Per-oral endoscopic myotomy (POEM) achieves an 80–90
Lower limbs can play a major compensating role for sagittal malalignment; however, little is known about the different types of compensation. This study aimed to identify different patterns of lower limb compensation and to determine which parameters may affect the recruitment of knee flexion versus hip extension. This study included adult spinal deformity (ASD) patients with full-body X-rays in erect position from a multicentric prospective database. All parameters were measured at baseline: demographics, clinical scores and radiographic parameters: pelvic parameters, pelvic incidence-lumbar lordosis (PI-LL) mismatch, T1 pelvic angle (TPA), sacro-femoral angle (SFA), knee flexion angle (KA), ankle dorsi-flexion angle (AA), pelvic shift (PSh), hip and knee osteoarthritis (OA) grade. A K-means cluster analysis was conducted to identify patterns of lower limb compensation based on SFA and KA. The optimal number of clusters was determined using the silhouette score. The different parameters were then compared across clusters. 871 ASD patients were included, of whom 66.9
Introduction Data on major complications and unplanned cardiac surgery (UCS) during left atrial appendage closure (LAAC) remain scarce. While feasibility and complication rates have been reported, little is known about outcomes after major complications. Objective We aimed to assess the annual incidence, trends, associated factors, and outcomes of major complications requiring or implying UCS during LAAC procedures. Method We conducted a nationwide retrospective cohort study using the French PMSI administrative database. All consecutive patients undergoing LAAC between 2016 and 2024 were included. Major complications were defined as immediate death, pericardial drainage, hemostasis via sternotomy, UCS with cardiopulmonary bypass (CPB) performed on the same calendar day as the LAAC procedure. Results Among 13,741 LAAC procedures, 135 patients (0.98%) experienced a major complication: 71 had isolated pericardial drainage (0.52%), 38 underwent hemostasis via sternotomy (0.28%), 21 underwent UCS with CPB (0.15%), and 5 died immediately (0.04%). The rate of major complications remained stable over time (∼1%) among the first eight years period of generalisation of LAAC procedure. In multivariable analysis, male sex was a protective factor (OR 0.55 [0.39–0.78]). No other usual cardiovascular risk factors were significantly associated with major complications. Mortality following a major complication was 10.4%, and was significantly associated with age (OR 1.49 [1.05–2.16]) and chronic kidney disease (OR 2.62 [1.49–4.94]). Despite their severity, emergency interventions (drainage, sternotomy, RCS) were associated with a high survival rate (over 80%). Conclusion Despite the increasing number of LAAC procedures, over the first 8 years period, major complication rate remained stable, around 1% over the first eight years, with no trend toward improvement. Nevertheless, nearly 90% of patients suffering a major complication were discharged alive.
Combining immunotherapy with chemoradiation is effective in locally advanced cervical cancer. However, the impact of induction combination immunotherapy on immune modulation and treatment response is poorly understood. In this phase II trial (NCT04256213), 40 females with locally advanced cervical carcinoma received one cycle of nivolumab-plus-ipilimumab immunotherapy before standard chemoradiation, followed by maintenance nivolumab. We show, using multiplex-immunofluorescence tissue imaging, a significantly increased CD8+/FOXP3+ cell ratio (primary endpoint; increase of 0.87 cells/mm², P = 0.0164) and proliferative CD8+ T-cell density after one cycle of combination immunotherapy. HOT score (27-gene-based signature identifying immunologically active tumors) also increased significantly (exploratory analysis; 0.17, P < 0.0001). Objective response rates (secondary endpoint) were 13
Background:EUS-guided gastroenterostomy (EUS-GE) is an effective option for the management of gastric outlet obstruction (GOO). Due to the poor prognosis of patients undergoing it, data on its long-term adverse events (AE) is scarce. Herein, we describe a cohort of patients with gastro-entero-colic fistula (GECF) as a late AE of previously successful EUS-GE.Methods:Patients who developed a GECF after EUS-GE from 10 high-volume centers were analyzed. Information collected included demographic characteristics, indications, clinical and technical success rates, stent type and size, fistula characteristics, management, and outcomes.Results:Sixteen cases were identified. The mean interval from index EUS-GE to the diagnosis of GECF was 4 to 8 weeks. The most common cause of GOO was pancreatic adenocarcinoma (PDAC). The transverse colon was the most common site for the GECF (14 patients). A 20 & times;10 mm lumen apposing metal stent (LAMS) was utilized in 10 patients. Endoscopic management with a variety of modalities was successful in 13 cases. Follow-up interval after endoscopic management of the fistula averaged 2 to 4 weeks. At the time of the manuscript elaboration, 10 patients had died, 5 were alive, and 1 was lost to follow-up.Conclusions:This is the first description of a cohort of patients with GECF after EUS-GE. The exact mechanisms leading to GECF in these cases are unknown. Possible explanations include inadvertent colon puncture during the index procedure and/or entrapment of mesocolon. More data is needed to further characterize this AE.
