Hospital Conde S. Januário

TPS607 Background: The combination of atezolizumab and bevacizumab (Atezo-Bev) has transformed the treatment landscape for unresectable hepatocellular carcinoma (HCC). With a response rate of approximately 30%, some patients become eligible for curative locoregional therapies (LRT) after successful systemic treatment. However, it remains unclear whether patients who achieve a partial response (PR) and are converted to a disease-free state with curative LRT have a similar prognosis to patients who achieve a complete response (CR) from Atezo-Bev alone. Additionally, it is unknown whether applying curative LRT improves survival outcomes for patients who achieve a PR. This study aims to address these critical questions. Methods: This multinational, retrospective study will enroll patients with clinically or histologically diagnosed HCC who received first-line Atezo-Bev and achieved a CR or PR according to RECIST v1.1. Patients must have started Atezo-Bev before September 30, 2024. Patients receiving concurrent anti-CTLA4 antibodies will be excluded. Curative LRT is defined as curative surgery, ablation, or definitive radiotherapy performed in patients who achieved a PR with Atezo-Bev treatment during their PR status. The primary endpoint is the recurrence-free survival (RFS) of patients who received curative LRT, compared to that of patients who obtained a CR solely from Atezo-Bev treatment. Secondary endpoints include the time to discontinuation of Atezo-Bev treatment after curative LRT, and the time from initiation of Atezo-Bev treatment to curative LRT; also, the overall survival and progression-free survival of patients who received curative LRT with be compared with those of patients who obtained CR solely from Atezo-Bev treatment and those of patients who obtained a PR after Atezo-Bev treatment but did not receive LRT. Disease-free status after curative surgery must be confirmed by imaging. Time from the best objective response to curative LRT will also be recorded. Data will be collected from up to 30 Asian sites, with an anticipated sample size of approximately 400 patients who received curative LRT and 1,200 patients who achieved a CR or PR without receiving curative LRT. Survival outcomes will be analyzed using Kaplan-Meier methods and compared with the log-rank test. They will be adjusted for baseline characteristics such as age, gender, HCC etiology, tumor extent, liver function reserve, alpha-fetoprotein level, and neutrophil/lymphocyte ratio using Cox proportional hazards models. The study is partially supported by Roche. Clinical trial information: NCT07091942 .

<title>Abstract</title> Background Major depressive disorder (MDD) is a mental illness that is highly prevalent worldwide. Besides its core symptoms, the cognitive dysfunction in MDD patients seriously impairs their social functioning and warrants attention. Cognitive dysfunction in MDD may be related to demographic characteristics, serum inflammatory marker levels and Body Mass Index (BMI, calculated as weight divided by height squared, in kg/m²). This study focuses on the cognitive dysfunction and its associated factors in first-episode, drug-naive patients with MDD . Methods The study enrolled overall 116 first-episode, drug-naive patients with MDD and 100 healthy controls (HC) for comparison. Demographic information was obtained from all participants. We used the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) to assess cognitive function and the 17-item Hamilton Depression Rating Scale (HAMD-17) to evaluate MDD symptoms. Levels of serum inflammatory markers, such as hypersensitive C-reactive protein (hs-CRP), leukocyte (WBC), neutrophil (NEUR), and eosinophil (EO) were measured. Subsequently, multiple linear regression analysis was utilized to determine factors linked to cognitive dysfunction across the five domains with MDD patients. Results In this study, MDD patients exhibited significantly poorer cognitive function across five domains - speed of processing (SOP), attention/vigilance (AV), working memory (WM), verbal learning (VIS), and visual learning (VRB) - compared with HC ( <italic>p</italic> &lt; 0.001). Their serum levels of hs-CRP ( <italic>p</italic> = 0.022), WBC ( <italic>p</italic> = 0.015), and NEUR ( <italic>p</italic> &lt; 0.001) were significantly elevated than HC, whereas the level of EO ( <italic>p</italic> = 0.031) was significantly lower. The results of Spearman correlation analysis indicated that BMI was connected to cognitive function among MDD patients, specifically in the domains of SOP (r = 0.274, <italic>p</italic> = 0.003) and AV (r = 0.189, <italic>p</italic> = 0.042). Multiple linear regression analysis indicated that education years and hs-CRP level were significantly influenced by the cognitive function in the VIS domain among patients with MDD. Conclusion Our study shows a potential link between serum hs-CRP levels, BMI and cognitive dysfunction in MDD patients. This indicates that serum hs-CRP could potentially serve as a promising biomarker to forecast cognitive dysfunction in MDD patients, offering significant clinical implications. Additionally, BMI appears to have a certain predictive value regarding cognitive function in patients with MDD.

