Systematic Treatment Research Articles

A Critical Exploration of Bargaining in Purchasing and Supply Management: A Systematic Literature Review

Bargaining with suppliers is a key Purchasing and Supply Management (PSM) activity but there is considerable ambiguity over what bargaining entails and the concept currently lacks a systematic treatment, despite its significant interest to PSM professionals. The literature shows that bargaining can be seen as an adversarial approach to negotiation (in contrast to more integrative/collaborative ones) and also the back-and-forth discussion over price and other variables between buying and supplying organisations to reach an agreement. In addition, many will move between fundamentally distributive and integrative approaches as the discussions play out. A systematic literature review of the Scopus, ProQuest, ScienceDirect, JSTOR and Web of Science databases was undertaken to address this gap, identifying 427 relevant journal papers that were systematically analysed. First, descriptive techniques identified the trajectory of published papers, methods, theories and their industrial context. Second, content analysis identified the key constructs and associated operational measures/variables of bargaining. Third, the constructs have then been ordered temporally and by areas of location (organisational/departmental and individual levels) to generate a model and inform a series of practice-based recommendations at different stages of the bargaining process. The findings will allow future researchers to use the constructs either directly in developing focused hypotheses to test relationships or as a basis for refinement and extension in cumulative theory building and testing. In addition, a series of focused research gaps have been identified, such as addressing the current contradictory findings of the effect of purchasing volume or organisational size on bargaining power.

Oncological outcomes of intraperitoneal chemotherapy in advanced ovarian cancer: BRCA mutation role

IntroductionThe knowledge of BRCA status offers a chance to evaluate the role of the intraperitoneal route in patients selected by biomolecular profiles after primary cytoreduction surgery in advanced ovarian cancer. Materials and methodsWe performed a retrospective, multicenter study to assess oncological outcomes depending on adjuvant treatment (intraperitoneal [IP] vs intravenous [IV]) and BRCA status (BRCA1/2 mutated vs. BRCA wild type [WT]). The primary endpoint was to determine progression-free survival. The secondary objectives were overall survival and toxicity. ResultsA total of 288 women from eight centers were included: 177 in the IP arm and 111 in the IV arm, grouped into four arms according to BRCA1/2 status. Significantly better PFS was observed in BRCA1/2-mutated patients with IP chemotherapy (HR: 0.35; 95% CI, 0.16–0.75, p = 0.007), which was not present in BRCA1/2-mutated patients with IV chemotherapy (HR: 0.65; 95% CI, 0.37–1.12, p = 0.14). Significantly better OS was also observed in IP chemotherapy (HR: 0.17; 95% CI, 0.06–043, p < 0.0001), but was not present in IV chemotherapy in relation with BRCA mutation (HR: 0.52; 95% CI, 0.22–1.27, p = 0.15). For BRCA WT patients, worse survival was observed regardless of the adjuvant route used. The IP route was more toxic compared to the IV route, but toxicity was equivalent at the long-term follow-up. ConclusionThis retrospective study suggests that BRCA status can help to offer an individualized, systematic treatment after optimal primary surgery for advanced ovarian cancer, but is limited by the small sample size. Prospective trials are essential to confirm these results.

Comparing the Efficacy of Topical 4% Benzoyl Peroxide Versus Topical 0.1% Adapalene for Treatment of Acne Vulgaris in Skin of Color Population: A South Asian Perspective.

