Significant Increase In Patients Research Articles

PCL Preservation vs. PCL Sacrifice: Comparing Patient Outcomes in Medial Congruent Total Knee Arthroplasty.

The aim of this study was to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (n=9) with either PCL preservation (n=264) or sacrifice (n=134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90 day complications, and patient reported outcomes were recorded for each patient. There were no differences in pre-op baseline function or patient-reported outcome measures (PROMs), Charlson Comorbidity Index (COI), or American Society of Anesthesiologists (ASA) class amongst patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12 week post-op Knee injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (p<0.05). Yet, no complications within the 90 day period were associated with PCL status and other patient-reported outcomes. This manuscript comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores and complication rates which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared to the PCL-preserving at early follow up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.

Estimation of antioxidant enzymes in hemodialysis patients

Background Oxidative stress in hemodialysis (HD) is a critical concern in the management of patients. HD, a life-sustaining renal replacement therapy, exposes individuals to various factors that promote the production of harmful reactive oxygen species within the body. These reactive oxygen species, including free radicals, can overwhelm the body’s antioxidant defenses, leading to oxidative stress. Objective This study aimed to evaluate the activities of superoxide dismutase (SOD), glutathione peroxides (GPx) and catalase (CAT), and serum malondialdehyde (MDA) levels with dyslipidemia in HD patients and compare them with control groups. Patients and methods The case–control study was conducted on 75 patients undergoing HD and 75 age-matched healthy controls. Oxidative stress markers include CAT, SOD, GPx, and MDA. Serum electrolytes including potassium ion (K+), phosphate (PO4), calcium (Ca+), urea, and creatinine (Cr) were measured for each group. Results Our results show a significant difference between patients and the control group in each of the oxidative stress markers, which are CAT, GPx, and SOD, showing a decrease that is statistically significant in patients in comparison to the controls. The level of MDA shows an increase that is statistically significant in patients in comparison to the controls. Serum electrolyte levels, which are K+, PO4, urea, and Cr, show a statistically significant increase in patients in comparison to the controls. Ca+ shows a decrease that is statistically significant in patients in comparison to the controls. Conclusions From the results, we could conclude that oxidative stress plays a role in HD patients and can affect the management of end-stage renal failure patients.

P-044 Increased CYP1A1 expression enhances sperm apoptosis in idiopathic infertile men

Abstract Study question How are the CYP1A1 and Caspase-9 genes expression and the relationship among the expression of these genes with sperm parameters in idiopathic infertile men? Summary answer The CYP1A1 and Caspase-9 gene expression showed a significant increase in patients in comparison with the healthy group. What is known already CYP1A1 (Cytochrome P450 Family 1 Subfamily A Member 1) plays a crucial role in xenobiotic metabolism induced by aryl hydrocarbon receptor (AHR). AHR, as a ligand-activated transcription factor is involved in exogenous ligand activation. CYP1A1 is one of the most essential enzymes in phase 1 of detoxification, metabolism, and bio-activation of carcinogens and is the most well-known target gene for AHR. Monooxygenase activity of CYP1A1 may lead to oxidative stress and the formation of reactive intermediates with destructive effects such as apoptosis in testicular germ cells. CYP1A1 may lead to apoptosis via Caspase-9 activation. Study design, size, duration In this study, we aimed to determine the CYP1A1 and Caspase-9 gene expression. Participants/materials, setting, methods The infertile idiopathic and healthy fertile men were selected and evaluated for sperm analysis and gene expression. The expression levels of CYP1A1 and Caspase-9 were also determined by real time PCR. Main results and the role of chance The sperm count, morphology and motility were significantly lower in patients compared to the control group (p &amp;lt; 0.05). The CYP1A1 and Caspase-9 gene expression showed a significant increase in patients in comparison with the healthy group (p &amp;lt; 0.05). Limitations, reasons for caution Further investigations of the effect of CYP1A1 and Caspase-9 expressions on infertility by using more infertile patients and also studying the effect of other important genes such as AHR can show us more accurate results. Wider implications of the findings Our results suggest that increased CYP1A1 and Caspase-9 expression could increase the rate of male infertility. In addition, the increase in Caspase-9 expression could lead to a reduced number of sperms and an increased infertility rate by increased apoptosis in the spermatogenic lineage. Trial registration number not applicable

