Treatment Centers Research Articles

The EPICOVID19-BS study: a web-based epidemiological survey in bariatric patients

Abstract Purpose To assess the occurrence and severity of SARS-CoV-2 infection/COVID-19, frequency of symptoms, clinical manifestations and behaviours in a sample of patients undergoing bariatric surgery (BS). Methods The EPICOVID19-BS is an observational cross-sectional study conducted in Italy during the second wave of the COVID-19 pandemic (September 2021-February 2022). Patients with severe/extreme obesity undergoing BS were asked to complete an online multiple-choice questionnaire and to provide additional clinical information and blood biochemistry. Positive COVID-19 cases were defined by the combination of positive nasopharyngeal swab test results and/or positive serological test results. Sociodemographic, clinical and behavioural characteristics were compared between positive and negative COVID-19 cases. Results A total of 745 participants were enrolled (mean age 44.5 ± 10.5 years SD, 78% female). The proportion of positive COVID-19 cases was 20.4%. They were more likely to be health care workers, to have close contacts with confirmed cases, to use anti-inflammatory drugs, to have immune system disorders, to have previous CMV infection, to have lower cholesterol levels and to have less metabolic syndrome than negative cases. Infected participants significantly increased their use of national health resources for minor health problems. The majority of participants experienced flu-like symptoms and taste and smell disturbances. Only 9.6% were hospitalised and none required intubation. Conclusions Our results seem to support the evidence that patients undergoing BS have a low rate of severe SARS-CoV2. Further longitudinal studies in multiple obesity treatment centres are needed to more effectively monitor and control obesity in this specific population. Graphical Abstract

The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China

PurposeTo evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables.MethodsWe retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from immediate and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Sixteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP.ResultsAfter eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction(P < 0.001), and at 3 mo (P < 0.001), 6 mo (P < 0.001) and 12 mo (P = 0.009) after surgery.ConclusionMUL is a significant independent factor that can contribute to short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment.

Surgical Repair of Giant Dissecting Pulmonary Artery Aneurysm Associated with Atrial Septal Defect and Pulmonary Arterial Hypertension: A Case Report

Pulmonary artery aneurysm (PAA) and pulmonary artery dissection (PAD) are rare and potentially fatal conditions that may lead to pulmonary artery (PA) rupture and cardiac tamponade. PAA is often associated with other cardiac and congenital heart diseases, such as atrial septal defect (ASD). We report a case of a patient with ASD and a giant dissecting PAA who underwent surgical repair to prevent potentially fatal outcome and discuss the probable etiologies of this case. We present a rare case of a 50-year-old woman with a secundum ASD and severe pulmonary arterial hypertension (PAH) who developed a giant PAA of 114 mm with dissection. The PAA caused extrinsic compression of the left main coronary artery (LMCA), which was misdiagnosed as coronary artery disease (CAD) at local hospital. Right heart catheterization revealed PAH of 73 mmHg and she was referred to our center for further treatment. After 4 months of lowering PAH treatment, she underwent successful surgical repair of the PAA to release the compression of LMCA, as well as mechanical valve replacement, fenestrated ASD closure and tricuspid valvuloplasty. She had an uneventful recovery and showed significant improvement in pulmonary hemodynamics and clinical symptoms at one-year follow-up. PAA with dissection is a rare complication of ASD and PAH that can potentially be fatal. Patients with large or symptomatic PAA and PAD may require early surgical intervention, particularly if they experience compression of nearby structures or are at risk of rupture. It is crucial to promptly refer and consult with specialists and ensure optimal preoperative hemodynamic management to enhance patient outcomes.

Educating patients in a French cancer treatment center: How to ensure therapy safety while reckoning patients’ knowledge and power to act

Educating patients in a French cancer treatment center: How to ensure therapy safety while reckoning patients’ knowledge and power to act

Viral Load Suppression in People Living with HIV Before and During the COVID-19 Pandemic in Brooklyn, New York.