Introduction Acne vulgaris is one of the most common skin problems encountered in the dermatology department. It is a chronic, inflammatory disease of the pilosebaceous unit, clinically presenting with comedones, papules, pustules, nodules, and cysts. With its particularly high prevalence in the younger population, it has significant adverse sequelae on patient's quality of life. At present, due to an enhanced understanding of the pathogenesis of acne, various therapeutic modalities are available. The current management strategies generally follow a systematic treatment escalation based on disease severity and treatment response. However meticulous choice of appropriate anti-acne medicine for the acne type is the key to the management plan. Starting with mild to moderate types of acne as per the Leeds photometric grading scale, the most useful topical agents include topical retinoids, benzoyl peroxide, and topical antibiotics while systemic therapies such as oral antibiotics or isotretinoin are generally reserved for moderate to severe acne treatment. The skin of color (SOC) population is a relatively neglected group concerning the optimum and safe management strategies in different dermatological conditions and acne is no different, where there remains a need for comparing the available topical modalities for appropriate drug selection in the treatment of mild to moderate acne in SOC population. Objective The objective of this study was tocompare the efficacy of topical 4% benzoyl peroxide versus topical 0.1% adapalenein the treatment of acne vulgaris in the SOC population. Methods The participants were divided into two groups, groups A and B. A total of 64 patients of both genders, with acne vulgaris (duration > three months) were included in the study. In group A, 32 patients were administered topical 0.1% adapalene whereas, in group B, 32 patients were given topical 4% benzoyl peroxide. Both medicines were applied at night daily. Patients were called for follow-up after 12 weeks. In both groups, the final efficacy evaluation was done using the Global Acne Grading System (GAGS) scoreafter 12 weeks of treatment period. Results In group A, the age ranged from 15 to 40 years with a mean age of 25.781±3.93 years while the duration of complaint was 5.843±1.27 months. GAGS score was 25.281±2.65 and mean BMI was 23.092±3.51 kg/m2. In group B, the mean age was 25.187± 4.06 years, the duration of complaint was 7.375±2.25 months, the GAGS score was 23.906± 2.60 while the mean BMI was 21.485±3.88 kg/m2. Efficacy in group A was noted in 25 (78.1%) patients as compared to 24 (75%) patients in group B (p =0.768). Conclusion The present study showed that the safety and efficacy of 0.1% adapalenethe traditional drug 4% benzoyl peroxide in the SOC population was comparable.

(265) Self-Image after Breast Cancer

Abstract Introduction Breast cancer is currently the first cancer diagnosed among women. The impact of its local treatments such as surgery and radiation and its systemic treatments such as chemotherapy, hormone-suppressant therapies and targeted therapies on women's bodies anatomically and physiologically and on their body image and body esteem are the major factors altering their sexual health and the quality of their spousal relationships. Objective We aim to evaluate the qualitative impact of breast cancer on its survivors' body-image. Methods We ran a prospective qualitative study using semi-structured interviews until saturation of findings. The patients included were women diagnosed, treated for breast cancer, and followed up in our institution. All participants were sexually active and no older than 55. The study enrolled 20 participants over a 6-month period (February 2022-July 2022). Results All participants had a history of breast surgery either lumpectomy or mastectomy (70%) with (one case) or without reconstructive surgery. All patients reported a history of radiation and chemotherapy. 60% had received hormone therapy with medically induced menopause. The majority of participants explained how their bodies had changed not only physically and anatomically on the outside but also on the inside especially in relation to the adverse effects of chemotherapy and hormone therapy. They also reported body emotional changes. This required an adaptation to their new body for them and their partners and entourage. The main themes emerging from their discourse were: physical and emotional adaptation to breast cancer per se and its local and systematic treatments, fear of others judgment and comments on their physical changes and loss or gain of self-esteem. Breast reconstruction was also an important theme it the participants verbatim. Conclusions The words and themes that characterized the participants' speeches highlighted the impact of cancer diagnosis and oncological therapies on breast cancer survivors. Being part of a psychological intervention focused on self-compassion and body acceptance helps breast cancer survivors develop a better perception and acceptance of their new bodies. Disclosure No.

