Stage 4A Research Articles

Quantitative evaluation of the wide-field fundus photographs in eyes with severe stage 3 and stage 4A retinopathy of prematurity

BackgroundThe aim of the study was to investigate the quantitative differences between severe stage 3 and stage 4A retinopathy of prematurity (ROP) by evaluating the pre-treatment fundus photographs.MethodsThirty-three eyes with clinical diagnosed as severe stage 3 were classified as severe stage 3 group. Twenty-two eyes with retinal detachment without foveal involvement were classified as stage 4A group. Quantitative measurements were performed on pre-treatment 130 degree fundus photographs.ResultsIn the severe Stage 3 group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 18 eyes (55%), in 5 eyes (15%), and in none of the eyes, respectively. In the stage 4A group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 21 eyes (96%), in 22(100%) eyes, and in 17 eyes (77%), respectively. Dragging and vertical tractional bands were higher in the Stage 4A group than in the severe stage 3 group (p = 0.000). Disc-to-fovea distance, the width of the fibrous membranes, the total area of the fibrous membranes, total retinoschisis, and detachment areas were significantly higher in the stage 4A group than in the severe stage 3 group (respectively, p = 0.000,p = 0.006, p = 0.024,p = 0.000).ConclusionsFibrous membranes and tractional bands can be detected in severe stage 3 ROP, but the width and the total area of the fibrous membranes and total retinoschisis-detachment area were found to be higher in stage 4A eyes. The dragging of the posterior pole can be an important diagnostic indicator for the diagnosis of stage 4A. Therefore this finding may be a simple auxiliary finding for diagnosis and prognosis of stage 4A ROP.

Observed Changes in the Distribution of Colon Cancer Metastasis: A National Cancer Database Review and Institutional Experience.

The University of Louisville has observed a near 70% drop in resectable/borderline resectable metastatic colorectal cancer in the past 5 years. The aim of this study was to evaluate the distribution of colon cancer metastasis at diagnosis and at recurrence. Stage was defined by the American joint committee on cancer (AJCC) eighth edition. Institutional review board approval was granted for post hoc review of stage II and III patients with colon cancer from the University of Louisville prospective hepatic database from 2002 to 2023, as well as for the National cancer database (NCDB) Participant user file (PUF) 2021. The Surveillance epidemiology and end-results (SEER) 22 database was also utilized to corroborate the findings in the NCDB. Between 2018 and 2021 pathological M1a decreased annually (51.9-46.3%), while M1c increased year-over-year (26.6-32.4%) and M1b stayed relatively the same (21.4-21.3%). These differences were significant on chi-squared analysis with a p value of < 0.001. Univariate analysis of the post hoc review between 2017 and 2020 revealed significant differences between stage 4a and 4c in terms of race (p value 0.018), carcinoembryonic antigen (CEA) at diagnosis (p value 0.037), CEA at recurrence (p value 0.012), presence of liver metastasis (p value 0.003), and referral pattern (p value 0.014). Multivariate analysis identified stage 4b as an independent predictor for hepatic metastasis (odds ratio; OR 4.69, p value 0.011). A significant change in the distribution of colon cancer metastases has occurred at an institutional and national level over the past 3-5 years. Interdisciplinary treatment strategies will have to be modified accordingly.

Long-term surgical outcomes and prognostic factors for advanced-stage retinopathy of prematurity after vitrectomy

Background/aimsThe aims of this study is to evaluate the anatomic, visual outcomes and associated prognostic factors in patients with advanced retinopathy of prematurity (ROP) following vitrectomy.MethodsA retrospective cohort study of...

525. PALLIATIVE MULTIMODALITY-THERAPY, EVEN WITH ABBREVIATED IMMUNOTHERAPY CAN MAKE CURATIVE SURGERY FOR SYNCHRONOUS LUNG AND ESOPHAGEAL CANCER POSSIBLE: A CASE REPORT

