Treatment Of Type Research Articles

Characteristics and Trajectory of Older Adults Supported by a Patient Navigator Program in a Hospital Setting: A Cohort Observational Study.

To improve transitions in care, a new patient navigation (PN) program was introduced to support older adults with complex care needs transition from hospital to home. The patient navigator is a community social worker embedded in the hospital's care teams. A cohort observational design was used to conduct the study by analysing the patient navigator's clinical notes and hospital's administrative data to describe the characteristics of patients, scope of the patient navigator's activities, and patient outcomes. Ninety patients were assigned to the patient navigator's caseload (November 2019-November 2021) in which the average age was 78.9 (range 55-95). The most frequent PN intervention types were referrals to community services (66%, n = 59) and discharge planning (61%, n = 55). The patient navigator supported 66% patients (n = 59) in returning home and provided follow-up care for 74 days (average). This study provides important insights into the patient navigator's role to guide decision makers in implementing PN programs for older adults in a hospital setting.

The effectiveness of telemedicine applications in mental health services: a meta-analysis study.

This study was conducted to reveal the effectiveness of telemedicine applications in mental health services. For this meta-analysis study, data were obtained by searching PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center databases for the last 5years in September-December 2023. After the review, 24 studies were included. In this meta-analysis, it was found that telemedicine interventions in mental health services decreased the depression level of individuals (SMD - 0.168, 95% CI - 0.315 to - 0.021; Z = - 2.243; p < .05). In addition, it was determined that the duration of the intervention played a role in the effectiveness of telemedicine interventions applied to individuals. In addition, it was determined that the type of intervention, the country where the research was conducted, and the patient group did not play a role in the effectiveness of telemedicine interventions applied to individuals. Telemedicine applications in mental health services can play an effective role in reducing the burden of chronic mental illness and improving patient outcomes.

Two-Dimensional Radiographic Diagnosis of Maxillary Canine Impactions

Background: The primary aim of this study was to evaluate, using conventional radiographic imaging, the height, angulation, and mesiodistal position of impacted maxillary canines to determine if these variables are significantly associated with the palatal or buccal positioning of the tooth. Methods: A retrospective analysis was conducted on all patients diagnosed and treated for at least one impacted maxillary canine over a 4-year period in the Principality of Asturias. The final sample included 159 impacted canines. The variables analyzed were age, gender, associated pathology, location, angulation, height, mesiodistal position, buccopalatal position, and treatment method. Follow-up periods ranged from 12 to 50 months. Results: The mean age of the patients was 21 years (range 10–41 years), with most cases occurring in patients aged 14 to 30 years. Females accounted for 66.1% of the sample, with a female-to-male ratio of 1.95:1. The type of treatment (extraction/traction, surgical–orthodontic approach) was significantly associated with patient age. Additionally, the proximity of the impacted canine crown to the palatal or buccal cortices was significantly related to the treatment choice. However, no significant relationship was observed between the palatal/buccal position of the canine crown and its height or angulation. Conclusions: In the present work, the upper canines included by the palatal did not have a greater height or angulation than the canines included by the vestibule.

Two-Year Experience of a Center of Excellence for the Comprehensive Management of Non-Small Cell Lung Cancer at a Fourth-Level Hospital in Bogota, Colombia: Observational Case Series Study and Retrospective Analysis

Background: This study aimed to provide a comprehensive analysis of 56 patients admitted to the Lung Cancer Clinical Care Center (C3) at Fundación Santa Fe de Bogotá (FSFB) between 2 May 2022 and 22 April 2024. The focus was on demographic characteristics, smoking history, comorbidities, lung cancer types, TNM classification, treatment modalities, and outcomes. Methods: This observational case series study reviewed medical records and included patients over 18 years with a confirmed diagnosis of non-small cell lung cancer (NSCLC). Data were collected and analyzed for demographics, comorbidities, treatment types, biomolecular profiling, and survival rates. Ethical approval was obtained, and data were anonymized. Results: The mean age was 71.8 years with a female predominance (53.6%). A history of smoking was present in 71.4% of patients. Adenocarcinoma was the most common type (75.0%), followed by squamous cell carcinoma (19.6%). At admission, the most frequent TNM stages were IA2 (17.9%) and IVA (16.1%). One-year survival was 68.8%, and 94.3% of stage I–IIIA patients underwent PET scans. Biomolecular profiling revealed 69.2% non-mutated EGFR, 90.4% ALK-negative, and various PDL-1 expression levels. Immunotherapy was received by 91.4% of patients, with Alectinib and Osimertinib being common. Grade III–IV pneumonitis occurred in 5.4% of patients. Conclusions: The study’s findings align with existing literature, highlighting significant smoking history, common adenocarcinoma, and substantial use of immunotherapy. Limitations include the observational design, small sample size, and short follow-up period, impacting the generalizability and long-term outcome assessment. Future research should address these limitations and explore longitudinal outcomes and emerging therapies.