Mortality comparison between axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SND) among breast cancer pantient: A meta-analysis and systematic review study

Introduction: Axillary lymph node dissection (ALND) is a crucial surgical procedure for breast cancer. It has guaranteed locoregional control of the disease, guided adjuvant therapy, and functioned as a staging tool. However, over the past 25 years, a more conservative approach has become the standard for surgical management of the axilla. Because sentinel lymph node biopsy (SNB) is less invasive and less morbid than axillary lymph node dissection (ALND), it has become the standard surgical procedure for axillary staging of clinically node-negative breast cancer. This study aimed to compare the mortality of breast cancer patients receiving ALND and SNB procedure. Methods: Our review includes randomized controlled trials of breast cancer patients undergoing ALND or SNB surgical techniques. A systematic literature search was performed from PubMed on December 2023 to search for articles reporting on survival rates between ALND vs SNB among breast cancer patients. The data obtained then underwent statistical evaluation, and a meta-analysis was conducted using Review Manager 5.4. In order to represent primary outcomes, the risk ratio was estimated using an inverse variance technique with a random-effects model. Heterogeneity was presented with total values, 95% confidence intervals (CI), and I values. Results: As many as 208 articles were found in the PubMed database search, and only six studies were included in this study. The six included trials all used chemotherapy and radiotherapy for systematic treatment. The length of follow-up varied from 33 months to 15 years. The total number of patients in the trials was 3,585, and the study period was from 2011 to 2023. The pooled analysis of the mortality outcomes showed that the heterogeneity of the data was low (I2 21%, p = 0.4). In the pooled analysis, the mortality of patients with SNB for surgical treatment was not significantly different compared to patients with ALND (OR:0.88; 95% CI:0.65-1.19). Conclusion: The mortality of patients undergoing SNB and ALND does not differ significantly, according to this pooled study. It demonstrates that the group without axillary dissection had a primary survival outcome that was not inferior to that of the dissection group.

Successful treatment of severe monkeypox case with advanced HIV infection using plasma from smallpox‐vaccinated healthy population: A case report

AbstractSince the first reported case of monkeypox in the UK in May 2022, there has been an upward trend in monkeypox cases and a global outbreak. However, reports of severe cases are relatively limited. In this study, we report a case of severe monkeypox in a patient with HIV. The patient presented with skin lesions that started on his face and around the penis and persisted for several months. Throughout the course of the disease, he received systematic symptomatic supportive treatment, topical remedies, and special care for the rash. He also underwent cidofovir antiviral therapy and smallpox‐vaccinated healthy population‐derived plasma therapy in succession, with the condition ultimately showing improvement after plasma treatment. After more than 3 months of hospitalization, he fully recovered. To the best of our knowledge, this is the first reported use of smallpox‐vaccinated healthy population‐derived plasma in the treatment of severe monkeypox cases.

171P Systematic review-based treatment algorithm for multidisciplinary treatment of lung cancer bone metastases

171P Systematic review-based treatment algorithm for multidisciplinary treatment of lung cancer bone metastases

A Conceptual Framework and Treatment Taxonomy for Respiratory Lung Volume Training (RLVT)

ObjectivesThe purpose of this study was to describe the theoretical and procedural framework of a novel intervention, Respiratory Lung Volume Training (RLVT), and to implement a standardized treatment taxonomy to operationalize the RLVT treatment paradigm. Study DesignThis study involved a prospective design with a consensus treatment classification process. MethodsThe Respiratory Lung Volume Training (RLVT) paradigm was developed based on biomechanical constructs governing the interactions of the respiratory and phonatory systems in voice production and principles of motor learning theory. In RLVT, higher levels of lung volume during speech are trained using multiple speech breathing targets while providing real-time visual biofeedback with superimposed guidelines for desired lung volume initiation and termination levels. For people with primary muscle tension dysphonia, RLVT can capitalize on non-muscular respiratory forces to increase efficiency of voice production with reduced speaking effort. To define and operationalize the treatment components of RLVT, six investigators with training in RLVT used the Rehabilitation Treatment Specification System (RTSS) to delineate the treatment targets, mechanisms of action, ingredients and dosing through a multi-stage, consensus decision-making process. ResultsThe finalized taxonomy for RLVT included four treatment targets, with three addressing the area of Respiratory Function and one addressing Somatosensory Function. For each treatment target, three categories of ingredients were defined: 1) Provide opportunities to practice breathing during voicing/speech, 2) Provide feedback, and 3) Provide volition ingredients. Within each ingredient category, three to seven specific ingredients were ultimately defined to further operationalize RLVT. ConclusionsThe RLVT paradigm is a theoretically driven approach for optimizing speech breathing patterns to increase efficient voice production in people with primary muscle tension dysphonia. By applying a standardized, systematic treatment taxonomy system to specify the components of RLVT, future researchers and clinicians can implement RLVT with improved fidelity and consistency to optimize treatment outcomes.