Nutrition Screening for 2-5 Years Old Children by Screening Tool for the Assessment of Malnutrition in Paediatrics in Outpatient Setting

Abstract Introduction and Aim of the work Malnutrition is the primary causative factor of pediatric mortality and repeated hospitalization. The aim of this study is to highlight the role of nutrition screening in identifying those at risk of malnutrition who may benefit from nutritional interventions and test whether the nutritional supplements are essential during nutritional rehabilitation. Patients and methods Screening for malnutrition of 3640 children at the outpatient clinic of Ain Shams Pediatric hospital by Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) followed by assessing 100 patients at high risk of malnutrition by anthropometric measurements, then BMI and z scores were computed. Oral nutritional supplement was advised in the rehabilitation program only in group A. Nutritional response testing was performed by reassessment at three and six months. Results The prevalence of underweight, stunting and wasting were 5.9%, 15.6%, and 9.4% respectively. As per STAMP, 14.7% were found to be nutritionally at low risk, 7.3% at intermediate risk, and 5.1% at high risk compared to 72.83% without risk for malnutrition. STAMP showed a significant increase in patients at low risk and decrease in patients at high risk through follow up in both groups with better percentages in group A which coincides with improvement in anthropometric indices. Conclusion STAMP is a sensitive, quick, and easy to use nutritional screening tool with a crucial role in identifying nutrition risk at outpatient services which can lead to implementing prompt nutritional rehabilitation. Tailored nutritional plans can accomplish good response and adding a nutritional supplement to the dietary plan ensures earlier goal achievement.

Biomarker Identification and Risk Prediction Model Development for Differentiated Thyroid Carcinoma Lung Metastasis Based on Primary Lesion Proteomics.

The rising global high incidence of differentiated thyroid carcinoma (DTC) has led to a significant increase in patients presenting with lung metastasis of DTC (LMDTC). This population poses a significant challenge in clinical practice, necessitating the urgent development of effective risk stratification methods and predictive tools for lung metastasis. Through proteomic analysis of large samples of primary lesion and dual validation employing parallel reaction monitoring and IHC, we identified eight hub proteins as potential biomarkers. By expanding the sample size and conducting statistical analysis on clinical features and hub protein expression, we constructed three risk prediction models. This study identified eight hub proteins-SUCLG1/2, DLAT, IDH3B, ACSF2, ACO2, CYCS, and VDAC2-as potential biomarkers for predicting LMDTC risk. We developed and internally validated three risk prediction models incorporating both clinical characteristics and hub protein expression. Our findings demonstrated that the combined prediction model exhibited optimal predictive performance, with the highest discrimination (AUC: 0.986) and calibration (Brier score: 0.043). Application of the combined prediction model within a specific risk threshold (0-0.97) yielded maximal clinical benefit. Finally, we constructed a nomogram based on the combined prediction model. As a large sample size study in LMDTC research, the identification of biomarkers through primary lesion proteomics and the development of risk prediction models integrating clinical features and hub protein biomarkers offer valuable insights for predicting LMDTC and establishing personalized treatment strategies.