Numerous intrinsic and extrinsic factors, notably the aging process, contribute to the development of infraorbital dark circles. These features, commonly associated with old age and fatigue, are caused by a disruption of dermal melanin and impairment of skin barrier function. Common aesthetic concerns affecting patients with infraorbital dark circles are primarily owing to lean and translucent lower eyelid skin overlying the orbicularis oculi muscle. This study aimed to present a novel technique for correcting infraorbital dark circles utilizing an adipose-derived extracellular matrix concentrate-adipose collagen fragment (ACF)-to correct infraorbital dark circles. Female patients (n = 94) aged 20-38 who presented infraorbital dark circles were enrolled to assess the efficacy of this technique for an eight-month follow-up. Following intradermal injections with ACF filler, the clinical outcome was determined by responses to GAIS and patient satisfaction surveys. Statistical analysis was performed with the one-way ANOVA test, and a p value of < 0.05 was considered statistically significant. Patients (n = 92) completed a single treatment session and underwent an eight-month follow-up. Eighty patients (86%) reported being "highly satisfied" or "satisfied" with the outcome and responded that the technique resulted in brighter, tighter, and smoother infraorbital skin. Over 97% of patients were rated as "improved," "much improved" and "Very much improved" throughout the follow-up on GAIS by three independent surgeons (p < 0.05). The statistical analyses demonstrated the percentage differences among groups are highly significant (p < 0.0001). No irregularity or lump was observed during the follow-up. Two patients were excluded from the study due to having undergone cosmetic eyelid surgery. Intradermal ACF filler represents a novel approach to addressing infraorbital dark circles and yields significantly high patient satisfaction. ACF fillers provide a degree of bio-stimulation, and adipose-derived concentrate is a natural filler with regenerative effects used in periorbital rejuvenation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications. Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage. Conversely, basilar artery perforator aneurysms (BAPAs) are a rare etiology. There is no consensus on the optimal management of ruptured BAPAs in the acute setting. We present a case series of 3 patients with ruptured BAPAs who were treated at our institution. Two patients had a modified Fisher grade of I, and one had a grade of IV on initial presentation. The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case. The 3 patients underwent endovascular treatment with Guglielmi detachable coils. Post-treatment, the patients had good clinical outcomes, and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage. However, one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition. The other 2 patients showed progressive recovery, and no aneurysm recurrence was observed at the 2-year follow-up. Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management. Early detection and prompt treatment is important to achieve favorable patient outcomes.

Hyperkalaemia is an electrolyte imbalance that impairs muscle function and myocardial excitability, and can potentially lead to fatal arrhythmias and sudden cardiac death. The prevalence of hyperkalaemia is estimated to be 6%-7% worldwide and 7%-10% in Asia. Hyperkalaemia frequently affects patients with chronic kidney disease, heart failure, and diabetes mellitus, particularly those receiving treatment with renin-angiotensin-aldosterone system (RAAS) inhibitors. Both hyperkalaemia and interruption of RAAS inhibitor therapy are associated with increased risks for cardiovascular events, hospitalisations, and death, highlighting a clinical dilemma in high-risk patients. Conventional potassium-binding resins are widely used for the treatment of hyperkalaemia; however, caveats such as the unpalatable taste and the risk of gastrointestinal side effects limit their chronic use. Recent evidence suggests that, with a rapid onset of action and improved gastrointestinal tolerability, novel oral potassium binders (e.g., patiromer and sodium zirconium cyclosilicate) are alternative treatment options for both acute and chronic hyperkalaemia. To optimise the care for patients with hyperkalaemia in the Asia-Pacific region, a multidisciplinary expert panel was convened to review published literature, share clinical experiences, and ultimately formulate 25 consensus statements, covering three clinical areas: (i) risk factors of hyperkalaemia and risk stratification in susceptible patients; (ii) prevention of hyperkalaemia for at-risk individuals; and (iii) correction of hyperkalaemia for at-risk individuals with cardiorenal disease. These statements were expected to serve as useful guidance in the management of hyperkalaemia for health care providers in the region.