Hepatoid Adenocarcinoma of the Stomach with Liver and Pulmonary Metastases: A Case Report and Literature Review

Hepatoid Adenocarcinoma of the Stomach (HAS) is a rare unique subtype of Gastric Cancer (GC) with a low incidence but a high mortality rate. We report a female case of 67-years-old with APF producing hepatoid adenocarcinoma of the gastric antrum with liver and lung metastases. Abdominal CT of the patient showed multiple liver masses, which were considered as metastatic tumors and proved to be adenocarcinoma by pathological examination of a biopsy. The gastroscopy revealed antral ulcer complicated with bleeding. The biopsy results of hepatoid adenocarcinoma were consistent with the results of liver masses. Moreover, α-Fetoprotein (AFP) increased sharply to 86332 ng/mL. Thus, the diagnosis of gastric hepatoid adenocarcinoma with liver metastasis was established. In terms of treatment, liver TACE embolization was performed first, followed by radical gastrectomy and resection of liver tumor. During the operation, multiple small tumors (less than 5cm in diameter) in the liver were treated by radiofrequency ablation. The patient recovered well after surgery, with a rapid decline in AFP. Postoperative CT indicated the presence of bioactive tumors in the liver and new tumors in the lung. Lung puncture pathology suggests tumor metastasis. Liver and lung were treated with radiofrequency ablation and SOX (Oxaliplatin and Tegacil) chemotherapy. There was no significant recurrence 20 months after surgery, and personalized systematic treatment for this patient was effective. Standard treatment for gastric hepatoid adenocarcinoma has not yet been established, and personalized systematic therapy is the preferred treatment.

Impact of Pain and Neuropsychiatric Symptoms on Activities in Nursing Home Residents (COSMOS Trial)

ObjectiveThis study aims to identify whether pain and dementia-related behavior are associated with different types of activities in nursing home residents, controlled for dementia severity. DesignCross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety). Setting and ParticipantsA total of 723 patients from 33 Norwegian nursing homes with 67 units (clusters). Participants aged ≥65 years, with a life expectancy of >6 months, and with valid data on activity were eligible for inclusion. MethodsActivity was operationalized in time (hours per week) and type (cognitive, social, physical, and no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and behavior with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for effect modification. ResultsA total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain score was associated with less time spent on activity in participants with severe dementia (estimate 0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P = .039). Apathy (OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P = .042; lack of inhibition OR, 0.894; P = .034). Conclusion and ImplicationsPain and dementia-related behavior may influence the participation in activities in the nursing home. There is an urgent need to investigate what type of activity stimulates people in different stages of dementia.

Research progress on acupuncture for weight loss based on the basic principles of traditional Chinese medicine for different syndrome types

With the development of society, people’s living standards continue to improve, and various unhealthy living habits often contribute to the growing obesity rates. An increasing number of individuals are focusing on their weight and seeking healthier methods of weight loss. Acupuncture, as a unique treatment within traditional Chinese medicine, has gradually gained attention due to its minimal side effects, safety, effectiveness, and overall regulation. However, clinical acupuncture treatments for weight loss often rely on empirical acupoint selection and lack a comprehensive and systematic diagnosis and treatment plan. Although many individuals seeking weight loss are aware of acupuncture, they often lack an understanding of its mechanisms. This article is based on the fundamental principles of traditional Chinese medicine, beginning with the etiology and pathogenesis, and delving into treatment methods, acupoint selection principles, and guidelines.

