The tracheostomy procedure in adults is an invasive intervention usually performed for complicated respiratory problems that cannot be managed conservatively. The proximity of the trachea and esophagus, along with shared pathways, can increase the likelihood of swallowing challenges in individuals with a tracheostomy. A post-tracheostomy care bundle provided by a multidisciplinary service significantly improves decannulation rates and oral diet tolerance. Eleven experts within the Union of European Phoniatricians (UEP) Swallowing Committee were selected based on their experience and practice in the field. Each working group conducted a bibliographic search on the assigned topics using Medline (PubMed), covering articles from the last 10 years or earlier if deemed of interest. Based on bibliographic research, each working group formulated a text supporting the position statements. The reference texts were revised through a series of periodic meetings, held at least quarterly, over a year (from June 2023 to June 2024), until a unanimous agreement was reached for all. A review group reviewed the material produced, providing final suggestions that were incorporated by the panel until the final document was reached, which was then proposed to a group of reviewers from the UEP Board. Dysphagia is a common complication in patients with tracheostomy tubes, with significant implications for patient safety and quality of life. They are susceptible to aspiration, and if it does occur, it is likely to be silent and difficult to detect during a clinical evaluation. It is necessary to prioritize the assessment and management of dysphagia alongside respiratory and ventilator considerations. Addressing swallowing difficulties early in the weaning process can help minimize complications and improve patient outcomes.
Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). Among 1,220 patients, 342 (28.0
As the population ages, the number of older people with frailty is expected to increase worldwide with consequent rising of expenditures for healthcare and long-term care. Effective methods for preventing or delaying the onset of disability are urgently required. Frailty is a common and important geriatric condition characterized by age-associated declines in multiple physiological mechanisms, leading to increased vulnerability to stressors and higher risk for adverse health outcomes. Significant advancements have been made in the understanding of the frailty pathophysiological background. Given its multidimensional nature, reversing frailty requires a comprehensive approach. In this context, several studies testing the effects of pharmacological approach, physical activity, nutritional intervention, or cognitive training showed evidence of efficacy in frail older adults. Important innovations in ongoing trials include the development of multidomain interventions. Challenges include the use of trial designs, the development of standardized, sensitive outcome measures, and the need for interventions that can be implemented in resource-poor settings. In this viewpoint paper, based on recent literature, our aim was to identify relevant studies performed to reverse or delay disability in frail older adults.
Abstract Introduction: In RRMM, increasing rates of pt attrition and decreasing durability of responses with each line of therapy (LOT) necessitate early treatment (tx) with the most effective therapies. Immunotherapies that are widely accessible across different MM tx settings have the potential to change the trajectory of RRMM. Teclistamab (Tec), the first approved BCMA×CD3 bispecific antibody (BsAb) for heavily pretreated RRMM, provided deep, durable responses in MajesTEC-1, with improved efficacy and safety in earlier LOTs. Daratumumab (Dara), a standard-of-care (SoC) foundational CD38 targeted therapy with direct on-tumor activity, has been shown to deplete immunosuppressive T-cells and expand cytotoxic T-cells, creating an immune-permissive microenvironment for synergistic Tec-mediated killing of MM cells. MajesTEC-3 (NCT05083169) evaluates Tec-Dara vs SoC DPd/DVd in RRMM. We report initial results for this first phase 3 study of BsAb therapy in MM. Methods: Eligible pts had 1-3 prior LOTs including a PI and lenalidomide (Len; pts with 1 prior LOT must have been Len-refractory) with progressive disease (PD) on or after the last LOT. Pts with prior BCMA-directed therapy or refractory to anti-CD38 were excluded; prior anti-CD38 exposure was permitted. Pts were randomized 1:1 to Tec-Dara or DPd/DVd. The Tec-Dara group received 28-day cycles (C) of Tec (1.5 mg/kg QW in C1-2 [C1 preceded by the approved step-up dose schedule]; 3 mg/kg Q2W in C3-6; and 3 mg/kg Q4W in C7+) with Dara; steroids were not required after C1 Day 8. Tec