Algorithm of surgical treatment of resistant forms of pulmonary tuberculosis

Objective. To improve the effectiveness of surgical treatment of multidrug–resistant pulmonary tuberculosis and extensively drug–resistant pulmonary tuberculosis. Materials and Methods. The work is based on the analysis of the results of treatment of 316 patients. The sequence of actions to determine the optimal type and extent of surgical intervention is regulated. Results. An algorithm for the surgical treatment of multidrug–resistant pulmonary tuberculosis and extensively drug–resistant pulmonary tuberculosis was developed and implemented, based on the results of a study of this complex category of patients who underwent preoperative preparation, a sequence of actions for surgical intervention, and postoperative management technology, taking into account current specific therapy regimens. Conclusions. The application of the developed algorithm of surgical treatment allowed to reduce the incidence of pulmonary tuberculosis recurrence and postoperative complications from (14.4 ± 2.3) to (7.0 ± 1.3)% and cure 92.5% of patients.

AHP SO07 - Dietetic Outpatient Service to Patients undergoing Oesophagogastric (OG) Surgery for Cancer

Abstract Background Nutrition is a modifiable risk factor impacting surgical outcomes in OG cancer. Its key role influencing health related quality of life is emerging with improved survivorship. Guidelines depicting optimal timing and type of dietetic intervention for this patient group are unclear. In order to best direct dietetic care, optimise timing of nutritional interventions and understand demand for service it is important to reflect on current provision. This audit aimed to describe the dietetic outpatient service to patients undergoing OG Surgery for cancer in a national centre for treatment of oesophageal cancer. Method A retrospective review of dietetic records and statistics. Patients who underwent oesophagectomy (O), gastrectomy (G) or subtotal gastrectomy (STG) for cancer between May 2022- May 2023 were included. Results 63 patients were included: 38 O, 17 TG, 8 STG. 11 were seen by the dietitian at first visit to OG Clinic (9 O, 1 TG, 1 STG) – 6 had an elective feeding tube (FT) inserted for neoadjuvant treatment (5 O, 1 STG). 83% attended a surgical pre-assessment dietetic appointment (36 O, 14 TG, 2 STG). 86% were reviewed within 1 month post O or TG, 75% post STG. 258 dietetic interventions occurred in the first year post-op (median 3.5, range 0-14). 64% in the first 3 months(m) post op, 16% at 3-6m, 10% at 6-9m, 10% at 9-12m. Conclusion In this high nutritional risk group only 18% are assessed by a dietitian at first visit to UGI MDT clinic. There is a successful pathway for immediate peri-operative dietetic care in patients post O and TG. The pathway for STG is less well established. Dietetic interventions are concentrated in the first 3 months after surgery. There is no established protocol to support longer term nutritional needs into survivorship. To inform practice a measure of patient experience and needs would be useful, to explore best delivery format and access routes to future services.

Sexual dysfunction in lymphoma survivors: a scoping review.