Analysis of problems occurring in the care of a patient with liver cirrhosis

Introduction: Liver cirrhosis is a disease whose development is influenced by many factors, including those related to lifestyle. The disease causes disturbances in the functioning of not only the liver but also many other organs and systems. During the course of the disease, there are a number of complications that affect the patient's functioning in all areas. Patients with liver cirrhosis require constant and systematic treatment and comprehensive care, including care provided by nursing staff. Purpose of research: Analysis of problems occurring in the care of patients with liver cirrhosis Material and methods: The study included 103 patients with liver cirrhosis, hospitalized from October 10, 2022 to April 10, 2023. in the Observation and Infection Ward for Adults of the SPZOZ in Puławy. The method used in the work was a diagnostic survey, the technique was a survey, and the research tool was an original survey questionnaire developed for the needs of the research. Results: Patients with liver cirrhosis have many problems of a physical nature and related to non-compliance with medical recommendations, which may affect the inhibition of the progression of the disease, the prevention of complications and the improvement of the general condition. Conclusions: Patients with liver cirrhosis have a number of physical problems, the knowledge of which may affect the organization of work of nursing staff, facilitate the identification of problems, help determine the goal of care and plan nursing interventions. Not all respondents followed the specialist's recommendations, including: in the field of pharmacotherapy, dietary recommendations, performing check-ups, reporting for follow-up visits and physical activity. An important element in the care of a patient with liver cirrhosis is patient education and motivation to follow recommendations that are important in stopping the progression of the disease, preventing complications and improving the general condition.

Prevalence of Tuberculosis Infection among Various Risk Groups in India: A Systematic Review and Meta-Analysis.

Treatment of tuberculosis (TB) infection (TBI) to prevent active TB disease is a key component of the National Strategic Plan to end TB in India, without which the strategies to end TB would be futile. There is a need to rapidly scale up access to effective shorter regimens for tuberculosis preventive treatment (TPT) to a wider set of risk groups. This applies for identifying high-risk groups for TPT expansion. Thus, our aim with this review is to determine the TBI prevalence in different risk groups in India. We searched databases like Embase, Medline, Scopus, and CINAHL for studies published between 2012 and 2023 to estimate TBI in different risk groups in India. The PRISMA guidelines were followed when reviewing the publications, and a predetermined search strategy was used to find relevant sources across various databases. Using MetaXL (MS excel) software, we pooled data based on a random-effects model, along with heterogeneity testing using Cochrane's Q and I2 statistic. A total of 68 studies were included from 10,521 records. TBI pooled prevalence was estimated using the IGRA data, while in the absence of IGRA data, TST data were utilized. The key findings revealed a total of 36% pooled TBI prevalence for all risk factors, 59% among smokers, 53% among diabetics and alcoholics, 48% among malnourished, 47% among contacts of TB patients, 44% among HIV, 36% among pregnant women, 35% among COVID-19 patients, 31% among healthcare workers, 18% among sarcoidosis patients, and 15% among rheumatoid arthritis patients in India. Our review depicted a high TBI burden among groups such as diabetes mellitus, smokers, malnourished, and alcoholics. WHO has yet to recommend for systematic screening and treatment for TBI among these groups for want of evidence which this study provides, highlighting the need to reprioritize the risk groups for tailored TPT strategies.

P679 Anti-TNF de-escalation following a treat-to-target strategy with golimumab therapy intensification to reach continuous clinical response in ulcerative colitis: the In-Target GETAID trial