Consistent care is crucial for the health maintenance of people living with human immunodeficiency virus (HIV) (PWH). The coronavirus 2019 (COVID-19) epidemic disrupted patient care in New York City (NYC), yet few studies investigated the association between COVID-19 and viral load suppression in PWH in NYC. This study aims to assess how the COVID-19 pandemic impacted HIV viral load and CD4 + T-cell counts in PWH. Medical records of 1130 adult HIV patients who visited the Special Treatment and Research Health Center in Brooklyn, NY, between January 2019 and May 2023 were compared across three timeframes (pre-pandemic, January 1, 2019 to December 31, 2019; first pandemic phase, March 19, 2020 to December 31, 2020; and second pandemic phase, January 1, 2021 to May 11, 2023). Demographic and clinical variables (e.g. viral load and CD4 + T cell count) were assessed. About 40% of patients did not have routine laboratory monitoring during the first pandemic phase compared with pre-pandemic. The mean HIV viral load was higher during the second pandemic phase compared with pre-pandemic (p = 0.009). The percentages of patients with undetectable HIV viral load and numbers (mm3) of CD4 + T-cells were similar for all time periods. These findings indicate that the COVID-19 pandemic may have exacerbated challenges for individuals who already had barriers to medication adherence or access. However, most individuals remained consistently on their antiretrovirals throughout the pandemic. Further studies are warranted to determine how to mitigate the impact of future pandemics for the health of PWH.

An Evaluation of the Demographics, Characteristics and Healthcare Utilisation of People with Asthma Referred to an Ambulatory Respiratory Hub

Background Asthma is the most treated condition in the Ulster Hospital Ambulatory Respiratory Hub (ARH). This multidisciplinary rapid assessment and treatment centre reviews respiratory patients to prevent hospital admission. This service evaluation (SE) may identify improvements for the service and better outcomes for asthma patients. Aims The demographics, clinical characteristics including biomarker profile and co-morbidities, alongside subsequent healthcare utilisation of patients with asthma were explored. Method Retrospective review of electronic healthcare records identified 151 patients with asthma attending the ARH between 1st July 2019 and 31st Dec 2019. Baseline demographics, clinical characteristics, comorbidities and asthma biomarkers were extracted. Patients were characterised according to their T2-biomarker expression and comparisons made. Healthcare utilisation was assessed by collecting data regarding hospital admissions, emergency department attendances and GP out of hours visits 6 months before and after attending the service. Results Most patients with asthma were female (73.5%), T2- biomarker low (74.2%) and had a high prevalence of obesity (49%). Prevalent comorbidities included rhinosinusitis, gastro-oesophageal reflux disease, depression and anxiety. Investigations included spirometry, chest x-ray and asthma biomarkers (fraction of exhaled nitric oxide and blood eosinophil count). Hospital admissions were reduced by 93%, ED attendances by 83.4% and GP OOH visits by 71.4% during the 6-month period following attendance. Conclusions The identification and management of common asthma comorbidities is important and should be routinely assessed. The ARH reduces healthcare utilisation for patients attending with asthma. It could provide additional support to the regional service enabling quicker access to biologic therapies.

Modeling the Structural Relationships of Attachment Styles with Readiness for Addiction with the Mediation Cognitive Regulation of Emotion in Addicts Who Are Quitting

Background: This research aimed to model the structural relationships of attachment styles with for addiction readiness with mediating variable cognitive regulation of emotion in quitting drug addicts. Methods: This is an analytical-cross-sectional study. The sample included 300 rehabilitated addicts (18 to 55 years old) were selected from 4 addiction treatment centers in Amol city in 1401 using stratified random sampling. The tools used in this research were the questionnaire on attachment styles, readiness for addiction,cognitive regulation of emotions. Data analysis was perfprmed based on structural equation modeling in Amos 22 software. Results: The findings manifested that attachment styles affect addiction readiness with the mediating variable being cognitive regulation of emotions in recovering addicts (P = 0.006, P = 0.0001). Attachment styles were directly related to the cognitive regulation of emotions in recovering addicts (P = 0.0001). Cognitive regulation of excitement had a direct association with readiness for addiction in drug addicts who are quitting (P = 0.0001). Conclusion:The results can beapplied in the interventions and trainings of addiction treatment clinics with regard to the predictive power of variables.

Nusinersen Treatment for Spinal Muscular Atrophy: Retrospective Multicenter Study of Pediatric and Adult Patients in Kuwait.

