ABSTRACT People living in prison are disproportionately affected by hepatitis B and C, yet access to prevention, testing, and treatment services remains inconsistent across Europe. Addressing this gap is critical to achieving viral hepatitis elimination targets by 2030. EuroHePP is a European toolkit developed to support national responses to viral hepatitis in prison settings. It was created through a structured, multi‐stage process involving evidence review, stakeholder consultations, and expert validation. The toolkit provides practical guidance across the full continuum of care, including prevention, testing, treatment, and monitoring, and promotes micro‐elimination approaches tailored to prison populations. It emphasises evidence‐based interventions such as opt‐out testing, decentralised and simplified models of care, harm reduction strategies, and continuity of care after release. By offering adaptable tools and frameworks for policymakers and practitioners, EuroHePP aims to strengthen prison health systems, reduce health inequalities, and accelerate progress towards hepatitis elimination at national and regional levels.
AIMS:Acetazolamide, an inhibitor of proximal tubular sodium reabsorption, improves decongestion in acute heart failure (AHF). The aim of the current subanalysis is to evaluate which factors influence decongestion success and the impact of acetazolamide on 3-month clinical outcomes. METHODS:This analysis of the Acetazolamide in Decompensated heart failure with Volume OveRload (ADVOR) trial, that randomised 519 patients with AHF to intravenous acetazolamide or matching placebo, assessed the relationship between acetazolamide treatment, residual congestion, and all-cause mortality and/or heart failure hospitalisation (HFH). RESULTS:After 90 days, 148 patients (28.7%) experienced the combined endpoint of all-cause mortality and HFH. Predictors of the occurrence of this endpoint were higher baseline doses of loop diuretics (HR = 1.60; 95% CI = [1.26-2.03]; p < 0.001) and higher natriuretic peptide levels (HR = 1.34; 95% CI = [1.09-1.65]; p = 0.006). Acetazolamide lowered the risk of residual congestion (OR = 0.54, 95% CI = [0.36-0.82]), and residual congestion at day 4 (HR = 1.70, 95% CI = [1.18-2.43], p = 0.004) and at discharge (HR = 2.43, 95% CI = [1.76-3.36], p < 0.001) were associated with a worse clinical outcome. The presence of residual congestion despite use of acetazolamide was associated with the highest event rate for all-cause mortality or HFH (p = 0.019). CONCLUSIONS:Residual congestion after decongestive treatment for AHF is associated with an increased risk of all-cause mortality and HFH. The upfront addition of acetazolamide reduced the incidence of residual congestion. However, patients with residual congestion despite acetazolamide use are at excessive risk for mortality and HFH, identifying a subset of patients requiring specialised heart failure care.
Abstract Introduction Pulsed field ablation (PFA) is a common treatment modality for the management of atrial fibrillation (AF), wherein electrical pulses induce irreversible electroporation in myocardial tissue, thereby creating durable, non-thermal lesions. The standardized workflow, which advises 8 PFA applications per pulmonary vein (PV), has established favorable safety and efficacy. In real-world clinical practice, the dosing regimen varies based on physician discretion, and dosing strategies outside of the standardized workflow have not been characterized. Purpose To examine the relationship between PFA applications, patient safety, and long-term outcomes. Methods The FARADISE registry (NCT05501873) is a prospective, real-world, standard-of-care registry enrolling AF patients clinically-indicated for a pentaspline PFA procedure. Standard workflows require eight applications per PV, targeting the left inferior pulmonary vein (LIPV), left superior pulmonary vein (LSPV), right inferior pulmonary vein (RIPV), and right superior pulmonary vein (RSPV). This analysis reports the average number of PV applications per de novo, PV isolation-only (PVI-only) patient. Patients were excluded if fewer or more than four standard workflow PVs were ablated, if they received more than 64 total PFA applications, or if less than 8 average PV applications were given. Patients were stratified into groups based on average PV PFA applications per patient: 8, >8 to 10, and >10. Safety and long-term outcomes at one year were compared across dosing cohorts. Clinical effectiveness was defined as freedom from arrhythmia recurrence, repeat procedure, or cardioversion. Results Among 607 patients meeting analysis criteria, 210 received an average of 8 PFA applications per PV, 223 received >8 and ≤10, and 174 received >10. Paroxysmal AF diagnosis (8: 71%, >8-10: 75%, >10: 74%, p=0.59) and female sex (8: 37%, >8-10: 34%, >10: 29%, p=0.27) were similar between groups, while age declined slightly in higher PV dosing groups (8: 65±10, >8-10: 62±10, >10: 61±11, p<0.01). Skin-to-skin procedure time increased as average PV dose increased (8: 40 [33-49] minutes, >8-10: 45 [37-60] minutes, >10: 51 [42-64] minutes, p<0.01), and serious adverse events were low across all groups (8: 1.0%, >8-10: 2.7%, >10: 0.6%, p=0.21). Clinical effectiveness trended upward as average PV dose increased (8: 74%, >8-10: 79%, >10: 83%, p=0.1) (Table 1). Conclusions In the real-world FARADISE registry, both guideline-based and physician-tailored dosing strategies produced favorable clinical effectiveness and few serious adverse events. These findings suggest that the pentaspline PFA catheter maintains a strong safety and effectiveness profile across dosing levels, supporting its flexibility in clinical practice.Boersma et al Figure 1
Lumbar stenosis decompression can be delivered through corridors differing in operative footprint, perioperative variables, and resource use. How surgeons report choosing among these corridors as disease extent increases has not been mapped. This survey characterized surgeon-reported use of decompression approaches across 1-, 2-, and 3 + level lumbar stenosis scenarios. An international cross-sectional survey of 131 spine surgeons from 38 countries captured non-mutually-exclusive reported use of five decompression approach families (open bilateral, open unilateral over-the-top, tubular/microscopic, uniportal endoscopic, biportal endoscopic) across the three scenarios. For respondents reporting unchanged strategy at higher extents, 1-level responses were carried forward, yielding modeled full-cohort estimates. Reported strategy was unchanged from 1-level to 2-level for 111/131 respondents (84.7