Lymphoma and cancer-related treatment can cause many complications, including sexual dysfunction, a common symptom experienced by lymphoma survivors during the disease trajectory and survivorship. A scoping review was performed to determine the current state of knowledge about sexual dysfunction in lymphoma survivors and identify knowledge gaps and implications for future research. PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO were searched to identify all primary peer-reviewed research articles published in the English language that were pertinent to sexual dysfunction in lymphoma survivors. The framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist were used to assess and synthesize the available evidence on sexual dysfunction in lymphoma survivors. This review provided supportive evidence that sexual function in lymphoma survivors is a major ongoing area of concern. Thirty eligible articles published from 1979 to 2023 were appraised in this review. Most of the studies (73.33%) used a cross-sectional design. Using the Methodological Index for Non-Randomized Studies, more than half of the publications (53.33%) achieved a C quality ranking. The reviewed studies revealed that sexual dysfunction was a prevalent symptom experienced by lymphoma survivors, with predictors such as age, gender, sex hormones, stage of disease, and types of cancer treatment. Healthcare providers need to consistently perform routine assessment of sexual function and provide adequate treatment options. The reviewed studies document the problem of sexual dysfunction and offer potential areas of improvement for clinical practice. However, in the majority of the studies, longitudinal data were not obtained which could provide valuable insights on sexual functioning in lymphoma survivors. Despite many years of research on sexual function in lymphoma survivors, substantial gaps in knowledge regarding sexual issues in this population remain. Healthcare providers should routinely assess sexual function of survivors and provide treatment options. Psychosexual interventions should be tailored for the needs of cancer survivors. Sexual function education is essential for all oncologists and should be included in the care pathway from diagnosis until survivorship.

EGS SO32 - Management of Spontaneous Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Spontaneous Oesophageal Perforation (SOP) is a rare gastro-intestinal surgical emergency with devastating morbidity and mortality. Given the rarity of the entity, there is no up-to-date evidence on outcomes in the context of centralized esophagogastric services neither consensus guidelines nor standardized treatment algorithms on how these should be optimally managed. Endoscopic Vacuum Therapy (EVT) has emerged as safe and effective option particularly in cases where major invasive surgery would otherwise be deferred. Herein, we sought to explore the effectiveness, patient benefit and related morbidity/mortality by exploring the strategy outcomes in SOPs prior to and during periods where EVT was available. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=72) presented or transferred to our tertiary oesophagogastric unit for SOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or perforation secondary to malignancy, iatrogenic, traumatic or food bolus were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day, 1-year mortality. Results In 2009-2017 pre-EVT period, 25/72 patients were managed a) 18/25 surgically with thoracotomy and T-tube, b) non-surgical 7/25, four were palliated. 30-day, 90-day mortality were 4/25 and 2/25, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 14/25 (56%), 90-day reintervention 8/25 (32%), median LOS 27 days. In 2018-2023 EVT period , 47/72 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 18/47, b) non-surgical 15/47, c) endoscopy 6/47, d) EVT in 14/47. 30-day mortality was 6/47, 90-day mortality 2/47, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 32/47 (68%), 90-day reintervention 26/47 (55.3%), median LOS 34 days. 1-year mortality was 5/25 and 3/47 respectively. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of spontaneous oesophageal perforations. Optimal patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is recommended as soon as such a diagnosis is confirmed.

EGS SO30 - Management of Iatrogenic Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass non-operative for early perforation without sepsis, endoscopic with endoclip/stent and surgical including primary repair, exclusion and diversion or oesophagectomy. Recently, Endoscopic Vacuum Therapy (EVT) has been introduced as safe and effective alternative approach. We sought to assess treatment outcomes in patients with IOPs prior to and during periods where EVT was available as treatment option. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=30) presented or transferred to our tertiary oesophagogastric unit for IOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or spontaneous perforation secondary to malignancy or benign pathology were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day and 1-year mortality. Results In 2009-2017 pre-EVT period, 11/30 patients were managed a) non-surgically 7/11, b) endoclip 3/11 and stenting 1/11. 30-day and 90-day mortality were 1/11, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 3/11 (27.3%), 90-day reintervention 8/11 (72.7%), median LOS 27 days. In 2018-2023 EVT period, 19/30 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 5/19, b) non-surgical 7/19, c) IR NJT, stent or PEG in 6/19 d) EVT in 4/19. 30-day mortality was 0/19, 90-day mortality 1/19 (5.2%), 90-day morbidity Clavien-Dindo &amp;gt;IIIa 7/19 (36.8%), 90-day reintervention 9/19 (47.4%), median LOS 61 days. 1-year mortality was 0/19 for both. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of iatrogenic oesophageal perforations. Careful patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is a sine qua non.

Being different during treatment: a qualitative study investigating patients' experiences of treatments for missing maxillary lateral incisors.

