Left bundle branch pacing (LBBP) and left bundle fascicular pacing (LBFP) are conduction system pacing techniques that preserve physiological ventricular activation. Whether proximal or distal capture yields superior electrical or echocardiographic outcomes is uncertain. To systematically evaluate and compare LBFP versus left bundle branch trunk pacing (LBBP) in terms of electrical synchrony and echocardiographic characteristics in patients requiring permanent cardiac pacing. We searched PubMed, Embase, and Cochrane through May 21, 2025, for randomized and observational studies comparing LBFP with LBBP. Outcomes of interest included QRS duration, V6 R-wave peak time (RWPT), left ventricular activation time (LVAT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and pacing thresholds. Statistical analysis was performed using a random-effects model, with heterogeneity assessed using I² statistics. Risk of bias was evaluated using the ROBINS-I. Six studies involving 2,989 patients (1,241 LBFP; 249 LBBP) were included. There were 3 prospective studies, 2 retrospective, and 1 that was both prospective and retrospective. There were no RCTs on this subject. LBFP was associated with a statistically shorter V6-RWPT (mean difference: − 3.50 ms; 95
Robotic total knee arthroplasty (TKA) enables repeated intraoperative quantification of preoperative alignment, flexion deformity, and medial and lateral compartment gaps in extension and at 90° flexion before component positioning, but the preoperative patterns guiding functional-alignment planning remain incompletely characterized. This study aimed to derive a pragmatic driver-based classification from preoperative robotic data and evaluate its internal coherence across the surgical workflow. We analyzed 68 consecutive primary functionally aligned robotic TKAs performed by a single surgeon using a CT-based robotic-arm platform. Preoperative variables included hip-knee-ankle angle (HKA), flexion deformity, and independent medial and lateral gaps in extension and at 90° flexion. A 10-case formative series informed concept generation; the finalized hierarchy was then applied to all cases using preoperative variables only. Four phenotypes were derived: bone-driven, ligament-driven, flexion-dominant, and mixed/complex (defined as the co-occurrence of two or more severe deformity drivers). Internal coherence was assessed through release escalation, corrected-state behavior, plan-to-final HKA fidelity, and mechanical and functional-alignment balance. Inter-observer reliability was tested by having five independent surgeons classify all cases blinded, with agreement quantified by Fleiss’ and Cohen’s kappa. All knees were classified: bone-driven, 40/68 (58.8
Abstract Rationale Seralutinib is an investigational, first-in-class tyrosine kinase inhibitor designed for inhalation and selective for PDGFRα, PDGFRβ, CSF1R, and cKIT, targeting proliferation, inflammation, and fibrosis ─ three core drivers of pulmonary vascular remodeling in PAH. The phase 2 TORREY trial of seralutinib added to standard-of-care treatment in adults with PAH WHO FC II or III met its primary endpoint of a statistically significant reduction in pulmonary vascular resistance (PVR) vs. placebo at 24 weeks. Methods PROSERA (NCT05934526), a phase 3, randomized, double-blind, placebo-controlled, multicenter trial, evaluated the efficacy and safety of inhaled seralutinib in PAH patients treated for up to 48 weeks. Eligible patients (WHO Group 1 PH, FC II or III; REVEAL Lite 2 Risk Score ≥5 or NT-proBNP ≥300 ng/L or PVR ≥800 dyne•s/cm5) on standard background therapy were randomized 1:1 to seralutinib 90 mg or placebo delivered by dry powder inhaler twice daily. The primary endpoint was change in six-minute walk distance (6MWD) from baseline to week 24 in the seralutinib treatment group vs. placebo. Key secondary endpoints included: time to clinical worsening (TTCW), proportion of patients with clinical improvement at week 24, change in NT-proBNP from baseline to week 24, and proportion of patients with ≥1-point decrease from baseline in REVEAL Lite 2 Risk Score at week 24. Safety endpoints included incidence of treatment-emergent adverse events (TEAEs) and serious TEAEs (SAEs). Patients who completed blinded treatment could be eligible to participate in an open-label extension study. Preliminary Blinded Results 390 patients were randomized at 132 sites worldwide. At baseline, mean age was 50.0 years. PAH etiologies included 61.0% idiopathic, 9.7% heritable, and 22.3% associated with connective tissue disease. 25.6% of patients were WHO FC II and 74.4% FC III. Mean time from diagnosis was TBD years. Most patients were receiving 2 (39.2%) or ≥ 3 (54.6%) PAH medications, 29.2% were receiving parenteral prostacyclin. Baseline PVR was 798.4 dyne•s/cm5, 6MWD was 373.7 m, and NT-proBNP was 986.8 ng/L. The difference in 6MWD from baseline to week 24 between seralutinib and placebo was TBD [SD] m (p=TBD). Secondary endpoints of TTCW, clinical improvement, NT-proBNP, and REVEAL Lite 2 Risk Score will be reported. The most common AEs were TBD (x%) and TBD (y%). SAEs and discontinuations related to AE will be reported. Conclusions The PROSERA study demonstrates⋯ [to be updated following unblinding of the data]. Funding Gossamer Bio, Inc. This abstract is funded by: Gossamer Bio, Inc.
Purpose This cross-sectional study examines disparities in access to radiation therapy (RT) across Brazil, a country with a population exceeding 210 million, focusing on the distances traveled by patients with cancer to receive RT. Using data from 2017 to 2022, the study aimed to assess geographic barriers to RT access and regional inequities. Methods and Materials Data from the Brazilian National Outpatient Procedure Authorization (Autorização de Procedimento Ambulatorial) system were collected as .dbc files and processed using Python. Variables included procedure type, procedure year, patient demographics (sex and race), patient’s city of residence, and treatment location (state and region). Additionally, the data captured whether the treatment necessitated travel to another city. Distances between patients’ residences and treatment facilities were calculated using the Haversine formula and analyzed in kilometers (km). This data was incorporated into a Power BI database for analysis. Statistical significance was assessed using ttests analysis of variance, analysis of variance weighted, analysis of covariance, and to account for both location and demographic factors to account for both location and demographic factors, such as race and sex with a threshold of P < .05. Results The study analyzed 840,779 RT procedures, of which 514,237 required intercity travel, whereas 326,542 were performed locally. The national average distance to access RT in Brazil was 120.1 km, with significant changes in nationwide distances from 2017 to 2022 (P < .001). Regional disparities were pronounced, with mean distances of 442.2, 238.9, 161.8, 73.8, and 71.3 km in the North, Midwest, Northeast, Southeast, and South regions, respectively (P < .001). The North region demonstrated the most significant improvement in the average distance to radiation from 2017 to 2022, with an 81.8 km reduction in distance (P = .009). The Southeast and South regions also experienced modest but statistically significant changes overtime (P < .05). Sex also influenced travel distances; women traveled an average of 122.3 km and men 117.3 km (P = .041). The distance also varied by procedure type and RT anatomic site indication (P < .001). Conclusions This study reveals considerable geographic disparities in RT access in Brazil, with marked differences observed among residents in less developed regions, and women. These findings point to potential and persistent inequities that may help to guide the strengthening of the health care infrastructure and developing targeted strategies to promote more equitable access to cancer treatment nationwide.