and Dara dosing were aligned with the approved Dara schedule. DPd/DVd were administered per approved schedules. Progression-free survival (PFS) by IRC was the primary endpoint; secondary endpoints included complete response or better (≥CR), overall response, minimal residual disease (MRD) negativity (10–5; next-generation sequencing), overall survival (OS), time to worsening of symptoms (MySIm-Q), and safety. Results: 587 pts were randomized (Tec-Dara, n=291; DPd/DVd, n=296). Median (range) age was 64 (25-88) yrs, median number of prior LOTs was 2 (1-3). With 34.5-mo median follow-up, Tec-Dara significantly improved PFS vs DPd/DVd (HR, 0.17; 95% CI, 0.12-0.23; P<0.0001); mPFS was NR and 18.1 mo, and 36-mo PFS rate was 83.4% and 29.7%, respectively. PFS benefit was consistent across all prespecified and clinically relevant pt subgroups, including age ≥75 yrs, Len-refractory, high-risk cytogenetics, ≥60% bone marrow plasma cells, soft-tissue plasmacytomas, and anti-CD38 exposed. Significantly higher rates of ≥CR (81.8% vs 32.1%; OR, 9.56; 95% CI, 6.47-14.14), overall response (89.0% vs 75.3%; OR, 2.65; 95% CI, 1.68-4.18), and MRD-negativity (58.4% vs 17.1%; OR, 6.78; 95% CI, 4.53-10.15) were observed with Tec-Dara (P<0.0001). There were 45 deaths with Tec-Dara and 96 with DPd/DVd, primarily due to PD (4.6%; 20.3%). OS significantly favored Tec-Dara (HR, 0.46; 95% CI, 0.32-0.65; P<0.0001), including across all prespecified subgroups. The 36-mo OS rates were 83.3% and 65.0%, respectively and >90% of Tec-Dara pts alive at 6 mo were also alive at 30 mo. Median time to worsening of MM symptoms was NR with Tec-Dara vs 39.9 mo with DPd/DVd (HR, 0.50; 95% CI, 0.34-0.72; P=0.0002). At data cutoff, 49.4% of pts remained on study tx (Tec-Dara, 71.0%; DPd/DVd, 28.3%). Median tx duration was twice as long with Tec-Dara vs DPd/DVd (32.4 vs 16.1 mo). Frequency of grade 3/4 (Tec-Dara, 95.1%; DPd/DVd, 96.6%) and grade 5 (7.8%; 6.2%) treatment-emergent adverse events (TEAEs), were comparable (safety set: Tec-Dara, n=283; DPd/DVd, n=290). Serious TEAEs occurred in 70.7% Tec-Dara and 62.4% DPd/DVd pts; tx discontinuations due to TEAEs were low (4.6% vs 5.5%). Any grade infections occurred in 96.5% and 84.1% of Tec-Dara and DPd/DVd pts, respectively; grade 3/4 infections occurred in 54.1% and 43.4%. New onset grade ≥3 infections decreased over time, coinciding with transition to Q4W dosing and supported by antimicrobial and Ig prophylaxis guidance. CRS rate was 60.1% (grade 1/2: 44.2%/15.9%) and ICANS was 1.1% with Tec-Dara. Conclusion: We demonstrate the clinically remarkable and statistically significant PFS and OS benefits of Tec-Dara vs SoC triplets in RRMM, with 83.4% of Tec-Dara pts alive and progression-free at 3 yrs. Infections with Tec-Dara were well managed with established protocols. This highly effective, off-the-shelf, immunotherapy combination represents a new SoC for RRMM as early as first relapse.
Background:Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit. A recent study showed that AMI occurs in over half of patients with acute ACL injuries. Purposes:To (1) determine the incidence of AMI within the 6 weeks after an anterior cruciate ligament reconstruction (ACLR) and (2) identify the risk factors associated with AMI after an ACLR. Study Design:Case-control study; Level of evidence, 3. Methods:Consecutive patients who sustained a primary ACLR between January and October 2023 were considered for study inclusion. Eligible patients underwent a standardized physical examination at 3 and 6 weeks postoperatively. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its clinical reversibility according to the Sonnery-Cottet classification. Results:A total of 210 consecutive patients with a primary ACLR were prospectively enrolled in the study. Respectively, 48.6% of patients had AMI at 3 weeks and 24.3% at 6 weeks postoperatively. Among them, 79.4% and 72.5% demonstrated reversible types (grade 1A or 2A), respectively. Multivariate analysis revealed that patients who had a preoperative AMI (odds ratio [OR], 8.27 [95% CI, 4.177-17.138]; P < .001), experienced immediate postoperative pain exceeding 7 out of 10 on the visual analog scale (VAS) (OR, 4.689 [95% CI, 2.144-10.814]; P = .0002), or did not have preoperative physical therapy (OR, 2.303 [95% CI, 1.186- 4.530]; P = .0149) were associated with a significantly greater risk of AMI at 3 weeks postoperatively. No risk factors were found at 6 weeks postoperatively. Conclusion:AMI occurs in 48.5% of patients at 3 weeks, and 24.2% at 6 weeks after an ACLR. Important risk factors identified for the presence of AMI at 3 weeks postoperatively included the presence of preoperative AMI, immediate postoperative VAS pain score of >7, and absence of preoperative physical therapy.