Spinal muscular atrophy is a neuromuscular genetic condition associated with progressive muscle weakness and atrophy. Nusinersen is an antisense oligonucleotide therapy approved for the treatment of 5q spinal muscular atrophy in pediatric and adult patients. The objective of this clinical case series is to describe the efficacy and safety of nusinersen in treating spinal muscular atrophy in 20 pediatric and 18 adult patients across six treatment centers in Kuwait. Functional motor assessments (Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders, Hammersmith Functional Motor Scale Expanded, and Revised Upper Limb Module) were used to assess changes in motor function following nusinersen treatment. The safety assessment involved clinical monitoring of adverse events. The results demonstrate clinically meaningful or considerable improvement in motor performance for nearly all patients, lasting over 4 years in some cases. A total of 70% of patients in the pediatric cohort and 72% of patients in the adult cohort achieved a clinically meaningful improvement in motor function following nusinersen treatment. Additionally, nusinersen was well-tolerated in both cohorts. These findings add to the growing body of evidence relating to the clinical efficacy and safety of nusinersen.

Risk Factors and Preventive Measures for Cardiovascular Diseases.

Background: Cardiovascular diseases are the most frequent cause of death worldwide. The aim of this study was to identify and demonstrate correlations between mortality data and etiological factors in EU countries. The relationships presented could thus provide a better understanding of etiological factors and possible points for interventions to prevent cardiovascular diseases. The focus was on the following diseases: hypertensive heart disease, atrial flutter/atrial fibrillation, myocardial infarction, and ischemic heart disease, as well as heart failure. Methods: The data in this study come from WHO databases. Connections between the mortality rates and the possible influencing factors were analyzed. The significant factors from the correlation analysis were simultaneously evaluated using a stepwise multiple regression analysis. Results: Analysis of hypertensive heart disease in women reveals the following factors to be significant: drug expenses, health expenses on gross domestic product, and smoking. For men, population density, first admission to a drug treatment center, and drug expenses per person emerged as important factors. Admission to drug treatment centers and length of hospitalization were significant factors for atrial fibrillation and flutter. Fine dust pollution was the most important factor in heart failure. The most important influencing factor for myocardial infarction and ischemic heart disease is nitrogen dioxide concentration. For women, the second highest value is health expenses, followed by the number of outpatient contacts per year. For men, outpatient contacts are in second place. Conclusions: Prevention measures must be taken by the government. The extent to which population density has an influence on cardiovascular diseases should be examined in more detail. In order to reduce the number of initial admissions to drug treatment centers, behavioral prevention related to drug use could be improved.

Trends of Buprenorphine Prescribing for Opioid Dependence Before, and During the Early and Later Part of the COVID-19: A Study from a Large Publicly-Funded Opioid Agonist Treatment Services in India.

The COVID-19 pandemic has affected the availability and access to medications for opioid dependence (OD). We examined the monthly trends in new buprenorphine/naloxone (BNX) treatment episodes, number of clinical visits for BNX, BNX dispensed per person, and BNX prescription over 56-month, which included pre-pandemic, during early, and later part of pandemic (Jan 2017 - Aug 2022). Research data were collected from the pharmacy database of a large publicly funded treatment center in India. A flexible, low-threshold service was adopted in April 2020 in response to the lockdown implemented on 25 March 2020. Change Point analyses were performed to examine monthly trends visually and statistically. We used Autoregressive integrated moving averages to forecast trends from April to Aug 2020 and March to August 2022, using Jan 2017 to March 2020 and March 2020 to February 2022 as training datasets. 993 patients were started on BNX treatment, 40452 BNX clinic attendances were made, 1401393 BNX tablets were dispensed, and 6795 new patients with OD were registered. The observed data for clinic attendance for BNX was significantly lower than the projected estimates in April -Aug 2020; however, observed new treatment episodes and monthly BNX prescriptions were within the 95% projected estimates; BNX dispensed per person was significantly more than the projected estimate. In contrast, observed BNX prescription trends surpassed the upper limit of 95% CI in March-Aug 2022. A low-threshold and flexible treatment service could mitigate the unintended consequences of pandemic-induced restrictions.