Abstract Background Achieving deep and continuous remission with tight control could allow de-escalation in patients with UC. The in-TARGET study was a prospective two-phase trial in UC patients initiating golimumab (GLM), that aimed to determine the proportion of patients with continuous clinical response (CCR) and endoscopic remission (ER) after one year of treatment optimization strategy (phase 1); then to assess treatment de-escalation outcome in these patients (phase 2). Methods This was a multicentre prospective interventional study in GETAID centres. The study included adult patients with active UC (Mayo Score ≥6 with an endoscopic subscore ≥2), naive to biologics. In the first part of the study, patients received a conventional GLM regimen, depending on their weight (&amp;lt;80 kg; ≥80 kg). At week 10, primary responders continued with the standard maintenance regimen (50 mg or 100 mg/4 w) and non-primary responders had systematic treatment optimization (&amp;lt;80 kg, GLM 100mg/4 w; ≥80kg, introduction of an immunosuppressant) (Figure 1). In the second part of the study, patients in CCR and in ER (Mayo endoscopic score 0-1) at w 54, had treatment de-escalation: GLM discontinuation for patients receiving 50mg, and dose de-escalation to 50mg for those receiving 100mg. Results A total of 197 patients were included, mean duration of UC was 75.9 (± 95.3) months, the mean total Mayo score was 8.4 (± 1.7). At w 10, 14 patients had stopped treatment for failure, 83 (42.1%) had a primary response, and 100 (50.7%) non-primary responders had treatment optimization. At w 54, 95 (48.2%) patients were still on GLM; of these, 64 (32.5%) patients were in CCR and ER. At w 0 and 10, no factors were associated with CCR + ER at w54. Serum GLM levels after w10 were not associated with CCR and ER at w54. No patient developed anti-GLM antibodies between w0 and w54. Sixty patients participated in the second de-escalation phase of the study: in 18 GLM was discontinued, in 38 GLM dose was de-escalated from 100 to 50mg/4 w, and 4 patients refused dose de-escalation. At w 108, 34/56 (60.7%) patients were in CCR and ER, with no change in treatment. No factors were associated with w108 remission. At w108, 23 patients had relapsed: 4/18 (22.2%) among GLM discontinuations, 19/38 (50%) among patients de-escalated from 100 to 50 mg/4w. During follow-up, no colectomy was reported, and 14 severe non-UC related adverse events occurred (3 severe infections, 2 severe anaemias, and 1 rectal cancer). Conclusion One third of UC patients achieved a CCR with ER at one year with optimized GLM therapy. After de-escalation of GLM, 60% of remitters at one year maintained deep remission at two years. Anti-TNF de-escalation following a treat-to-target strategy could be considered in some UC patients.

Anxiety, Depression, Stress, and Test Anxiety are Inversely Associated with Academic Performance Among Undergraduate Students Post-COVID-19 Confinement

ABSTRACT Background Addressing mental health illnesses among the college student population is pressing since they are associated with a decline in academic performance. Purpose This cross-sectional study investigates the impact of mental health illnesses and test anxiety on academic performance of 201 undergraduate students post-COVID-19 in U.S.A. Methods: A survey was administered between October 20th and November 3rd 2022 to collect data on demographics, mental health variables and GPA. Results Significant negative associations were observed between academic performance and depression (ß = –0.022, p < .01), anxiety (ß = –0.015, p = .01), stress (ß = –0.021, p < .01), and test anxiety (ß = –0.011, p < .01). There was a significant difference in GPA between all labels of depression and stress (P = .01 and P < .01 respectively). For test anxiety and GPA, there was significant dose response relationship; the higher the test anxiety level, the lower the GPA (P < .01). Discussion Governments and higher education institutions should provide the necessary academic, social, mental, and financial support during and post-confinement. Translation to Health Education Practice The findings may be valuable for health educators who can reach stakeholders and highlight the importance of addressing these mental health illnesses and applying systematic mental health treatment plan on college campuses.

Efficacy and safety of surufatinib in biliary tract cancer: Preliminary results of a real-world study.