Abstract Background Synchronous lung and esophageal carcinomas are problematic. When both cancers are locally advanced, combined surgical treatment is rarely possible because of high-risk or insufficient respiratory reserve. Palliative treatment including immunotherapy can sometimes offer significant tumor response and potentially prolong survival in patients with PDL-1 tumor expression. However the place of immunotherapy for potentially rendering inoperable patients operable is still unknown. Methods Case report: A 78-year-old male with smoking history was diagnosed with synchronous locally advanced adenocarcinoma of the Gastroesophageal Junction (GEJ) cT3cN1cM0 and bilateral lung adenocarcinomas stage 4a, cT2cN1cM1a (right lower lobe 43mm confirmed by CT-guided biopsy, left upper lobe 32mm and additional S6 left lower lobe nodule). The patient was considered incurable by MDT and palliative treatment was offered as both cancers had significant PDL-1 expression (GEJ: CPS score &amp;gt;1, Lung: PDL-1 expression 90%). Pembrolizumab immunotherapy was started but poorly tolerated (severe myositis) and stopped again after only 6 weeks. The left-sided lung cancer had by then already regressed and stereotactic irradiation (SBRT 5x12Gy) of the right-side lung cancer was administered resulting in further local tumor control (figure). Endoscopic tumor re-evalution showed a Siewert type 2 tumor (uT3N1) similar to the initial endoscopy 15 months before. Both side lung adenocarcinomas remained regressed and the left lower lobe nodule was unchanged (6mm). Mediastinal lymph node staging by EBUS was negative. Thirteen months after initial diagnosis, 4 cycles of neo-adjuvant chemotherapy (FLOT) were administered. Combined synchronous surgery was finally done 16 months after initial diagnosis. A minimally invasive combined resection included a laparoscopic &amp; thoracoscopic Ivor-Lewis MIE, left thoracoscopic wedge of the lower lobe nodule and a right lower lobectomy with radical lymph node dissection. Post-operative course was smooth: Clavien-Dindo score 1, hospital stay 18 days. Final pathology Distal third adenocarcinoma (1.5x1.2cm above Z-line) with major partial response ypT2N0M0, R0, 0/43 lymph nodes (subcarinal signs of nodal response), right lower lobe tumor of 60x55mm with residual 1.2mm focus of residual viable adenocarcinoma (ypTisN0M0, R0) and left lower lobe hamartoma (6mm). Follow-up showed no recurrence 9 months after surgery (25 months from initial diagnosis). Conclusions: 1) Despite much abbreviated palliative immunotherapy (6 weeks), SBRT and FLOT our patient was down-staged within 16 months from an initially palliative situation to a potential cure with complete resection of all tumors. 2) Synchronous combined radical laparoscopic &amp; thoracoscopic Ivor-Lewis esophagectomy with lung lobectomy can be feasible after immuno-, chemo- and radiotherapy even in elderly patients.

Time series and risk factors associated with mortality in women with cervical cancer from 2000 to 2021

IntroductionCervical cancer is a significant public health problem worldwide. The development of cervical neoplasms is associated with persistent infection by oncogenic subtypes of the HPV virus, which are responsible for around 70% of cervical cancers.A study carried out in Brazil between 2002 and 2021 recorded 133,429 deaths from cervical cancer.. MethodologyAn observational, retrospective, cross-sectional, quantitative study was carried out using data collected by the Cancer Registry Service of the Haroldo Juaçaba Hospital/Ceará Cancer Institute (HHJ/ICC) over 22 years. ResultsThe sample consisted of 9096 women. The mean age was 51.4 ± 15.5, ranging from 15 to 100, with a median age of 60 years. Median overall survival was 59.77. The most frequent histological type was squamous cell carcinoma, with 8023 (88.2 %) cases. Around 25 % of patients (n = 2270) entered the service with stage 4A. The most common treatment was radiotherapy combined with chemotherapy (n = 3270, 35.9 %), followed by surgical removal (n = 1909, 21.0 %).In multivariate analysis, age (p = 0.019), race (p = 0.016), low level of education (p < 0.001), tumor location, staging (p < 0.001), and treatment (p = 0.011) were risk factors independently associated with a higher chance of death in the sample studied. ConclusionThe sociodemographic characteristics of mortality from cervical cancer in patients followed up at the Haroldo Juaçaba Hospital (HHJ/ICC) highlight the higher frequency of deaths in women aged over 60, indigenous and black, with low levels of education, as well as clinical variables related to tumor location, staging and type of treatment.