التنبؤ المبكر بالاعتلال الكلوي لمرضى عراقين مصابين بالسكري النوع الثاني بدلالة تقييم بعض العوامل البيوكيمائية ذات الصلة

داء السكري من النوع 2 (T2DM) هو مرض معقد يصيب العديد من الأعضاء إلى جانب البنكرياس مثل الكلى والكبد والدماغ والعين. بسبب ارتفاع السكر في الدم لفترات طويلة وعدم السيطرة على مرض السكري مع وجود عوامل خطر أخرى ، يمكن أن تحدث مضاعفات مرض السكري. تشمل مضاعفات مرض السكري مضاعفات الأوعية الدموية الدقيقة والأوعية الدموية الكبيرة التي تستهدف الكلى. تهدف الدراسة الحالية إلى التحقق من مستوى الانجوتينسن المحول للانزيم ACE-2)) ، عامل نمو النسيج الضام (CTGF) جنبًا إلى جنب مع بعض العوامل البيوكيميائية ذات الصلة في النساء المصابات بداء السكري واعتلال الكلية السكري مقارنة بالضوابط الصحية. اشتملت الدراسة على 90 مريض تتراوح أعمارهم بين 30-65 سنة. يعانون من مرض السكري من النوع 2 مقسمون إلى ثلاث مجاميع على أساس معايير ACR تشمل البيلة الألبومينية الطبيعية ، البيلة الألبومينية الدقيقة ، البيلة الألبومينية الكبيرة 30 مريضًا لكل مجموعة و 30 شخصًا يتمتعون بصحة جيدة كانوا بمثابة المجموعة الضابطة ، منمن زاروا مستشفى بغداد التعليمي / المدينة الطبية و مستشفى اليرموك التعليمي ، في الفترة ما بين ديسمبر 2021 ومايو 2022. تم تحديد مستوياتACE-2 و CTGF باستخدام تقنية ELISA. أظهرت النتائج وجود فروق ذات دلالة إحصائية بين مجموعات المرضى والمجموعة الضابطة لعامل CTGF ، ووجد أن مستويات ACE-2 تزيد بشكل كبير في مجموعات المرضى عن مجموعة التحكم الصحية. كما أظهرت النتائج أن كلا من سكر الدم الصائم FBS و هيموكلوبينA1C (HbA1C)قد زاد بشكل ملحوظ في مجموعات المرضى مقارنة بالمجموعة الصحية. علاوة على ذلك ، كشفت قيم معدل الترشيح الكبيبي المقدر( ( eGFR عن فروق ذات دلالة إحصائية بين جميع المجموعات المدروسة ، وكذلك اظهرت نتائج ACR وجود فروقات ذات دلالة إحصائية بين مجموعات المرضى الثلاثة ، والتي تمثل المعايير الأساسية لتصنيف مجموعات المرضى. على أساس النتائج التي تم الحصول عليها في هذه الدراسة ، يمكن استنتاج ان عاملي ACE-2 و CTGF يمكن تطبيقهما كواسمات تنبؤية مبكرة موثوقة للكشف عن المرض.

The impact of purified protein derivative prior to intravesical bacillus Calmette-Guérin for the treatment of patients with non-muscle invasive bladder cancer.

The aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG. The study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated. There were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions. The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.

Estimate the Correlation Between Some Antioxidant Biomarkers and Pseudo Peroxidase Activity of Hemoglobin in Patients With Chronic Kidney Disease

Background: Hemoglobin, being a hemoprotein, may operate as a peroxidase due to the hemolysis process and the release of heme into the bloodstream. Objective: Evaluation of the oxidative biomarkers and peroxidase activity of hemoglobin in patients with the final stage of renal failure. Materials and Methods: The study encompassed a total of 200 blood samples, with 140 samples collected from patients diagnosed with Chronic Kidney Disease (CKD) and 60 samples obtained from individuals who were considered healthy control subjects. Results: Levels of various serum parameters, including total protein, urea, creatinine, albumin, free amino, disulfide, ischemia-modified albumin (IMA), peroxidase activity, and specific activity, exhibited a significant increase in patients with Chronic Kidney Disease (CKD) when compared to the control group consisting of healthy individuals. Conversely, CKD patients demonstrated a notable decrease in levels of glomerular filtration rate (GFR), hemoglobin, native thiols, and total thiols compared to the control group. Conclusion: Oxidative biomarkers may present useful information about oxidative stress and help to diagnose CKD patients in their advanced stages of the disease.