486 Background: When applied in the second-line treatment for biliary tract cancer (BTC) pts, surufatinib (a small-molecule inhibitor of VEGFR1-3, FGFR1 and CSF-1R) monotherapy has demonstrated moderate clinical efficacy and has demonstrated favorable tolerability and safety profiles. This study was to evaluate the efficacy and safety of surufatinib as a therapy for BTC in a real-world setting. In particular, pts who received resection for BTC with positive margins would be eligible for this study. This population indicates a poor prognosis, for their tumor environment is complex, which is an obstacle to R0 resection. However, no proper treatment for this population has been recommended yet. Methods: This is an ongoing single-arm, multi-center, open-label real-world study conducted in China. The study would enroll 200 pts with unresectable or surgical resection with positive margins BTC. Pts would receive surufatinib with or without combination as adjuvant (namely pts with positive margin after resection), first- or further-line therapy, at a proper dose (200-300mg) judged by physicians once per day in 28-day cycles. The primary endpoint is relapse-free survival (RFS) for pts whose primary lesions were resected, and progression-free survival (PFS) for those had evaluable lesions. If available, tumor assessments were performed every 2 cycles ± 7 days according to RECIST version 1.1. Results: By Sep 10, 2023, 56 eligible pts had been enrolled, of whom 16 (28.6%) were female. The median age was 64 (range: 39-81). 28 (50.0%), 24 (42.9%), and 4 (7.1%) pts received surufatinib as adjuvant, first-line, and above treatment, respectively. As to location, 23 cases were intrahepatic cholangiocarcinoma (ICC), and 33 cases were extrahepatic cholangiocarcinoma (ECC) or gallbladder cancer (GBC). With a median follow-up time of 9.5 (range: 1.1-20.3) mo, the global mRFS/mPFS was 10.4 (95% CI: 9.0-13.9) mo. The mRFS of pts who received surufatinib as adjuvant treatment was 11.3 (95% CI: 10.4-NA) mo, and mPFS of those who received surufatinib as systematic treatment was 9.0 (95% CI: 7.8-10.8) mo. Pts with ICC demonstrated an mRFS/mPFS of 10.4 (5.8-NA) mo, and those with ECC or GBC demonstrated 10.4 (9.5-NA) mo. The global mOS was 15.8 (12.4-NA) mo. Among those with primary lesion unresected (n=28), 2 pts (7.1%) achieved CR, 5 (17.9%) pts PR, 16 (57.1%) pts SD, and 5 (17.9%) pts suffered PD. The ORR was 25.0%, and DCR was 82.1%. No new safety signal was observed. Conclusions: Surufatinib exhibited promising efficacy and manageable toxicity on pts with BTC in the real-world setting. Clinical trial information: NCT05064852 .

Bethe ansatz solutions and hidden [formula omitted] algebraic structure for a class of quasi-exactly solvable systems

The construction of analytic solutions for quasi-exactly solvable systems is an interesting problem. We revisit a class of models for which the odd solutions were largely missed previously in the literature: the anharmonic oscillator, the singular anharmonic oscillator, the generalized quantum isotonic oscillator, non-polynomially deformed oscillator, and the Schrödinger system from the kink stability analysis of ϕ6-type field theory. We present a systematic and unified treatment for the odd and even sectors of these models. We find generic closed-form expressions for constraints to the allowed model parameters for quasi-exact solvability, the corresponding energies and wavefunctions. We also make progress in the analysis of solutions to the Bethe ansatz equations in the spaces of model parameters and provide insight into the curves/surfaces of the allowed parameters in the parameter spaces. Most previous analyses in this aspect were on a case-by-case basis and restricted to the first excited states. We present analysis of the solutions (i.e. roots) of the Bethe ansatz equations for higher excited states (up to levels n=30 or 50). The shapes of the root distributions change drastically across different regions of model parameters, illustrating phenomena analogous to phase transition in context of integrable models. Furthermore, we also obtain the sl(2) algebraization for the class of models in their respective even and odd sectors in a unified way.

Nomograms predict survival in elderly women with triple-negative breast cancer: A SEER population-based study.