Efficacy of Indirect Laser Photocoagulation in Cases with Retinopathy of Prematurity Presenting with Late Stage 3 Turning into Stage 4A

Abstract Background Retinopathy of prematurity (ROP) is a preventable irreversible cause of blindness in children especially in developing countries. Early detection and management of type 1 ROP with intravitreal injection of Anti-VEGF or indirect laser photocoagulation is the cornerstone of preventing blindness from this disease. Screening programs for ROP are mandatory for picking cases early before retinal detachment develops. Standardized screening programs are still lacking in developing countries, like Egypt, so cases may present in later stages. Cases presenting too late with Stage 4 and 5 ROP are managed surgically with lens-sparing vitrectomy or lensectomy vitrectomy. A portion of the cases present at the transition from stage 3 into stage 4a ROP. Management of those cases with intravitreal anti-VEGF was reported to cause acute crunch and tractional retinal detachment. Management with laser photocoagulation has not been discussed before. Methods This is a retrospective interventional, non-comparative study. Review of records of ROP cases presenting after 4 weeks from delivery having stage 3 turning into stage 4a ROP for which indirect laser photocoagulation was done were collected in the period from January 2017 till May 2019. Gestational age, birth weight, postmenstrual age at first presentation, date of laser photocoagulation and number of sessions, fundus images showing initial regression and final regression and if any recurrences happened were recorded. Results Nine treatment naive eyes of five premature infants were included. Mean GA was 30.4+/- 1.5 wks (range, 28-32 wks; median, 31). Mean BW 1190+/- 174.6 gm (range, 900-1300; median = 1300). Mean PMA at presentation 42.5+/-5.7 wks (range, 38.5-52.5; median, 40.5). All 9 eyes presented with plus disease and highly elevated fibrovascular ridge with significant fibrous component in Zone II. 7 eyes (77.7%) had secondary retinoschisis, localized tractional retinal detachment. 2 eyes (22.2%) showed temporal dragging. All eyes received Indirect laser photocoagulation to the avascular retina (near confluent burns) one session for each eye. No skip areas were reported. 5 eyes (3 patients) were done under topical anesthesia and 4 (2 patients) under general anesthesia. All 9 eyes (100%) showed complete regression of ROP with release of traction, restoration of retinal anatomy at a mean of 3.7+/- 2.7 months (range, 2-8.5 months; median, 2.5 months). Conclusion Indirect laser photocoagulation is an effective treatment measure in premature infants presenting late with fibrovascular proliferation having high fibrous components and starting Stage 4a ROP in Zone II. Laser rather than IVI of Anti-VEGF may save those infants from crunch phenomenon and need for vitrectomy with final good anatomical and thus visual outcomes.

Anatomic and Functional Outcomes of Vitrectomy for Advanced Retinopathy of Prematurity: A Systematic Review.

The success of vitrectomy in the advanced stages of retinopathy of prematurity (ROP) is defined not only by anatomical results, but also by functional outcomes. Studies have indicated that vitrectomy produces better outcomes when performed at an earlier stage (stage 4 vs. stage 5 ROP). This study reviewed the outcomes of vitrectomy in advanced stages of ROP and the associated factors. PubMed, ScienceDirect, Cochrane, Wiley, and WorldCat databases were systematically searched for articles published in the last 10 years. Studies involving participants with stages 4 and 5 ROP who underwent vitrectomy were included. The final search was performed on March 24, 2023. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool.The results were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Ten studies were included in the review. A total of 1179 eyes underwent vitrectomy (72% lens-sparing vitrectomy [LSV] and 28% lensectomy-vitrectomy [LV]). LSV was mainly performed in stage 4 ROP and LV in stage 5 ROP. Anatomical and functional successes were more significant in stages 4A and 4B than in stage 5. Factors that improved prognosis included no plus diseases, stage 4, prior treatments such as laser or intravitreal anti-vascular endothelial growth factor injection, and sparing the lens intraoperatively. Vitrectomy resulted in better outcomes in patients with stage 4 ROP. Early detection and a strict screening protocol are needed to prevent ROP progression into stage 5.

Non-surgical treatment of stage 4A retinopathy of prematurity

BackgroundRetinopathy of prematurity (ROP) is a major cause of visual impairment in premature infants, often requiring surgical interventions in advanced stages. This retrospective case series study investigates non-surgical management for Stage 4A ROP, specifically the use of combined laser therapy and intravitreal anti-vascular endothelial growth factor (VEGF) injections.MethodsTen eyes from five infants with Stage 4A ROP were treated with a combined laser and anti-VEGF approach. Comprehensive follow-up examinations were conducted to evaluate the treatment outcomes.ResultsThe study demonstrated successful retinal attachment without complications, showcasing the efficacy and safety of this non-surgical method. A comparison with surgical interventions highlighted the potential benefits in terms of reduced adverse effects.DiscussionThis combined treatment emerges as a promising first-choice option for Stage 4A ROP, offering rapid regression without surgical intervention, particularly in early stages. However, larger randomized clinical trials are necessary to validate these findings and establish definitive guidelines for managing this complex condition.ConclusionCombined laser and anti-VEGF therapy proved to be an effective and safe non-surgical approach for Stage 4A ROP, with the potential to reduce the need for surgery, especially in its early presentation. Further research is required to confirm these findings and provide comprehensive recommendations for clinical practice.