Agenesis of one or more teeth is common among patients who are referred for orthodontic treatment. The most common treatments are orthodontic space closure (SC) and implant replacement (IR), which are widely studied, but the experiences of patients receiving these treatments have received little attention. The aim of this qualitative study is to explore how treatments to address missing maxillary lateral incisors (MMLIs) are experienced by individuals who are treated using either orthodontic SC or IR. This study is conducted in Sweden and based on semi-structured interviews with 13 individuals who have completed treatment, either orthodontic SC (n = 7) or IR (n = 6), to address the lack of one or two maxillary lateral incisors. Data were analysed in accordance with the grounded theory approach. Findings were classified into the main category of being different during treatment and into three associated sub-categories. The first category, that is being different due to missing teeth, refers to when a person experiences being different because of the anterior spacing The second category, that is being different due to fixed appliance, refers to when the appliance itself makes a person different. The two first categories exemplify being different in terms of appearance. The third identified category, that is being different due to treatment appointments, refers to the need to spend time differently because of having appointments at the clinic for treatment. Patients MMLIs consider their treatment to start at the time of diagnosis. They experience feelings of being different irrespective of whether the type of treatment is orthodontic SC or IR. The experience of being different differs in timing and causes depending on the treatment method.

The influence of physical exercise on negative emotions in adolescents: a meta-analysis

BackgroundAdolescence is also accompanied by ongoing mood changes (relative to childhood and adulthood), which can trigger more extreme negative emotional responses. Physical exercise alleviates negative emotions and reduces the risk of mental illness. However, the effect of physical exercise on negative emotions in adolescents is unclear, so it is valuable to synthesize previous studies with meta-analysis.ObjectiveTo examine the influence of physical exercise (PE) intervention on negative emotions in adolescents aged 10 to 19 years.MethodsWe retrieved the articles from PubMed, Web of Science, EBSCO, Cochrane, and Embase up to April 11, 2024. The main search terms were physical exercise, negative emotions, adolescents, randomized controlled trials. The meta-analysis was conducted using Review Manager 5.3. A random-effects model was employed to calculate the standardized mean difference (SMD) and 95% confidence interval (CI). Subgroups were analysed as the type of negative emotions, type of control group, intervention type, duration, time, frequency.ResultsThe PE intervention group exhibited a significantly superior improvement in alleviating negative emotions compared to the control group (SMD = -0.59, 95% CI: -0.92 to -0.26, p &amp;lt; 0.01, Z = 3.50, I² = 95%). PE was particularly effective in mitigating adolescent depression (SMD = -0.67, 95% CI = -1.07 to -0.28, p &amp;lt; 0.01, I² = 96%) but did not yield significant results in reducing adolescent anxiety (SMD = -0.29, 95% CI = -0.63 to 0.05, p = 0.10, I² = 95%).ConclusionPE intervention can ameliorate negative emotions in adolescents.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024534375.

Abstract 4131381: Comparison of Dietary Macronutrient Interventions for Weight and Cardiovascular Risk Factor Reduction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trial

Background: Dietary interventions play a crucial role in weight management and reducing cardiovascular risk factors. Our study aims to compare the effectiveness of four dietary macronutrient interventions on weight loss and cardiovascular (CV) risk factor reduction through a systematic review and network meta-analysis. Methods: We conducted a comprehensive literature search on PubMed, Scopus, Embase, and Cochrane Library up till May 2024 to identify randomized controlled trials (RCTs) comparing four macronutrient dietary interventions including Mediterranean Diet (MD), Keto, Dietary Approaches to Stop Hypertension (DASH), and Intermittent Fasting (IF) with study period ≥ 6 months or 24 weeks. The primary outcomes of interest were weight loss, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Body Mass Index (BMI), High density lipoprotein (HDL), Low density Lipoprotein (LDL), cholesterol levels and C-reactive protein (CRP) levels. Outcomes were reported as standard mean difference (SMD). Results: Our analysis identified 50 studies enrolling 5368 patients (MD=3554; DASH=838; Keto=206; IF=770). Regarding BP outcome, MD and DASH had significant reduction in SBP and DBP respectively (MD [SBP]: -0.76 mmHg vs DASH [DBP]: -1.92 mmHg) respectively. In contrast, IF showed a significant rise in SBP (0.87). MD participants also had significant weight loss (-1.06 kg) and a moderate decrease in BMI (-0.79) when compared with other diets. Furthermore, IF, keto, and MD showed moderate increase in HDL levels (0.61, 0.77 and 0.33) respectively. In contrast, DASH resulted in a moderate decline in HDL levels (-0.92). IF and MD resulted in modest decline in LDL levels (-0.45 and -0.42) respectively. In contrast, Keto demonstrated non-significant rise in LDL (0.35). DASH showed a significant decrease in triglycerides (-3.02). Lastly, MD demonstrated a significant reduction in CRP (-0.89). Conclusions: MD and DASH were superior to other dietary interventions in terms of weight loss and CV risk factors. Further research is required to tailor specific types of dietary interventions and assess their long-term efficacy on weight loss and CV risk reduction.