The effective treatment of breast cancer in elderly patients remains a major challenge. To construct a nomogram affecting the overall survival of triple-negative breast cancer (TNBC) and establish a survival risk prediction model. A total of 5317 TPBC patients with negative expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) who were diagnosed and received systematic treatment from 2010 to 2015 were collected from the American Cancer Surveillance, Epidemiology and End Results (SEER) database. They were randomly divided into training set (n= 3721) and validation set (n= 1596). Univariate and multivariate Cox regression analysis were used to identify prognostic features, and a nomogram was established to predict the probability of 1-year, 3-year and 5-year OS and BCSS. We used consistency index (C-index), calibration curve, area under the curve (AUC) and decision curve analysis (DCA) to evaluate the predictive performance and clinical utility of the nomogram. The C-indices of the nomograms for OS and BCSS in the training cohort were 0.797 and 0.825, respectively, whereas those in the validation cohort were 0.795 and 0.818, respectively. The receiver operating characteristic (ROC) curves had higher sensitivity at all specificity values as compared with the Tumor Node Metastasis (TNM) system. The calibration plot revealed a satisfactory relationship between survival rates and predicted outcomes in both the training and validation cohorts. DCA demonstrated that the nomogram had clinical utility when compared with the TNM staging system. This study provides information on population-based clinical characteristics and prognostic factors for patients with triple-negative breast cancer, and constructs a reliable and accurate prognostic nomogram.

A bulk-surface continuum theory for fluid flows and phase segregation with finite surface thickness

In this continuum theory, we propose a mathematical framework to study the mechanical interplay of bulk-surface materials undergoing deformation and phase segregation. To this end, we devise a principle of virtual powers with a bulk-surface dynamics, which is postulated on a material body P where the boundary ∂P may lose smoothness, that is, the normal field may be discontinuous on an edge ∂2P. The final set of equations somewhat resemble the Navier–Stokes–Cahn–Hilliard equation for the bulk and the surface. Aside from the systematical treatment based on a specialized version of the virtual power principle and free-energy imbalances for bulk-surface theories, we consider two additional ingredients: an explicit dependency of the apparent surface density on the surface thickness and mixed boundary conditions for the velocity, chemical potential, and microstructure.

P-25 Unusual cause for spontaneous hypoglycemia: Hirata's Disease in Iraqi patient

Abstract Introduction Hirata's Disease, is a rare condition characterized by episodes of spontaneous hypoglycemia associated with hyperinsulinemia with positive insulin autoantibodies. Hypoglycemia is common in patients with diabetes mellitus especially those who are taking insulin therapy or insulin secretogogues oral medications but spontaneous hypoglycemia is rare and there is no clear figures about those patients in Iraq. We receive a lot of persons claim to have hypoglycemia but most of them fail to fulfill the Whipple triad. Although endogenous hyperinsulinemic hypoglycemia especially insulinoma is very rare condition, it is still concern for endocrinologist in patients presented with presumed hypoglycemia. Clinical Case A 43 year old female presented with frequent fainting attacks over several weeks. She has no past medical history a part of localized areas of vertigo for which she received no systematic treatment. Initial medical evaluation was unremarkable but with documented hypoglycemia below 40 mg/dl. She has normal heart, brain, kidney, liver, thyroid and adrenal function. She has multiple emergency admissions treatment with glucose infusion. She gains more weight as she eats more to avoid hypoglycemia. Her specific lab during the attack shows high serum insulin level (141.10 mIU/ml) with high C-peptide 18.55 ng/ml Work up for insulinoma shows normal MRI abdomen, normal endoscopic ultrasound and negative PET Gallium 68 scan. There are no previous reports of Insulin autoimmune syndrome in Iraq. The insulin autoantibodies in this patient were very high (more than 300.00 U/ml) which highly suggestive of this syndrome after excluding other factors that may cause elevation of these autoantibodies. Patient condition persist for about eight months and was advised for small multiple meals and diazoxide was not used much because it is not available in Iraq widely. Her condition resolved spontaneously after one year with dietary modifications. Conclusion Hirata syndrome is very rare but important cause of spontaneous hypoglycemia that should not be ignored. Up to our knowledge this is the first documented case in Iraq.