The feasibility of pathogenetic therapy for chronic viral hepatitis C in adult HIV-infected patients

In the third decade of the XXI century, HIV infection and viral hepatitis C remain urgent problems of modern medicine. Only in the Russian Federation in 2023, more than 1.6 million HIV-infected people and about 2 million patients with chronic viral hepatitis C are registered. Patients with a combined course of these diseases are of particular concern. However, insufficient coverage of etiotropic therapy for patients with chronic viral hepatitis C due to its high cost leaves pathogenetic therapy as the only available method of treatment for many of them. Material and Methods. Clinical data of patients hospitalized in the day hospital of the state budgetary health care institution "Samara Regional Clinical Center for AIDS Prevention and Control" were used. Physical, virological, immunological, biochemical and general clinical methods, elastometry of liver tissue were used for examination of hospitalized patients. Statistical processing of the results was performed using the application program "Statgrarhics Plus for Windows". Pathogenetic therapy was carried out in a two-week course in accordance with the "Recommendations for the diagnosis and treatment of adult patients with hepatitis C" (2013) and included (along with protective regime and therapeutic nutrition) the use of detoxification and metabolic therapy. Antiretroviral therapy with 3–4 drugs was carried out in 68% of the patients. Results. It was shown that the prescribed course of pathogenetic therapy of chronic viral hepatitis C did not have the expected effectiveness in the majority of patients referred for treatment according to the dynamics of changes in the values of "liver tests", despite the fact that the "right subcostal syndrome" was eliminated in 75.7% of persons with stage 3 and 66.7% with stages 4A and 4B of HIV infection. Statistical studies of the relationship (linear, rank and canonical) did not reveal its presence between the results of the conducted treatment and the complex of initial clinical and clinicallaboratory data obtained during hospitalization of the examined persons. Discussion. The presence of cytolysis syndrome and "right subcostal syndrome" is not a valid criterion for referral to a two-week course of pathogenetic therapy of chronic viral hepatitis C in order to obtain a positive result in the majority of patients with stages 3, 4A and 4B of HIV infection. Other baseline data (virologic and immunologic indices, degree of liver tissue fibrosis, indices of general and biochemical blood analysis) had no reliable correlation with the results of treatment, which did not allow their use for predicting the effectiveness of the prescribed treatment. Antiretroviral therapy was not associated with the results of pathogenetic therapy of chronic viral hepatitis C according to the indicators of cytolysis syndrome and "right subcostal syndrome", despite the fact that most of the prescribed drugs had a hepatotoxic effect.

Long-Term results of macular buckle for MTM stage 3-4 With maculoschisis and macular detachment without and With lamellar macular hole.

To report the long-term anatomical and functional results of macular buckle for Myopic Traction Maculopathy (MTM) in stages 3a, 3b, 4a, and 4b according to the MTM Staging System (MSS). Retrospective observational cohort study involving 55 consecutive patients with MTM in stages 3a, 3b, 4a, and 4b who underwent macular buckle (MB). Postoperative outcomes, including optical coherence tomography (OCT) scans to evaluate the MTM stage and its progression, were evaluated 1-month postoperatively (i.e., "intermediate follow-up") and at last follow-up ranging between 6 and 156 months postoperatively (i.e., "final follow-up"). Fifty-five eyes affected by MTM who underwent MB were enrolled. The mean preoperative and postoperative axial length was 31.13 ± 2.14 and 29.73 ± 2.16 mm, respectively (p < 0.01), with a mean axial shift of 1.32 ± 0.77 mm. The mean sample best corrected visual acuity (BCVA) at baseline, intermediate, and final follow-ups was 0.87 ± 0.36, 0.73 ± 0.31, 0.41 ± 0.32 logMar, respectively (p < 0.01). Foveal and retinal anatomical improvements were achieved in 50 (91%) and 53 (96.4%) eyes at intermediate follow-up, respectively. In the final follow-up, 54 (98.2%) and 55 (100%) eyes showed foveal and retinal anatomical improvements, respectively. MB as a single procedure, when applied to MTM in stages 3a, 3b, 4a, and 4b, leads to significant anatomical and functional improvement. The MTM Staging System allows us to evaluate the best surgical technique and the surgical timing tailored to the different stages to increase the surgery's success and lower the complications of each technique.