Adolescents who enter state custody concurrently with a psychiatric hospitalization

Some youth enter state custody concurrently with a psychiatric hospitalization. This can happen when youth have serious emotional disturbances and parents or guardians relinquish custody in order to pay for inpatient psychiatric care. We studied a population of 521 adolescents who entered state custody through the Illinois Department of Children and Family Services (IDCFS) concurrently with a psychiatric hospitalization between our study period from July 2018 to March 2023, and compared them to populations entering state custody in that time period through medical hospitalization and conventional placements. A large majority (79.5 %) of those in the psychiatric hospitalization group entered custody without a finding of parental abuse or neglect or because parents locked out the child, an action some parents take to force the state to take custody Their median length of stay of 56 days suggests that many youth stayed beyond medical necessity. Almost two-thirds went from the psychiatric hospital to a group home or residential treatment center. We discuss how such use of psychiatric hospitalization and congregate care contrasts with policy emphasizing serving youth in the least restrictive setting.

Comparative analysis of risk factors associated with degeneration of adjacent segments: zero-profile anchored spacer vs. anterior cervical plate and cage construct.

Anterior cervical discectomy and fusion (ACDF) is an established treatment for cervical degenerative disc disease, but cervical spine surgery may affect sagittal alignment parameters and induce adjacent segment degeneration (ASD). This study aimed to determine the risk factors for developing ASD following anterior cervical plate and cage (ACPC) compared with the use of zero-profile anchored spacer (ROI-C). A retrospective contrastive study included 105 patients who underwent ACPC or ROI-C between January 2014 and October 2019 at our treatment centre. There were 50 cases in the ROI-C group and 55 patients in the ACPC group. Clinical and radiological results and the incidence of ASD were assessed after surgery. All patients were further divided into the ASD and non-ASD groups for subgroup analysis. At each follow-up time, there was no statistically significant in radiographic parameters between the two groups. The overall ASD rate was higher in the ACPC group than in the ROI-C group (65.5% vs. 44.0%, p = 0.027). The low preoperative Cobb angle, low preoperative segment angle (SA), and loss of Cobb (ΔCobb) were significantly correlated with ASD. However, clinical outcomes were not associated with ASD at any postoperative follow-up visit. Equally good therapeutic effects were achieved with both the ROI-C and ACPC. The occurrence of ASD was considerably higher in the ACPC group than in the ROI-C group. The preoperative Cobb angle, preoperative SA, and ΔCobb were the most associated with an increase in the risk of ASD.

Racial and gender differences in relapse potential and treatment acceptance among rural residents in a substance use disorder treatment program.

To examine racial and gender differences in treatment acceptance and relapse potential among rural residents admitted to a substance use disorder (SUD) treatment program. A cross-sectional study using data collected from a sample of 1850 rural residents admitted to a South Carolina state-run SUD treatment center between the years of 2018 and 2020. Chi-square and t-tests were used to compare treatment acceptance and relapse potential by race and gender. Multivariate logistic regression analyses was conducted to further examine the relationship of race and gender with treatment acceptance and relapse potential after adjusting for potential confounding variables. Approximately 50% of participants were classified as being accepting of their treatment and committed to changing their substance use, and there were no racial or gender differences in the bivariate and multivariate analyses. Approximately 25% of participants were classified as having low/no potential risk for relapsing, and there were no racial or gender differences in the bivariate analysis. However, the adjusted odds ratio of relapsing risk were lower among White compared to Black adults [AOR = 0.49 with 95% CI (0.31-0.77)]. This study suggests there are no gender or racial differences in treatment acceptance for SUD but that Black adults are at greater risk of relapsing relative to White adults. Additional research is needed to identify factors that increase Black adults' risk for relapse to inform interventions that can improve SUD treatment outcomes in this population.

Donor side effects experienced under minimal controlled ovarian stimulation with in vitro maturation vs. conventional controlled ovarian stimulation for in vitro fertilization treatment

To evaluate oocyte retrieval experiences and side effects under minimally controlled ovarian stimulation (COS) treatment for invitro maturation (IVM) of oocytes compared with conventional COS treatment. A retrospective survey study. Clinical invitro fertilization treatment center. Data were collected from subjects undergoing minimal COS treatment (n = 110; 600-800 IU follicle-stimulating hormone) for IVM of oocytes and conventional COS treatment for egg donation (n = 48; 1,800-2,600 IU follicle-stimulating hormone) from April 2022 to November2023. Minimal and conventional COS treatments. The most common side effects experienced during ovarian stimulation and after oocyte pick-up, satisfaction level, and the likelihood of recommending or repeating minimal or conventional COS. Statistical analysis included Mann-Whitney U test and χ2 tests, with a significance level. During minimal COS treatment, most subjects did not experience breast swelling (86%), pelvic or abdominal pain (76%), nausea or vomiting (96%), and bleeding (96%). After oocyte pick-up, the majority (75%) reported no pelvic or abdominal pain. The most common side effect was abdominal swelling (52%). Compared with conventional COS cycles, minimal COS subjects reported significantly less postretrieval pain, with 33% experiencing no pain (vs. 6%) and with a reduced severe level of pain (5% vs. 19%), leading to fewer subjects requiring pain medication (25% vs. 54%). Additionally, 85% of women were very satisfied with minimal stimulation treatment and would recommend or repeat the treatment. Reducing the hormonal dose for ovarian stimulation has a beneficial effect on subjects, suggesting the combination of minimal COS treatment with IVM techniques is a well-tolerated alternative for women who cannot or do not wish to undergo conventionally controlled ovarian hyperstimulation treatment.