GAMMA KNIFE AND QUALITY OF LIFE: A REVIEW ON THE USE OF RADIOSURGERY IN BRAIN TUMORS

INTRODUCTION: Considering the quality of life of patients with brain tumors, several treatment alternatives have been developed over time, aiming at a less invasive potential and providing a permanent functional capacity for the individual. In this regard, in recent decades there has been debate about radiosurgery for the treatment of brain tumors. OBJECTIVE: The objective of this study was to evaluate the feasibility of Gamma Knife radiosurgery, considering patient safety. METHODS: This article is characterized as an integrative literature review of an exploratory nature, in the PubMED and Cochrane databases, the search was restricted to observational studies and randomized clinical trials as primary data to contemplate the outcomes Quality of life, neurological preservation, recurrence, cerebral complications and overall survival. RESULTS: The analysis of the collected data demonstrated that, in general, radiosurgery by the Gamma Knife platform preserves quality of life in several cases, mainly in smaller benign brain tumors. The disease recurrence rate after 3 years of radiosurgery ranged from 20 to 40%, depending on the type of tumor and treatment, with the highest recurrence rate in grade III meningiomas and high-grade gliomas. The 5-year recurrence rate ranged from 60 to 80%, and was therefore higher than that of more invasive treatments. CONCLUSION: The qualitative synthesis of these data proves the efficacy of radiosurgery and may suggest to neurosurgeons the possibility of treating brain tumors in patients who are not eligible for conventional surgery or in patients with non-bulky tumors.

Enhancing daily oral PrEP adherence with digital communications: Protocol for a systematic review and meta-analysis.

Pre-exposure prophylaxis (PrEP) stands as an effective tool in preventing HIV transmission among individuals at risk of HIV infection. However, the effectiveness of daily oral PrEP is contingent on the adherence of its users, which can pose a challenge for many individuals. Various studies have explored different interventions aimed at bolstering PrEP adherence. One recurring type of intervention revolves around digital communication (e.g., SMS, mobile applications) to send reminders for PrEP usage. The objective of our systematic review and meta-analysis is to address the following research question: What is the effectiveness of digital communication interventions in enhancing daily oral PrEP adherence among individuals at a heightened risk of HIV infection? This paper presents our study protocol. We will conduct searches across four health-related databases: Embase, PubMed, Web of Science, and PsycINFO. We will also explore other sources, including clinical trials registries and grey literature. Our search will be restricted to original randomized controlled trials published in English, French, and Spanish conducted since 2012, when PrEP was approved, to today. To ensure rigor, three reviewers will perform the systematic review and meta-analysis. This systematic review will adhere to the guidelines outlined in the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our primary outcome of interest is proper daily oral PrEP adherence, which we will measure using association metrics (e.g., odds ratios). This review will offer insights into the effectiveness of utilizing digital communication methods to assist individuals at risk of HIV in improving their PrEP adherence. International Prospective Register for Systematic Reviews (PROSPERO) number CRD42023471269.

Overtreatment of Prostate Cancer Among Men With Limited Longevity in the Active Surveillance Era.