Radiotherapy Results in Locally Advanced Sinonasal Cancer: Turkish Society for Radiation Oncology, Head and Neck Study Group 01-005.

This study aims to examine the treatment outcomes and related factors in locally advanced sinonasal cancer across Turkiye. Twelve centers participants of the Turkish Society for Radiation Oncology Head and Neck Study Group attended the study. One hundred and ninety-four patients treated with intensity-modulated radiation therapy between 2001 and 2021 were analyzed retrospectively. The survival analysis was performed using the Kaplan-Meier method. Acute and late toxicity were recorded per Common Toxicity Criteria for Adverse Events V4.0. The median age was 58 years and 70% were male. The majority of tumors were located in maxillary sinus (59%). Most of the patients (%83) had T3 and T4A disease. Fifty-three percent of patients were in stage 4A. Radiotherapy was administered to 80% of the patients in the adjuvant settings. Median 66Gy dose was administered in median 31 fractions. Chemotherapy was administered concomitantly with radiotherapy in 45% of the patients mostly with weekly cisplatin. No grade ≥4 acute and late toxicity was observed. The median follow-up was 43 months. The 5-year and 10-year overall survival (OS); locoregional recurrence-free survival (LRFS); distant metastasis-free survival (DMFS), and progression-free survival (PFS) rates were 61% and 47%; 69% and 61%; 72%, and 69%, and 56% and 49%, respectively. In the multivariate analysis, several factors demonstrated significant influence on OS, such as performance status, surgery, and lymph node involvement. Moreover, surgery was the key prognostic factor for LRFS. For DMFS, lymph node involvement and surgical margin were found to be influential factors. In addition, performance status and lymph node involvement were identified as significantly affecting PFS. In our study, the authors obtained promising results with IMRT. Performance status, lymph node involvement, and surgery emerged as the primary factors significantly influencing OS.

Scleral Buckling for Retinopathy of Prematurity: A Case Report

Introduction : Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease that affects premature infants. Patients with advanced ROP require surgery to minimize retinal distortion and prevent total retinal detachment. This case reports the efficacy of scleral buckling (SB) in a patient with stage 4B ROP in both eyes within 3 months.&#x0D; Case Illustration : A 4-month-old female baby presented to the Pediatric Ophthalmology Division in Cipto Mangunkusumo Hospital with the chief complaint of no eye contact in both eyes. Her eyes moved by themselves since the age of 3.5 months and sometimes looked crossed. The patient presented to the pediatrician and was referred to the pediatric ophthalmology division for further management. There was a history of premature delivery at 30 weeks with oxygen therapy for 3 weeks. Pediatric Ophthalmology Division performed ultrasonography and Retcam and diagnosed ROP stage 4B in both eyes. Scleral buckling was performed by vitreoretinal division in the right and left eyes at 49 and 52 weeks postmenstrual age, respectively.&#x0D; Discussion : Vitrectomy and scleral buckling are the surgical options in advanced ROP. Vitrectomy is ideally performed in stage 4A without macular involvement. We considered performing SB because vitrectomy seems to be ineffective in this patient and the patient is more prone to intraocular complications.&#x0D; Conclusion : Scleral buckling is effective in preventing further progression of retinal detachment, reducing vitreoretinal traction and preventing ischemia in the retinal detachment. In short-term follow-up, we found no worsening of progression. However, further follow-up is needed to demonstrate the long- term efficacy of SB in advanced ROP.

Long-term trajectories of clinical staging in first-episode psychosis and their associated cognitive outcome: A 21-year follow-up study

Cognitive deficits are already present before psychosis onset but are a key feature of first-episode psychosis (FEP). The objective of this study was to investigate the cognitive outcomes of a cohort of FEP patients who were diagnosed using the clinical staging approach and were followed for up to 21 years.We analyzed data from 173 participants with first-admission psychosis who were followed-up for a mean of 20.9 years. The clinical staging assessment was adapted from the clinical staging framework developed by McGorry et al.1 Cognitive assessment was performed using the MATRICS Consensus Cognitive Battery (MMCB) at the end of follow-up.FEP patients who were longitudinally diagnosed in the lowest clinical stages (stages 2A and 2B) showed better performance in attention, processing speed, and MCCB overall composite score than those in the highest clinical stages (stages 4A and 4B). There was a significant linear trend association between worsening of all MCCB cognitive functions and MCCB overall composite score and progression in clinical staging. Furthermore, the interval between two and five years of follow-up appears to be associated with deficits in processing speed as a cognitive marker.Our results support the validation of the clinical staging model over a long-term course of FEP based on neuropsychological performance. A decline in some cognitive functions, such as processing speed, may facilitate the transition of patients to an advanced stage during the critical period of first-episode psychosis.