Urticaria (defined as the presence of hives, angioedema, or both) can be caused by a variety of etiologies ranging from more common conditions such as chronic spontaneous urticaria (CSU) to rarer conditions such as hereditary angioedema (HAE). Specialist referral may be necessary in cases of severe urticaria or HAE, but access to specialist services remains limited in certain regions, such as the Greater Bay Area (GBA) of China. To address this, the Hong Kong-Macau Severe Hives and Angioedema Referral Pathway (SHARP) was initiated by the Hong Kong Institute of Allergy and Macau Society of Dermatology to promote multidisciplinary collaboration and regional exchange of expertise in the diagnosis and management of severe urticaria. A nominated task force of dermatologists and immunologists who manage patients with severe urticaria formulated the consensus statements (CS) using the Delphi method. The consensus was defined a priori as an agreement of ≥80%. A total of 24 CS were formulated, including four statements on classifications and definitions, seven statements on diagnosis, and 13 statements on management and referral. The definitions for acute/chronic urticaria and severe CSU were stated. Unnecessary investigations and inappropriate medications were discouraged. The characteristics and recommended approach to suspected bradykinergic angioedema were specified. Stepwise treatment options using second-generation antihistamines, omalizumab, or cyclosporin for patients with CSU were addressed, and the importance of access to HAE-specific medications was emphasized. Furthermore, an integrated referral pathway for patients with severe hives and angioedema was constructed. The SHARP provides guidance for the management and specialist referral of patients with severe hives and angioedema in Hong Kong and Macau.

BACKGROUNDNext-generation sequencing comprehensive genomic panels (NGS CGPs) have enabled the delivery of tailor-made therapeutic approaches to improve survival outcomes in patients with cancer. Within the China Greater Bay Area (GBA), territorial differences in clinical practices and health care systems and strengthening collaboration warrant a regional consensus to consolidate the development and integration of precision oncology (PO). Therefore, the Precision Oncology Working Group (POWG) formulated standardized principles for the clinical application of molecular profiling, interpretation of genomic alterations, and alignment of actionable mutations with sequence-directed therapy to deliver clinical services of excellence and evidence-based care to patients with cancer in the China GBA.METHODSThirty experts used a modified Delphi method. The evidence extracted to support the statements was graded according to the GRADE system and reported according to the Revised Standards for Quality Improvement Reporting Excellence guidelines, version 2.0.RESULTSThe POWG reached consensus in six key statements: harmonization of reporting and quality assurance of NGS; molecular tumor board and clinical decision support systems for PO; education and training; research and real-world data collection, patient engagement, regulations, and financial reimbursement of PO treatment strategies; and clinical recommendations and implementation of PO in clinical practice.CONCLUSIONPOWG consensus statements standardize the clinical application of NGS CGPs, streamline the interpretation of clinically significant genomic alterations, and align actionable mutations with sequence-directed therapies. The POWG consensus statements may harmonize the utility and delivery of PO in China's GBA.

BackgroundCurrent guidelines recommend potent P2Y12 inhibitors for patients after acute coronary syndrome. However, the data on the efficacy and safety of potent P2Y12 inhibitors in elderly Asian populations was limited. We aimed to investigate the major adverse cardiovascular events (MACE), bleeding events, and net adverse clinical events (NACE) with ticagrelor and clopidogrel in Taiwanese patients aged 65 and older after acute myocardial infarction (AMI).MethodsThis retrospective population-based cohort study was conducted using data from the National Health Insurance Research Database. The AMI patients aged ≥65 years who underwent percutaneous coronary intervention (PCI) and survived after 1 month were included. The patients were separated into 2 cohorts depending on the type of dual antiplatelet therapy (DAPT) they received: ticagrelor plus aspirin (T + A) or clopidogrel plus aspirin (C + A). We used inverse probability of treatment weighting to balance the difference between these 2 study groups. The outcome included all-cause mortality, MACE (cardiovascular death, nonfatal ischemic stroke, and nonfatal myocardial infarction), intracerebral hemorrhage, major bleeding, and NACE which is composed of cardiovascular death, ischemic and hemorrhagic events. The follow-up period was up to 12 months.ResultsFrom 2013 to 2017, a total of 14,715 patients who met the eligibility criteria were separated into 2 groups: 5,051 for T + A and 9,664 for C + A. Compared to patients with C + A, patients who received T + A had a lower risk of cardiovascular death and all-cause death, with an adjusted HR of 0.57 [95% confidence interval (CI), 0.38–0.85, p = 0.006] and 0.58 (95% CI 0.45–0.74, p < 0.001), respectively. No differences were found in MACE, intracranial and major bleeding between the 2 groups. In addition, the patients with T + A had a lower risk of NACE with an adjusted HR of 0.86 (95% CI 0.74–1.00, p = 0.045)ConclusionAmong elderly AMI patients receiving DAPT after successful PCI, ticagrelor was a more favorable P2Y12 inhibitor than clopidogrel because of lowering the risk of death and NACE without increasing the risk of severe bleeding. Ticagrelor is an effective and safe P2Y12 inhibitor in Asian elderly survivors after PCI.