Expressions of CD80 and CD86 in Cancer Patients and Its Prognostic Significance

Background: Strategies for modulating the tumor microenvironment (TME) have opened up new treatment paths in a variety of malignancies, with dramatic but variable intertemporal success. Consequently, studying TME's molecular players may aid in understanding how tumor cells and TME interact. Tumor cells and infiltrative tumor lymphocytes express immune checkpoint proteins including Cluster of Differentiation 80 (CD80) and CD86 on their surface. CD80 and CD86 are members of the immunoglobulin superfamily (IgSF). The costimulatory protein CD28, which is present on the outermost portion of all T cells, and the inhibitory receptor CTLA-4 (cytotoxic T-lymphocyte antigen-4, also known as CD152) are ligands for CD86 and CD80. CD28 and CTLA-4 have essential yet opposing functions in T cell activation. T cell responses are stimulated when they bind to CD28, but they are suppressed when they connect to CTLA-4. Aim of the study: The goal of the study was to determine how much the CD80 and CD86 genes were expressed genetically. In five blood malignancies and ten solid tumors. Methods: Clinical specimen were collected from patient with different cancers attending Kirkuk oncology centre. Patients were categorised into two main groups: solid tumour group and Blood derived cancer group alongside with their control counterparts. The study investigated the genetic expression of the CD80 and CD86 genes using q RT-PCR technologies. Results: Using q RT- PCR we measured the expression of a gene CD80 /CD86. The results showed different levels of elevation in patient samples of solid tumors and hematological tumors and compared with the control group for this study First, evaluation of this marker CD80/CD86 in solid tumors showed a significant increase in patients with brain cancer compared to their counterparts in the control group. Secondly, the second solid tumor appears increased gene expression as ovarian cancer. The least expressed solid tumors are breast cancer. As for cancers that occur in the blood, lymphoma has an upregulation expression. And the least expression is CD80/CD86 were in ALL. Conclusion: There is evidence that several cancer types and immune cells have expressed CD80 and CD86. This investigation demonstrated that the cell surface markers CD80/CD86 have a role in progression of carcinomas of the brain.

Periodic limb movements in patients with suspected obstructive sleep apnea without comorbid conditions.

Periodic limb movement disorder (PLMD) and obstructive sleep apnea (OSA) are overlapping clinical syndromes with common risk factors. However, current literature has failed to establish a clear pathophysiological link between them. Thus, little is known about periodic limb movements (PLM) in otherwise healthy patients with suspected OSA. We performed a retrospective analysis of 112 patients (age: 44.5 ± 12.0 years, 14.3% female) with suspected OSA who underwent full night polysomnography for the first time. Patients with chronic diseases of any kind, recent infections, malignancies, or daily or regular use of any type of medication were excluded. Group comparisons were made based on the severity of OSA (using the apnea hypopnea index, AHI) or the periodic limb movement index (PLMI). Both, PLMI and the total number of periodic limb movements during sleep (PLMS), showed a significant increase in patients with severe OSA. In addition, AHI and apnea index (AI) were significantly higher in patients with PLMI >15/h, with a similar trend for hypopnea index (HI) (p < 0.001, p < 0.001, and p > 0.05, respectively). PLMI was significantly positive correlated with AHI, AI, and HI (r = 0.392, p < 0.001; r = 0.361, p < 0.001; and r = 0.212, p < 0.05, respectively). Patients with PLMI >15/h were significantly older (p < 0.001). There was no significant association between body mass index (BMI) and PLMI >15/h. We found a significant association between the severity of OSA and PLM in our study population with suspected OSA but without other comorbidities. PLMI and PLMS were significantly increased in patients with severe OSA. Future prospective studies with larger collectives should verify the presented results and should include mechanistic aspects in their evaluation.