Vitrectomy Results for Stages 4 and 5 Retinopathy of Prematurity in Iraq.

Stage 4 and 5 retinopathy of prematurity (ROP) is a serious condition that may require surgical intervention at some point. Timely intervention is a key element and, with the peculiarity of eyes among this group that necessities a certain level of surgical standards, operations cannot be undertaken in any surgical eye center. To recognize the outcomes of vitrectomy in Iraqi preterm babies with stage 4 and 5 ROP, and to study factors that might increase the risk of re-detachment in operated eyes. A prospective cohort study undertaken from November 2020 to June 2023 for Iraqi preterm babies presenting with stage 4 and 5 ROP requiring surgical intervention. Each patient had a follow-up duration of 9 months. The primary follow-up outcome was anatomical success rate (flat versus detached), and the secondary outcome was to identify the postoperative complications. This study enrolled 19 children; 11 males and eight females (number of eyes operated on was was 31), with a mean gestational age of 29.4±2.1 weeks. There were six (19.4%) eyes that did not develop any complications, five (16.1%) eyes developed postoperative vitreous hemorrhage, five (16.1%) eyes developed cataract, three (9.7%) eyes underwent a second vitrectomy, and seven (22.6%) eyes developed secondary glaucoma. The surgical success rates were 90.9% for stage 4a, 57.1% for stage 4b, and 33.3% for stage 5a. This study presented the first surgical experience for vitrectomy in children with retinopathy of prematurity in our country, and the results were encouraging with an overall surgical success rate of 64.5%, and 19.4% of eyes did not develop any complication until the 1-year of follow-up.

Surgical outcomes in aggressive retinopathy of prematurity (AROP)-related retinal detachments.

Aggressive retinopathy of prematurity (AROP) is a severe and progressive variant of retinopathy of prematurity (ROP) rapidly forming fibrous tissue extending from the disc toward the posterior lens surface progressing to Stage 5 disease without traversing the classical course that includes Stages 1 to 3. Since AROP behaves differently from type 1 ROP, this study was undertaken to evaluate the surgical outcome of AROP-related detachments. Retrospective analysis of data from electronic medical records of babies diagnosed with AROP-related detachments who underwent micro-incision vitrectomy surgery (MIVS) was included. The demographic data, details of primary intervention (laser and/or intravitreal bevacizumab), and surgery were noted. In a subset of patients, surgical intervention was planned early at the onset of fibrovascular tissue. 43 eyes of 26 babies with median birth weight 1175 g and median gestational age of 29 weeks were analyzed. 42/43 eyes underwent primary intervention in form of laser and/or anti-VEGF injection before surgery. 41.8%, 25.5%, and 32.5% eyes progressed to stages 4A, 4B, and 5, respectively, requiring surgical intervention. 66% eyes underwent lensectomy and vitrectomy (LV), and 44% eyes underwent lens sparring vitrectomy (LSV). 58% eyes had attached macula. 44% eyes that had a relatively less vascular diseases had better anatomical outcome (P = 0.019). At final follow-up, 53.4% eyes followed or at least had light fixation, and 77.7% eyes undergoing LSV fixated and/or followed light compared to 33% for LV (P = 0.04). Challenges in AROP include rapid progression to advanced stages of ROP requiring close monitoring and multiple interventions. Surgeries for AROP have a favorable anatomical and functional outcome in 58% and 53%, respectively. Eyes undergoing lens sparing vitrectomy had better visual outcomes.

