two groups (p < 0.13). Compared with a traditional training program, this step-by-step microsurgical curriculum based on our clinical scenario simulator results in significant improvement in acquisition of microsurgical skills.

Exploring the influence of DNA methylation and single nucleotide polymorphisms of the Myostatin gene on growth traits in the hybrid grouper (Epinephelus fuscoguttatus (female) × Epinephelus polyphekadion (male)).

Investigations into the correlation between growth characteristics and DNA methylation levels, along with genetic variations, can provide fundamental insights to enhance growth performance in groupers. The Myostatin (mstn) gene plays a vital role in regulating skeletal muscle development and growth. This study scrutinized the DNA methylation levels of the mstn gene across hybrid groupers (E. fuscoguttatus (♀) × E. polyphekadion (♂)) and their parental species, to evaluate its impact on growth attributes in grouper fish. The nucleotide sequence of the mstn gene was directly sequenced in the hybrid grouper, exhibiting different growth performance to identify the single nucleotide polymorphisms (SNPs) of the mstn gene and explore their correlation with growth characteristics. The findings revealed no significant differences in global DNA methylation levels within muscle tissue among the hybrid grouper and parents. However, significant differences in DNA methylation sites were discovered between the hybrid grouper and E. polyphekadion at sites 824 and 1521 (located at exon 2 and intron 2, respectively), and between E. fuscoguttatus and E. polyphekadion at site 1521. These variations could potentially influence the mRNA expression of the mstn gene. The study also identified that SNP g.1003 T > C in exon 2 of the mstn gene was significantly associated with various growth traits including body weight, total length, body length, head length, caudal peduncle height, and body height (p < 0.01). Specimens with the TT genotype at site 1003 demonstrated superior growth performance compared to those with the TC genotype. Furthermore, microstructural analyses of muscle tissue showed that the average area and diameter of muscle fibers in TT genotype individuals were significantly greater than those in TC genotype individuals. Therefore, this research provides robust evidence linking the DNA methylation level and polymorphisms of the mstn gene with growth traits, which could be beneficial for grouper breeding programs.

Lumbar Epidural versus Caudal Epidural for Postoperative Analgesia After Lower Extremity Osteotomy Surgery in Pediatric Patients with Osteogenesis Imperfecta: A Propensity-Matched Cohort Analysis in a Single-Center Over 9 Years.

Although pediatric epidural analgesia is a well-established technique used perioperatively. It is unclear whether a lumbar or caudal epidural is suitable for osteogenesis imperfecta (OI) patients, which may be associated with brittle bones and spine deformity. We conducted a retrospective study to investigate and compare the efficacy of the two continuous epidural techniques in pediatric patients undergoing lower extremity osteotomy surgery using a propensity score-matched analysis (PSMA). A total of 274 patients were included. Patients' age, weight, and height were adjusted using PSMA. 90 patients were matched for further analysis, with 45 patients in the lumbar epidural group (Group L) and 45 patients in the caudal epidural group (Group C). Pain scores were categorized into three grades: mild (0-3), moderate (4-6), and severe (7-10), and compared between the two groups. Additionally, operation time, operation site, blood loss, scoliosis, oral analgesic medications, and catheter or nerve-related complications were compared. There were no significant differences in operation time, operation site, scoliosis, and blood loss between the two groups. The percentage of moderate to severe pain during movement was significantly higher in Group L than in Group C, with 37.5% versus 17.5% on the second-day post-operation (P=0.039). However, no statistically significant difference was observed on other days. Additionally, there was no significant difference in oral medication consumption and complications between the two groups. Both lumbar and caudal epidural analgesia can be effectively used postoperatively, and a caudal epidural should be considered where performing a lumbar epidural is challenging in OI pediatric patients.

Preoperative tamsulosin effect on postoperative urinary retention following spinal surgery: A randomized controlled trial

BackgroundCurrent study aims to investigate pre-surgical medical intervention on the reduction of POUR incidence in patients undergoing spine surgery. MethodThe study was a single center double-blind randomized placebo clinical trial. Participants were individuals over 18 years old who underwent spinal surgery at the Educational and Therapeutic Hospital between 2020 and 2023. Inclusion criteria included the ability to provide informed consent and follow the study schedule, while exclusion criteria included certain medical conditions, current medication use, and inability to take oral medication after surgery. ResultsThe study enrolled 100 patients. There was no significant difference in age or gender distribution between the tamsulosin and placebo groups, but the tamsulosin group had a lower prevalence of diabetes. The duration of surgery was shorter in the tamsulosin group, and there was no significant difference in the surgical site. The tamsulosin group had significantly less post-void residual volume on the eighth day of the study, but there were no significant differences in urine output volume during surgery or residual urine volume before or after surgery. ConclusionTamsulosin may be effective in preventing postoperative urinary retention (POUR), but its effectiveness in treating established POUR is uncertain. The Tamsulosin group had significantly lower post-void residual volume after spine surgery. Considering the low risk of adverse effects, Tamsulosin could be considered for high-risk patients. However, patients should be aware of potential risks and seek medical attention if they experience adverse effects. Further research is needed to determine the best dosage and duration of treatment.

External and Internal Validity Considerations in Youth Effectiveness Trials: Lessons Learned from the COMET Study

ABSTRACT Objective Effectiveness trials aim to increase the generalizability and public health impact of interventions. However, challenges associated with this design present threats to external and internal validity. This paper illustrates these challenges using data from a two-site randomized effectiveness trial, the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET) and presents recommendations for future research. Method COMET was a randomized effectiveness trial conducted in 19 community mental health clinics in two states comparing three interventions: treatment as usual (TAU), TAU with measurement-based care (TAU+), and the Unified Protocol forTransdiagnostic Treatment of Emotional Disorders in Adolescents with MBC (UPA). Participants included 176 clinicians (mean age = 35.5; 85.8% cisgender female; 53.0% racially and/or ethnically minorized) and 196 adolescents (mean age = 14.7; 65.3% cisgender female; 69.4% racially and/or ethnically minorized). Analyses outlined participant flow from recruitment to study completion, described participant characteristics, and examined site differences. Results Analysis of participant flow suggested that recruitment and retention of clinicians and adolescents was challenging, raising questions about whether participants were representative of participating clinics. Both the clinician and adolescent samples were racially and ethnically diverse and adolescents were low income and clinically complex. Significant site differences were observed in clinician and adolescent characteristics. Conclusions While this study was successful in recruiting a diverse and historically under-represented sample, difficulties in recruitment and retention raise questions about external validity and site differences present challenges to internal validity of study findings. Suggestions for future effectiveness studies, drawing from implementation science approaches, are discussed.