Association of serum IL-30 and soluble GP130 with the risk of psoriasis vulgaris

Cytokines play a major role in the pathogenesis and progression of psoriasis. Interleukin (IL)-30 is a multifunctional cytokine. It binds to glycoprotein 130 (GP130) and inhibits the GP130 signaling pathways of psoriasis associated cytokines such as IL-6, IL-11, and IL-27. The study intended to assess associations of IL-30 and GP130 with the risk of psoriasis and Psoriasis Area Severity Index (PASI) score. Therefore, we measured the serum levels of IL-30 and GP130 in psoriasis patients and in a control group. An enzyme linked immunosorbent assay (ELISA) technique was used to measure IL-30 and GP130 levels in the serum of 43 patients and 43 normal controls. Statistical analysis of IL-30 and GP130 serum levels among patients and control groups and their correlation with PASI scores were performed. IL-30 serum levels showed a significant increase in patients with psoriasis compared with controls (p&lt;0.001) and a positive correlation with PASI scores. While serum levels of GP130 were not different in psoriatic patients and in the control group. Furthermore, the receiver operating characteristic (ROC) curve showed that IL-30 had diagnostic ability for prediction of psoriasis in comparison to controls, at cut of point of &gt;14.34 showed a sensitivity of 97.7%, 100% specificity. In conclusion, IL-30 was elevated in psoriasis patients than controls, therefore, it can be considered a sensitive biomarker for diagnosis of psoriasis.

Surgical treatment of chronic pancreatitis in children

Chronic pancreatitis in children is a continuous or recurrent disease characterized by irreversible inflammatory and destructive changes in the pancreas (PG), progressive fibrosis, accompanied by a gradual decrease in its exocrine and endocrine functions. In recent decades, there has been a significant increase in patients with CP; the incidence in children is estimated at 2 cases per 100,000 people. According to the literature, pancreatic cancer in the outcome of chronic pancreatitis in childhood is 6.2%. Mortality rates for CP vary in different studies: 15-20% of children with CP die from complications and secondary disorders. The purpose of the study is to study current problems and determine the prospects for the treatment of chronic pancreatitis in children based on a review of modern literature. Materials and methods. As part of the preparation, a systematic review of the world and domestic literature on the surgical treatment of chronic pancreatitis in children was carried out. Results. A literature search confirmed the lack of consensus regarding the surgical treatment of CP in children. The small number of observations does not allow us to analyze the long-term results of surgical treatment of children with CP. Patients with hereditary pancreatitis pose a particular challenge; treatment algorithms for this group of patients are not described in the literature. Also in the literature there are isolated descriptions of complications with CP in children; there are no reliable results of the effectiveness of surgical intervention for endocrine and exocrine insufficiency in children. It is necessary to conduct scientific and practical research to develop indications for surgical treatment of children with CP and to verify specific complications.

Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers – a randomized controlled study

BackgroundThis study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs.MethodsIn this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention.ResultsThe coalesced group (DT and DT +) revealed a significant increase in patients’ perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group’s HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation.ConclusionsThe DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one’s final days.Trial registrationThis study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.

Trends in management and outcomes of colon cancer in the United States over 15 years: Analysis of the National Cancer Database.

Management of colon cancer has changed over the last few decades. We assessed the trends in management and outcomes using the US National Cancer Database (NCDB). A retrospective analysis of all patients with colonic adenocarcinoma between 2005 and 2019 was conducted. The cohort was divided into three equal time periods: Period 1 (2005-2009), Period 2 (2010-2014), and Period 3 (2015-2019) to examine treatment and outcomes trends. The primary outcome was 5-year overall survival (OS). The study included 923,275 patients. A significant increase in patients with stage IV disease was noted in Period 3 compared to Period 1 (47.9% vs. 27.9%, respectively), whereas a reciprocal reduction was seen in patients with locally advanced disease (stage II: 20.8%-12%; stage III: 14.5%-7.7%). Use of immunotherapy significantly increased from 0.3% to 7.6%. Mean 5-year OS increased (43.6 vs. 42.1 months) despite the increase in metastatic disease and longer time from diagnosis to definitive surgery (7 vs. 14 days). A reduction in 30-day readmission (5.1%-4.2%), 30- (3.9%-2.8%), and 90-day mortality (7.1%-5%) was seen. Laparoscopic and robotic surgery increased from 45.8% to 53.1% and 2.9% to 12.7%, respectively. Median postoperative length of hospital stay decreased by 2 days. Rate of positive resection margins (7.2%-6%) and median number of examined lymph nodes (14-16) also improved. Minimally invasive surgery and immunotherapy for colon cancer significantly increased in recent years. Patient outcomes including OS improved over time.