Impact of quality of life and geographic distance on radiation adherence in patients with locally advanced cervical cancer residing in rural areas.

e13512 Background: The efficacy of curative-intent chemoradiation in treating cervical cancer is intricately tied to patient adherence to treatment protocols, often influenced by quality of life. In many areas of the world, treatment centers are often located far from where patients live. We sought to evaluate the impact of distance from the hospital and the quality of life on radiation adherence, especially for patients in the Country of Georgia. Methods: A prospective study conducted at Todua Clinic, Tbilisi, Georgia, from May 2023 - January 2024, involved locally advanced cervical cancer patients undergoing chemoradiation. The study was reviewed by the Todua Clinic Research Ethics Board. The questionnaire was offered at a baseline, at a radiation consult. Quality of life was assessed using the Functional Assessment of Cancer Therapy–Cervical Cancer Version 4. Distance categories (50-100km, 100-200km, 200-300km) were measured, and patient information was extracted from medical records. Radiation nonadherence was defined as missing ≥2 days of external beam radiotherapy. Inclusion criteria comprised stage II and III cervical cancer, prescribed chemoradiation therapy, and rural residency. Multivariable logistic regression was performed to control for confounding variables. Results: Out of the total 50 patients who were asked to participate, 22 declined (reasons for declining: 35% -no mood, 15% - too tired, 45% - not interested, 5% found questions inappropriate to answer) and 28 (56%) participated. 53% of patients were deemed adherent to the prescribed treatment. Statistical analyses unveiled an intriguing trend where mean adherence rates increased with distance from the hospital. However, the Chi-squared test yielded a p-value of 0.065, indicating a marginal significance. The breakdown of mean adherence rates by distance revealed 30.8% for 50-100 km, 66.7% for 100-200 km, and 83.3% for 200-300 km. Educational levels did not significantly impact treatment adherence, despite lower educational attainment in more distant rural areas. The analysis of Quality of Life (Score S) exhibited a negative coefficient (-0.01639), suggesting a subtle decrease in the likelihood of treatment adherence as Quality-of-Life scores increased. Conclusions: This study unveils the interplay between living distance, Quality of Life, and radiation adherence in locally advanced cervical cancer patients in the Country of Georgia. Our findings are interesting because, unlike in other countries where adherence tends to drop as distance increases, we noticed that adherence rates went up when patients lived farther away. One possible reason for this is that some patients move temporarily to cities like Tbilisi just for their radiation treatment. However, we recognize the need for a larger group of people to make our results more reliable and better understand their significance.

Prevalence of and factors associated with chronic kidney disease among patients infected with human immunodeficiency virus attending care and treatment centers at tertiary hospitals in dodoma, Tanzania