Отдельные аспекты применения ингибиторов VEGF в лечении ретинопатии недоношенных

Nowadays increasing use of VEGF (vascular endothelial growth factor) inhibitors in the ROP (retinopathy of prematurity) treatment, undergoing clinical trials in Russian Federation, as well as the widely VEGF inhibitors off-label using, make this review higly relevant. In this work it was possible to reflect some significant aspects of the VEGF inhibitors application in the ROP treatment, which the researchers focus on. Evaluating the effectiveness of VEGF inhibitors in the treatment of ROP in zone II (stage 3+), bevacizumab therapy and retinal laser coagulation proved to be effective. The use of 0.2 mg of ranibizumab is more effective compared to laser treatment in patients with ROP stage 3+. Analysis of the treatment effectiveness of ROP in zone I (stages 1+, 2+, 3+) showed that ranibizumab is more effective than retinal laser coagulation (68% and 61%, respectively), however, without statistically significant differences. Results of surgical treatment of ROP indicate its high efficiency at stage 4a. There are limited data, according to the results, the combination of vitrectomy with the introduction of VEGF inhibitors leads to a faster regression of the disease. Data on the systemic effects of VEGF inhibitors available in the literature are contradictory, which requires further study of this problem. Key words: retinopathy of prematurity, VEGF inhibitors, literature review

Association Between Fat Depletion and Prognosis of Amyotrophic Lateral Sclerosis: CT-Based Body Composition Analysis.

The purpose of this study was to present the results of our investigation of the prognostic value of adipopenia and sarcopenia in patients with amyotrophic lateral sclerosis (ALS). Consecutive patients with ALS with abdominal computed tomography (CT) were retrospectively identified at a single tertiary hospital between January 2010 and July 2021. Deep learning-based volumetric CT body composition analysis software was used to obtain abdominal waist fat volume, fat attenuation, and skeletal muscle area at the L3 level, then normalized to the fat volume index (FVI) and skeletal muscle index (SMI). Adipopenia and sarcopenia were defined as the sex-specific lowest quartile and SMI reference values, respectively. The associations of CT-derived body composition parameters with clinical variables, such as body mass index (BMI) and creatinine, were evaluated by Pearson correlation analyses, and associations with survival were assessed using the multivariable Cox regression analysis. Eighty subjects (40 men, 65.5 ± 9.4 years of age) were investigated (median interval between disease onset and CT examination = 25 months). The mean BMI at the CT examination was 20.3 ± 4.3 kg/m2 . The BMI showed a positive correlation with both FVI (R = 0.70, p < 0.001) and SMI (R = 0.63, p < 0.001), and the serum creatinine level was associated with SMI (R = 0.68, p < 0.001). After adjusting for sex, age, King's stage, BMI, creatinine, progression rate, and sarcopenia, adipopenia was associated with shorter survival (hazard ratio [HR] = 5.94, 95% confidence interval [CI] = 1.01, 35.0, p = 0.049). In a subgroup analysis for subjects with nutritional failure (stage 4a), the HR of adipopenia was 15.1 (95% CI = 2.45, 93.4, p = 0.003). Deep learning-based CT-derived adipopenia in patients with ALS is an independent poor prognostic factor for survival. ANN NEUROL 2023;94:1116-1125.

Patterns of treatment failure in patients with nasopharyngeal carcinoma and salvage treatment outcome: A retrospective analysis study

IntroductionIn Saudi Arabia, head and neck cancers represent 6 % of all malignancies. 33 % of these are nasopharyngeal. Thus, we aimed to distinguish patterns of treatment failure and salvage treatment outcomes among patients with nasopharyngeal carcinoma (NPC). MethodsA retrospective review of patients treated for NPC in a tertiary care hospital. From May 2012 to January 2020, we retrospectively reviewed 175 patients that fit our inclusion criteria. Those who did not complete their treatment, started treatment in another institution, or did not complete a 3-year follow-up were excluded. In addition, the primary treatment outcome and the salvage treatment for those who failed initial treatment were collected and analyzed. ResultsPatients were predominantly stage 4 disease. 67 % of the patients were alive without evidence of disease during their last follow-up. However, 75 % of failure occurs in the first 20 months of completing the treatment regimen. Neoadjuvant therapy and delays in referral play a significant role in treatment failure. For failed cases, concurrent salvage chemoradiotherapy showed the best survival. ConclusionAdvanced stage 4A and T4 nasopharyngeal carcinoma should receive the maximum treatment, with a close follow-up, particularly during the first 2 years after treatment. Furthermore, the excellent outcome from salvage chemoradiotherapy and radiotherapy alone would make physicians aware of the importance of aggressive primary treatment.

Association of CD47 Expression with Clinicopathologic Characteristics and Survival Outcomes in Muscle Invasive Bladder Cancer.