Expressions of CD80 and CD86 in Cancer Patients and Its Prognostic Significance

Background: Strategies for modulating the tumor microenvironment (TME) have opened up new treatment paths in various malignancies, with dramatic but variable intertemporal success. Consequently, studying TME's molecular players may aid in understanding how tumor cells and TME interact. Tumor cells and infiltrative tumor lymphocytes express immune checkpoint proteins, including Cluster of Differentiation 80 (CD80) and CD86 on their surface. CD80 and CD86 are members of the immunoglobulin superfamily (IgSF). The costimulatory protein CD28, which is present on the outermost portion of all T cells, and the inhibitory receptor CTLA-4 (cytotoxic T-lymphocyte antigen-4, also known as CD152) are ligands for CD86 and CD80. CD28 and CTLA-4 have essential yet opposing functions in T cell activation. T-cell responses are stimulated when they bind to CD28 but suppressed when they connect to CTLA-4. Aim of the study: The goal was to determine how much the CD80 and CD86 genes were expressed genetically in five blood malignancies and ten solid tumors. Methods: Clinical specimens were collected from patients with different cancers attending Kirkuk Oncology Centre. Patients were categorized into two main groups: the solid tumor group and Blood derived cancer group alongside their control counterparts. The study investigated the genetic expression of the CD80 and CD86 genes using q RT-PCR technologies. Results: Using q RT- PCR, we measured the expression of a gene CD80 /CD86. The results showed different levels of elevation in patient samples of solid and hematological tumors, which were compared with the control group for this study. First, evaluation of this marker CD80/CD86 in solid tumors showed a significant increase in patients with brain cancer compared to their counterparts in the control group. Secondly, the second solid tumor appears to have increased gene expression as ovarian cancer. The least expressed solid tumors are breast cancer. As for cancers that occur in the Blood, lymphoma has an upregulation expression. The lowest expression is CD80/CD86, which was in ALL. Conclusion: There is evidence that several cancer types and immune cells have expressed CD80 and CD86. This investigation demonstrated that the cell surface markers CD80/CD86 have a role in the progression of brain carcinomas.

Valvular Prostaglandins Are Elevated in Severe Human Aortic Valve Stenosis.

Aortic valve stenosis (AVS) is the most common valvular disease in the developed world. AVS involves the progressive fibrocalcific remodeling of the aortic valve (AV), which impairs function and can ultimately lead to heart failure. Due to gaps in our understanding of the underlying mechanisms of AVS, there are no pharmacological treatments or dietary interventions known to slow AVS progression. Recent studies have begun to suggest oxylipins-a class of bioactive lipids-may be dysregulated in the valves of patients with AVS. We utilized high-performance liquid chromatography-tandem mass spectrometry to conduct a targeted oxylipin analysis on human AV tissue and plasma from a cohort of 110 patients undergoing AV surgery. We identified 36 oxylipins in human AV tissue with all showing significant increase in patients with severe AVS. A multivariate model including patient characteristics and valvular oxylipins identified the arachidonic acid-COX (cyclooxygenase) pathway-derived prostanoids to be the most associated with AVS severity. Plasma oxylipin levels were measured in a subset of AV surgery patients and compared with a control group of healthy participants, showing distinct oxylipin profiles between control and disease. Our comprehensive analysis of oxylipins in the human AV identified the inflammatory and osteogenic regulating prostanoids to be positively correlated with AVS severity. This elucidation of prostanoid dysregulation warrants further research into COX inhibition to mitigate AVS.