BackgroundThe burden and risk of developing chronic kidney disease (CKD) among patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is higher than in the general population. This study aimed to determine prevalence of and associated factors with CKD among adults infected with human immunodeficiency virus at tertiary hospitals in Dodoma, Tanzania. Methodology: A cross-sectional study was carried out between November 2022 to April 2023. Patients’ demographic data, and clinical measurements were obtained on the day of the visit. Laboratory investigations were performed as standard of care. Descriptive and inferential analyses were performed, and variables associated with CKD were identified by multivariable logistic regression. ResultsA total of 223 patients were enrolled, with a median age of 47 (IQR 38–56) years, and 72.2 % were female. The CKD prevalence was 23.3 % whereby 18.4 % had CKD stage 3a, 4.5 % had CKD stage 3 b, and 0.4 % had CKD stage 4. CKD was observed largely among patients with obesity (34.15 %), anemia (29.41 %), hypertension (45.00 %), and diabetes mellitus (50.00 %). Variables with higher odds for CKD after adjusted analysis were hypertension (OR 3.03, 95 %% CI 1.29–7.11, P = 0.0109), diabetes mellitus (OR 4.50, 95 % CI 1.35–15.03, P = 0.0144), obesity (OR 3.07, 95 % CI 1.11–8.47, P = 0.0301), anaemia (OR 2.42, 95 % CI 1.12–5.26, P = 0.0252) and for each one-unit increase in age (years), there was statistically significant increase in the odds of having CKD by 1.084 folds (OR = 1.084, 95 % CI 1.039–1.131, p = 0.0002). ConclusionThe prevalence of CKD among patients with HIV/AIDS is high. Age, obesity, anaemia, hypertension, and diabetes mellitus were strongly associated with CKD suggesting a need for integrating initiatives for non-communicable disease control in this population.

Rapid detection of Ebolavirus using isothermal recombinase-aided amplification.

Ebolavirus disease (EVD) is an often-lethal disease caused by the genus Ebolavirus (EBOV). Although vaccines are being developed and recently used, outbreak control still relies on a combination of various factors, including rapid identification of EVD cases. This allows rapid patient isolation and control measure implementation. Ebolavirus diagnosis is performed in treatment centers or reference laboratories, which usually takes a few hours to days to confirm the outbreak or deliver a clear result. A fast and field-deployable molecular detection method, such as the isothermal amplification recombinase-aided amplification (RAA), could significantly reduce sample-to-result time. In this study, a RT-RAA assay was evaluated for EBOV detection. Various primer and probe combinations were screened; analytical sensitivity and cross-specificity were tested. A total of 40 archived samples from the 2014 to 2016 Ebola outbreak in West Africa were tested with both the reference method real-time RT-PCR and the established RT-RAA assay. The assay could detect down to 22.6 molecular copies per microliter. No other pathogens were detected with the Ebolavirus RT-RAA assay. Testing 40 samples yield clinical sensitivity and specificity of 100% each. This rapid isothermal RT-RAA assay can replace the previous RT-RPA and continue to offer rapid EBOV diagnostics.

Clinical procedures for in vitro maturation treatment

To demonstrate clinical techniques for invitro maturation (IVM) treatment, including stimulation recommendations, small follicle pick-up procedures, and compact cumulus-oocyte complex (COC) search practice. This video utilizes live-action footage from surgery and embryology practice for a representative IVM treatment cycle, with step-by-step instructions and recommendations for practice procedures. Invitro fertilization (IVF) clinic. Patients undergoing IVM treatment. The patient(s) included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites. Identification of treatment cohorts, IVM definitions, and recommendations for stimulation treatments. A visual demonstration of COC extraction techniques from small antral follicles includes tubing, needle types, considerations when using double lumen or sheath needles, needle pressure, ultrasound, needle flushing, and aspiration technique. Visual demonstration of oocyte search and IVM preparation, including filtering follicular aspirate, prevention of COC cooling, identification of compact COCs, and general parameters of different IVM approaches. Clinical techniques for small follicle ovum pick up and compact COC identification for IVM treatment. Successful IVM treatment of patients can be achieved using minimal ovarian stimulation, effective small follicle retrieval, and efficient compact COC identification with flexibility in approach depending on clinical constraints and preference. Invitro maturation treatment is an efficacious and safe treatment for high ovarian reserve and hyper-responding patients undergoing IVF treatment, in which the retrieval of multiple immature COCs and their exvivo maturation can be achieved with little to no invivo stimulation. Practice procedures vary between treatment centers and IVM techniques. This video provides practice recommendations paired with a visual demonstration of techniques to assist in standardizing the approach and expanding the practice to more centers.

Cost-utility analysis of a supervised exercise program for patients with metastatic breast cancer in the PREFERABLE-EFFECT randomized controlled trial (RCT).