Men with limited life expectancy (LE) have historically been overtreated for prostate cancer despite clear guideline recommendations. With increasing use of active surveillance, it is unclear if overtreatment of men with limited LE has persisted and how overtreatment varies by tumor risk and treatment type. To determine if rates of overtreatment of men with limited LE have persisted in the active surveillance era and whether overtreatment varies by tumor risk or treatment type. This cohort study included men with clinically localized prostate cancer in the Veterans Affairs health system who received a diagnosis between January 1, 2000, and December 31, 2019. LE was estimated using the validated age-adjusted Prostate Cancer Comorbidity Index (PCCI). Treatment trends among men with limited LE were assessed using a stratified linear and log-linear Poisson regression in aggregate and across PCCI and tumor risk subgroups. The mean (SD) age for the study population of 243 928 men was 66.8 (8.0) years. A total of 50 045 (20.5%) and 11 366 (4.7%) men had an LE of less than 10 years and LE of less than 5 years based on PCCI scores of 5 or greater and 10 or greater, respectively. Among men with an LE of less than 10 years, the proportion of men treated with definitive treatment (surgery or radiotherapy) for low-risk disease decreased from 37.4% to 14.7% (absolute change, -22.7%; 95% CI, -30.0% to -15.4%) but increased for intermediate-risk disease from 37.6% to 59.8% (22.1%; 95% CI, 14.8%-29.4%) from 2000 to 2019, with increases observed for favorable (32.8%-57.8%) unfavorable intermediate-risk disease (46.1%-65.2%). Among men with an LE of less than 10 years who were receiving definitive therapy, the predominant treatment was radiotherapy (78%). Among men with an LE of less than 10 years, use of radiotherapy increased from 31.3% to 44.9% (13.6%; 95% CI, 8.5%-18.7%) for intermediate-risk disease from 2000 to 2019, with increases observed for favorable and unfavorable intermediate-risk disease. Among men with an LE of less than 5 years, the proportion of men treated with definitive treatment for high-risk disease increased from 17.3% to 46.5% (29.3%; 95% CI, 21.9%-36.6%) from 2000 to 2019. Among men with an LE of less than 5 years who were receiving definitive therapy, the predominant treatment was radiotherapy (85%). Among men with an LE of less than 5 years, use of radiotherapy increased from 16.3% to 39.0% (22.6%; 95% CI, 16.5%-28.8%) from 2000 to 2019. The results of this cohort study suggest that, in the active surveillance era, overtreatment of men with limited LE and intermediate-risk and high-risk prostate cancer has increased in the VA, mainly with radiotherapy.

EPID-17. REAL-WORLD OUTCOMES OF BRAIN METASTASES FROM PANCREATIC CANCER: AN ANALYSIS OF 1266 PATIENTS

Abstract BACKGROUND Brain metastases (BMs) from pancreatic cancer (PC) are uncommon. This study examined patterns of care and clinical outcomes for PC BMs. METHODS A retrospective analysis was conducted on PC BMs patients in the US National Cancer Database between 2010-2020, following STROBE guidelines. Treatments were categorized into systemic therapy (Sys) alone, stereotactic radiosurgery (SRS)±Sys, whole brain radiation (WBRT)±Sys, and no brain-specific treatment (NoTx). Primary outcome was median overall survival (mOS), with corresponding hazard ratio for death (HR) and 95% confidence intervals. Prognostic factors were determined using multivariable Cox proportional-hazards analysis including age, sex, race/ethnicity, insurance, Charlson-Deyo score (CDS), concurrent metastases (CMs), and treatment type. RESULTS Of 170,071 metastatic PC patients, 1,266 (0.7%) PC BM patients were included. 45.7% were female and 81.3% were White. Median age was 66.0 years (IQR:58.0-74.0). 34.4% had bone CMs, 45.4% had lung CMs, 60.2% had liver CMs. 48.1% of patients received NoTx, 22.6% Sys, 12.4% WBRT+Sys, 9.8% WBRT, 4.6% SRS+Sys, and 2.5% SRS. mOS (95% CI) was 2.4 months (2.2-2.5) in patients with BMs and 3.9 months (3.8-3.9) in those without BMs (P&amp;lt;0.001). Amongst BM patients, SRS+Sys had a significantly higher mOS of 7.8 months (6.1-14.3) followed by WBRT+Sys: 5.2 months (4.2-6.8), Sys: 4.8 months (4.2-5.8), WBRT: 2.0 months (1.6-2.2), SRS: 1.8 months (1.4-3.7), and NoTx: 1.2 months (1.0-1.3) (P&amp;lt;0.001). Patients treated with SRS alone (HR:2.9, 1.8-4.7, P&amp;lt;0.001), WBRT alone (HR:2.9, 2.0-4.0, P&amp;lt;0.001), and Sys alone (HR:1.5, 1.1-2.1, P=0.009) had significantly lower survival than with SRS+Sys. Patients treated in nonacademic facilities (HR:1.3, 1.1-1.4, P&amp;lt;0.001) and those with CMs (HR:1.4, 1.2-1.6, P&amp;lt;0.001) had poorer survival. CONCLUSIONS BMs in PC are rare and associated with lower survival. SRS+Sys was associated with the best prognosis, but &amp;lt;5% received it. 48% of patients receiving NoTx had mOS of 1.2 months. Future studies exploring care variations are warranted.