Abstract TMP37: Improved Outcomes for Acute Ischemic Stroke Patients After Implementation of the RapidAI Platform in a Comprehensive Stroke Center in Santiago, Chile

Introduction: In Latin America (LATAM), the prevalence of stroke is alarmingly high. The advancement of artificial intelligence (AI) technologies has potential to dramatically improve healthcare outcomes. RapidAI is a software solution that utilizes AI to quickly analyze imaging data to identify vascular occlusions and salvageable tissue. Physicians receive notifications and can review source images on the Rapid mobile app (RMA). Methods: This was a retrospective analysis of 1,672 consecutive acute stroke patients (AIS) treated at Clinica Alemana de Santiago between 2014-2023. Primary outcomes were the number of AIS patients treated with thrombolysis (IV tPA), mechanical thrombectomy (MT), or decompressive craniectomies as well as time to treatment. Secondary outcomes included discharge Modified Rankin score (mRS) and hospital length of stay (LOS). Results: This analysis included 824 patients pre-RapidAI installation and 848 after installation of Rapid CTP with hypodensity, CTA, ASPECTS, LVO and RMA communication. The baseline NIHSS and last know well to hospital arrival was balanced between the 2 study cohorts. Median time to IV tPA improved by 42 minutes (80 to 38 minutes, p &lt; 0.0001). IV tPA utilization increased from 23% to 30% post-Rapid (p = 0.0033). MT procedure utilization increased from 5% pre-Rapid to 10% (p &lt; 0.0001). Decompressive craniectomies were reduced from 13 to 4, LOS was unchanged. There was a favorable shift in the distribution of mRS scores at discharge in post-Rapid patients (p = 0.031) and a significant increase in mRS 0-1 outcomes (61% vs 45%). Discussion: Following implementation of the AI software platform in a comprehensive stroke center like Clinica Alemana, there was a significant increase in patients treated with IV tPA, faster door to tPA and/or MT times, a decrease in the number of DCTs, and improved discharge mRS scores. This work supports future studies expanding the use of AI technology for improving stroke outcomes in LATAM.

Abstract WP126: Improved Stroke Outcomes Following Implementation of RapidAI Platform at Ascension-Illinois

Introduction: The rapid advancement of artificial intelligence (AI) technologies holds promise for improving healthcare outcomes. RapidAI is a software solution that utilizes AI to rapidly analyze imaging data to identify vascular occlusions and salvageable tissue. Physicians receive notifications and can review source images on the Rapid mobile app (RMA). Methods: Data for this study were obtained from the Get with the Guidelines Stroke database. The study focused on adult patients (18 years or older) admitted to Alexian Brothers Medical Center in Illinois between 2019-2022 who were diagnosed with acute ischemic stroke. Primary outcomes were the number of AIS patients treated with thrombolysis (IV tPA or IV TNK) and/or mechanical thrombectomy (MT) and time to treatment. Door to MT puncture times for transfer patients were analyzed separately from direct presentation patients. Discharge Modified Rankin score (mRS) was assessed as a secondary clinical outcome. Results: This analysis included 1,732 patients, 1,193 prior to installation of the RapidAI platform and 539 after installation of Rapid CTP, CTA, ASPECTS, LVO and RMA. Median door to femoral puncture time for MT cases decreased from 2 hr 28 min to 1 hr 58 min (p=0.012) post-Rapid for non-transfer patients. Door to femoral puncture times for transfer patients were unchanged. MT procedure volume increased from 9.6% to 14.5% (p=0.007). IV tPA/TNK volume and door-to-needle (DTN) times were unchanged; 15% treated with tPA/TNK pre-Rapid and 14% post-Rapid, DTN 48 vs 47 min. There was an improvement in the distribution of discharge mRS scores in post-Rapid patients (p&lt;0.0001). Discussion: Following implementation of the AI software platform there was a significant increase in patients treated with MT, faster door to MT times for non-transfer patients, and improved discharge mRS scores. These data support future studies expanding the use of AI technology to improve stroke outcomes.