11121 Background: Exercise for patients with metastatic breast cancer (mBC) significantly reduced fatigue and improved quality of life (QoL) in the multinational PREFERABLE-EFFECT RCT (NCT04120298). Evidence on the cost-effectiveness of exercise for patients with mBC is lacking, albeit essential for implementation in clinical practice. In this study, we evaluated the cost-utility of an exercise program for patients with mBC in the EFFECT RCT. Methods: We conducted a cost-utility analysis using data from the 357 EFFECT trial participants (mean age 55 ± 11 yrs, 75% on 1st/2nd line treatment). These participants, from centers in NL, DE, SE, PL, ES, AU, were randomized to either a 9-month supervised exercise intervention (n=178) or a usual care control group (n=179). We used a societal perspective with a time-horizon of 9 months. Two different scenario analyses (SA) were used to determine intervention costs using a bottom-up micro-costing method: SA-1) 1-on-1 supervision; SA-2) 4-on-1 supervision. Data on healthcare resource use, productivity loss and QoL (converted to QALYs) were collected with country-adapted, self-report questionnaires, including the iMCQ, iPCQ and EQ-5D-5L, at 3-, 6- and 9-months post-baseline. Multiple imputation was performed, and bootstrapping was used to study uncertainty. Results: Compared to usual care, supervised exercise led to a QALY gain of 0.015 (95% CI: -0.02; 0.05) over a 9-month period, corresponding to an increase of 5.3 days in perfect health. The mean intervention costs were €1,696 in SA-1 and €609 in SA-2. The mean total cost differences (adjusted for center and line of treatment) were -€27 (SA-1), and -€1,112 (SA-2), in favor of the exercise group ( Table). The greatest cost-savings occurred in hospital costs, meaning that the exercise group had lower hospital costs compared to the control group (€4,430 vs €5,211). The probability of supervised exercise being cost effective at a willingness-to-pay threshold of €20.000 or €80.000 per QALY gained was 62% or 76% in SA-1, and 91% or 92% in SA-2, respectively. Conclusions: Exercise for patients with mBC is likely to be cost-effective when individually supervised and even dominant (greater cost-savings and more effective) when group-based. Based on our positive findings for both effectiveness and cost-effectiveness, we recommend supervised exercise to be reimbursed as supportive care during treatment for mBC. Clinical trial information: NCT04120298 . [Table: see text]

Addition of IL-6 and phosphate to the m-EASIX score and detection of ICANS and CRS progression.

e14511 Background: Cytokine release syndrome (CRS) and immune cell associated neurotoxicity syndrome (ICANS) can be severe complications of CAR-T infusion. Both syndromes have been associated with endothelial dysfunction which prompted prior use of a modified version of the Endothelial Activation and Stress Index (m-EASIX) to predict the occurrence of severe grades of ICANS and CRS. Recent studies have linked low phosphorous (P) levels to both syndromes, and IL-6 is a known mediator of both. Our study aimed to enhance early prediction of CRS and ICANS by integrating both P and IL-6 into the m-EASIX score. Methods: This retrospective study included 44 patients (26 male and 18 female) ranging from 42 to 86 years old with non-Hodgkin's lymphoma presenting to the University of Arizona Cancer Center for CAR-T treatment. P, CRP, IL-6, and LDH were recorded up to 7 days before and 14 days after CAR-T infusion. All platelet levels were recorded the day of infusion. Variations of the m-EASIX score as outlined in table 1 were then calculated. The values of P were cubed to ensure relative differences in P had proportional consistency to differences in other values. The scores were then used to generate ROC curves for the occurrence of CRS, ICANS, and the progression of CRS to grade ≥2 with CI generated through the Wilson/Brown method. Results: Of the 44 patients, 21 developed CRS alone, 12 developed ICANS+CRS, and 11 developed neither. 18 patients had progression of CRS to grade ≥2. The median day of onset for CRS, ICANS, and progression of CRS to grade ≥2 was 2, 5, and 4 days respectively. Day 3 post infusion yielded the highest values of area under the curve (AUC) with each variation of the m-EASIX score statistically significant with a p&lt;0.001 as represented in table 1. The addition of P and IL-6 to the m-EASIX score increased AUC, sensitivity, and specificity for the occurrence of CRS, ICANS, and progression of CRS to grade ≥2. Conclusions: The inclusion of P and IL-6 in the m-EASIX score improved the sensitivity and specificity of detecting CRS, CRS progression, and the development of ICANS on the 3rd day post infusion. Larger scale studies investigating the efficacy of inclusion of P and IL-6 in the m-EASIX score in guiding early interventions to mitigate complications associated with CAR-T therapy are necessary. [Table: see text]