CD47 is an antiphagocytic molecule that plays a critical role in immune surveillance. A variety of malignancies have been shown to evade the immune system by increasing the expression of CD47 on the cell surface. As a result, anti-CD47 therapy is under clinical investigation for a subset of these tumors. Interestingly, CD47 overexpression is associated with negative clinical outcomes in lung and gastric cancers; however, the expression and functional significance of CD47 in bladder cancer is not fully understood. We retrospectively studied patients with muscle invasion bladder cancer (MIBC) who underwent a transurethral resection of bladder tumor (TURBT) and subsequently underwent radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC). CD47 expression was examined by IHC in both TURBT and matched RC specimens. The difference in CD47 expression levels between TURBT and RC was also compared. The association of CD47 levels (TURBT) with clinicopathological parameters and survival outcomes was evaluated by Pearson's chi-squared tests and the Kaplan-Meier method, respectively. A total of 87 MIBC patients were included. The median age was 66 (39-84) years. Most patients were Caucasian (95%), male (79%), and aged >60 (63%) and most often (75%) underwent NAC prior to RC. Of those who received NAC, 35.6% were responders and 64.4% were non-responders. The final reported stages as per AJCC for all patients were as follows: stage 0 (32%), stage 1 (1%), stage 2 (20%), stage 3 (43%), and stage 4a (5%). A total of 60% of patients were alive; of those, 30% had disease recurrence and 40% died from bladder cancer at a median follow-up of 3.1 (0.2-14.2) years. CD47 levels were detectable in 38 (44%) TURBT samples. There was no association between CD47 levels and clinicopathological parameters such as age, gender, race, NAC, final stage, disease recurrence, and overall survival (OS). Patients aged >60 (p = 0.006), non-responders (p = 0.002), and at stage ≥ 3 (p < 0.001) were associated with worse OS by a univariate analysis and stage ≥ 3 remained significant even after a multivariate analysis. In patients managed with NAC, there were decreased CD47 levels in RC specimens compared to the TURBT specimens, but this did not reach statistical significance. CD47 expression was not a predictive nor prognostic marker for MIBC patients. However, expression of CD47 was detected in nearly half of MIBCs, and future studies are needed to explore the potential role of anti-CD47 therapy in these patients. Furthermore, there was a slight positive trend in decreased CD47 levels (from TURBT to RC) in patients receiving NAC. As a result, more research is needed to understand how NAC may modify immune surveillance mechanisms in MIBC.

CHALLENGES IN DIAGNOSING SPLENIC ABSCESSES IN HIV-INFECTED PATIENTS

Objective: Improve the quality of treatment for HIV-infected patients with heart attacks and splenic abscesses by optimizing the diagnosis of these pathological processes. Material and Methods: From 2004 to 2019, 14,405 HIV-infected patients, including 34 patients with suspected splenic abscesses, were treated in the surgical department of the Infectious Clinical Hospital State Budgetary Healthcare Institution (ICH SBHI) No.2. The average age was 34.9 years, 22 males and 12 females. Three patients had stage 3, ten people had stage 4A, ten patiens had stage 4B, and eleven people had stage 4B HIV infection. Patient management followed the generally approved algorithms of the Ministry of Health of the Russian Federation for surgical patients (taking into account the HIV-infection co-morbidity). The following was done: complaints and anamnesis were collected, the duration of HIV-infection, adherence to ART, presence of opportunistic and concomitant diseases were carefully determined, an abdominal ultrasound imaging and an abdominal CT scan were performed. Four patients were diagnosed with splenic infarction; they were treated conservatively and discharged in a satisfactory condition. Surgical treatment was performed in 30 out of 34 patients in the period from 1 to 57 days from admission to the hospital, usually on day 9. 26 of them were discharged and 4 patients died. All 30 surgical patients received antibiotic therapy, surgical material was examined histologically, the cause of the splenic process was determined and therapy was adjusted (if tuberculosis had been diagnosed, patients were moved to an anti-TB hospital, if lymphoma had been diagnosed, patients were moved to an oncohematology department). Results: When examining HIV-infected patients with complaints of abdominal pain and hyperthermia, a detailed history of HIV infection, adherence to ART, viral load and immune status (if the patient knows these data), the presence of concomitant pathological conditions should always be clarified, as wells as abdominal ultrasound and abdominal CT scan should be performed as early as possible. All surgical materials should be examined histologically to verify the cause of the splenic process. Patients in stages 4B-4B, not adhering to ART, with a high viral load and low immune status, suffering from drug addiction and HCV infection, more often get complicated forms of the disease.