Pilot implementation of a telemedicine care bundle: Antimicrobial stewardship, patient satisfaction, clinician satisfaction, and usability in patients with sinusitis.

Telemedicine-specific clinical pathways (CPWs), coupled with electronic health record (EHR) order panels, provide an opportunity to ensure evidence and guideline concordant care for conditions at risk for inconsistent diagnoses and management strategies. Standardized provider and patient-facing illness scripts may fill gaps in clinicians' communication skills secondary to a training deficit in virtual care delivery. We aimed to implement and assess the impact of a novel care bundle for sinusitis on antimicrobial use, patient satisfaction, clinician satisfaction, and usability in patients with sinusitis. A sinusitis care bundle (SCB) for virtual urgent care patients included a sinusitis CPW with communication scripts, sinusitis order panels (SOP), and a patient education smart-phrase (SPESP) within visit instructions. Antimicrobial use was assessed during a 15-month period prior to the start of SCB element implementations and 14-months following, using statistical process control charts. Patient satisfaction was measured using Likert-style surveys. Clinician satisfaction was assessed using a novel survey addressing the SCB-targeted domains (decision support, communication, efficiency, usability, and overall satisfaction). There were 69,785 and 64,019 evaluable patients in the pre-care and post-care bundle periods, respectively. Despite a significant increase in patients receiving a sinusitis diagnosis in the post-care bundle period (3.2% pre- vs. 6.2% post-, p < 0.001), antimicrobial prescribing decreased by 3.9% (p < 0.001), with statistical process control evidence of special cause change. There was a 5.1% decrease (p < 0.001) in negative patient survey responses after implementation. Clinician survey revealed substantial agreement in the domains relating to improving communication with patients and/or families, with the highest satisfaction for the SPESP over the SOP. Implementation of a telemedicine care bundle for patients diagnosed with sinusitis can balance multiple elements of quality care. The combination of a clinical care pathway, standardized language, and order panels within the EHR has the potential to improve patient satisfaction and decrease antimicrobial prescribing.

Global DNA and RNA Methylation Signature in Response to Antipsychotic Treatment in First-Episode Schizophrenia Patients.

Schizophrenia is a heterogeneous chronic psychiatric disorder influenced by genetic and environmental factors. Environmental factors can alter epigenetic marks, which regulate gene expression and cause an array of systemic changes. Several studies have demonstrated the association of epigenetic modulations in schizophrenia, which can influence clinical course, symptoms, and even treatment. Based on this, we have examined the global DNA methylation patterns, namely the 5-methylcytosine (5mC), 5-hydroxymethylcytosine (5hmC), 5-formylcytosine (5fC); and the global RNA modification N6-methyladenosine (m6A) RNA methylation status in peripheral blood cells. First-Episode Psychosis (FEP) patients who were diagnosed with Schizophrenia (SCZ) and undergoing treatment were stratified as Treatment-Responsive (TR) and Treatment-Non-Responsive (TNR). Age- and sex-matched healthy subjects served as controls. The methylation pattern of 5mC and 5hmC showed significant increases in patients in comparison to controls. Further, when patients were classified based on their response to treatment, there was a statistically significant increase in methylation patterns in the treatment non-responder group. 5fC and m6A levels did not show any statistical significance across the groups. Further, gender-based stratification did not yield any significant difference for the markers. The study highlights the increased global methylation pattern in SCZ patients and a significant difference between the TR versus TNR groups. Global 5mC and 5hmC epigenetic marks suggest their potential roles in schizophrenia pathology, and also in the treatment response to antipsychotics. Since not many studies were available on the treatment response, further validation and the use of more sensitive techniques to study methylation status could unravel the potential of these epigenetic modifications as biomarkers for SCZ as well as distinguishing the antipsychotic treatment response in patients.