Surgery versus radiation for clinically positive nodal prostate cancer in an other cause mortality risk weighted cohort.

This study examined cancer control metrics between surgery and radiation for clinically positive nodal prostate cancer in an other-cause mortality weighted cohort, to circumvent limitations in previous studies. The Surveillance, Epidemiology, and End Results Research Plus database was queried to identify men with clinically positive nodal prostate cancer at diagnosis between 2004 and 2017 who were treated with surgery or radiation. A competing-risks regression model was used to calculate the 10-year other-cause mortality risk using available covariates, including treatment type. Inverse probability of treatment weighting was then used to balance covariates, including other-cause mortality risk. Then, competing-risks cumulative incidence curves and multivariable models, which were weighted on the calculated other-cause mortality risk, were used to examine the impact of treatment type on cancer-specific mortality, after accounting for covariates. 4739 patients underwent surgery whereas 1039 underwent radiation. The median follow-up was 4.7years (2.6-8.2). Other-cause mortality was statistically different between treatment arms in the unweighted cohort (Gray's p = 0.005), but that difference disappeared in the weighted cohort (Gray's p = 0.2). At 10years, the cancer-specific mortality rate was 27.6% (22.2-33.9) for radiation versus 18.1% (16.2-20.3) for surgery (p < 0.001). On competing-risks multivariable analysis, radiation had 1.86-fold (95% CI 1.69-2.12) higher hazard likelihood from one year to the next compared to surgery (p < 0.001). Clinically positive nodal patients treated with radiation fare worst cancer-specific mortality than those that underwent surgery, using calculated other-cause mortality risk.

Effect of Electrofriction Treatment on Microstructure, Corrosion Resistance and Wear Resistance of Cladding Coatings

In recent years, the issue of increasing the wear resistance of the working bodies of agricultural machinery designed for cutting and breaking the soil has received special attention. The surface layers of working bodies of agricultural machinery during operation are subjected to intensive abrasive wear, which leads to rapid wear of equipment and a reduction in its service life. The induction cladding method using materials such as Sormait-1 is widely used to increase the wear resistance of tool working surfaces. However, after coating, additional heat treatment is required to improve the physical and mechanical properties of the material and increase its durability. In electrofriction technology (EFT) hardening, the surfaces of the parts are subjected to melting under the influence of electric arcs. In this work, three types of surface treatment of L53 steel have been investigated: induction cladding using Sormait-1, electrofriction treatment, and a combination of induction cladding followed by electrofriction treatment. The microstructure was analyzed using optical microscopy and scanning electron microscopy. Erosion and abrasion tests were carried out in accordance with ASTM G65 and ASTM G76-04 international standards to evaluate the wear resistance of the materials under mechanical stress. A dendritic structure was formed after the induction cladding of the Sormait-1 material, but subsequent electrofriction treatment resulted in a reduction of this dendritic structure, which contributed to an increase in the hardness of the material. However, the highest hardness, reaching 965 HV, was recorded after electrofriction treatment of L53 steel. This is explained by needle martensite in the structure, which is formed as a result of quenching. Further, the influence of structural characteristics and hardness on erosion and abrasion wear resistance was examined. The analysis showed that the material microstructure and hardness have a decisive influence on the improvement of wear resistance, especially under conditions of intensive erosion and abrasive friction.

Comprehensive analysis of genotypic and phenotypic characteristics of biotinidase deficiency patients in the eastern region of Türkiye

Background. Biotin is a water-soluble vitamin that plays a key role in carboxylation. The formation of free biotin is impaired in biotinidase deficiency (BD), resulting in impaired biotin-dependent carboxylase functions. Based on the percentage of residual serum enzyme activity, BD is classified as partial and profound. Methods. Retrospective data including gender, age, parental consanguinity, family history, biotinidase activity analyses, type of deficiency (partial-profound), physical examination, treatment, and genotypes were evaluated in patients diagnosed with biotinidase deficiency in a single center in the eastern region of Türkiye. Patients whose biotinidase enzyme activity was below 30% with biallelic variants in the BTD gene were diagnosed as BD. Results. A total of 302 patients were included in the study. Parental consanguinity was present in 135 (44.7%) of them. Two hundred eighty-six (94.7%) were diagnosed by neonatal screening, 14 (4.6%) by family screening and two (0.06%) by clinical symptoms. Ninety-two (30.5%) of the patients were followed-up with profound deficiency and 210 (69.5%) with partial deficiency. A total of 306 variants were detected. Twenty different variants (3 novel - 3 rare) and 31 different genotypes were detected. The 3 most frequently detected variants were c.410G&gt;A (p.Arg137His; 47.3%), c.1270G&gt;C (p.Asp424His; 29.7%), and c.38_44delGCGGCTGinsTCC (p.Cys13Phefs*36; 15.3%). The 3 most frequently identified genotypes were c.410G&gt;A (p.Arg137His) / c.1270G&gt;C (p.Asp424His) compound heterozygous (32.4%), c.410G&gt;A (p.Arg137His) homozygous (24.8%), and c.38_44delGCGGCTGinsTCC (p.Cys13Phefs*36) / c.1270G&gt;C (p.Asp424His) compound heterozygous (12.2%). Patients with c.410G&gt;A (p.Arg137His) homozygous variant, c.38_44delGCGGCTGinsTCC (p.Cys13Phefs*36) homozygous variant and c.38_44delGCGGCTGinsTCC (p.Cys13Phefs*36) / c.410G&gt;A (p.Arg137His) compound heterozygous variant were statistically significantly associated with profound deficiency. Compound heterozygosity of c.410G&gt;A (p.Arg137His) / c.1270G&gt;C (p.Asp424His) variants were significantly associated with partial deficiency. Conclusions. The association between the BTD genotype and biochemical phenotype is not always consistent. Our study provides valuable data by adding variants with genotype-phenotype correlations to the literature and three novel variants, which can provide significant guidance in clinical follow-up.

IMMU-32. DIPEPTIDYL PEPTIDASE-4 (DPP-4) MEDIATED CD8+ T-CELL REGULATION IN GLIOBLASTOMA

Abstract Glioblastoma (GBM) remains to be one of the deadliest cancers with poor prognosis and limited treatment options. While immunotherapies have revolutionized the field for other cancers, GBM remains resistant to these types of interventions partly due to its highly immunosuppressive tumor microenvironment, which is characterized by accumulation of exhausted CD8+ T cells. Therefore, there is a pressing need to identify molecular targets for improve anti-tumorigenic T cell response. Previous studies in our laboratory identified dipeptidyl peptidase-4 (DPP-4), an exopeptidase and a membrane-bound signaling receptor, as a potential marker of immunosuppression in GBM. While DPP-4 is well-drugged due to its role in insulin metabolism, the function of DPP-4 in immune regulation and cancer remains poorly defined. I observed that DPP-4 is highly expressed by CD8+ T cells GBM patients and preclinical models. Furthermore, DPP-4 levels increased with the exhaustion or memory differentiation of effector T cell. Pharmaceutical inhibition of DPP-4 enriched expression of genes related to lymphocyte activation and mitochondrial metabolism. These transcriptional changes were accompanied by enhanced T cell proliferation, cytotoxic function, and effector mediator production under exhaustion conditions. These findings suggest that pharmacological inhibition of DPP-4 promotes anti-tumorigenic function of CD8+ T-cell by preventing exhaustion and support future translational efforts to repurpose DPP-4 inhibitors as immunotherapy agents in GBM, given their favorable safety profiles.