The internal mammary artery (IMA) is a critical vessel for both autologous breast reconstruction (ABR) and coronary artery bypass grafting (CABG), creating potential conflict when both procedures are needed. This review evaluates evidence on the feasibility, safety, and vascular consequences of using the IMA in ABR while preserving future CABG options. A PRISMA-2020 aligned systematic review assessed IMA use in ABR and implications for future CABG. PubMed, EMBASE, and Web of Science were searched through March 10, 2025, using terms related to ABR and CABG. Ten studies (2004–2025) met inclusion criteria, involving female patients aged 24–77 years. Most studies used the deep inferior epigastric perforator flap for ABR, with the IMA as the predominant recipient vessel. Notably, end-to-side arterial anastomosis and dissection at or below the fourth intercostal space were frequently applied to preserve IMA length and integrity for future CABG. Myocardial complication rates after ABR were comparable to flap loss rates, and one patient subsequently underwent CABG using an alternative graft due to prior IMA harvest. Importantly, one cohort study introduced the Breast Reconstruction and Internal Mammary Artery Assessment (BRIMA) score, a cardiovascular risk-stratification tool designed to guide IMA selection in reconstructive planning. The IMA may be used in selected ABR cases without significantly limiting future CABG if end-to-side anastomoses or internal mammary artery perforators preserve conduit integrity. Because the IMA is the primary CABG graft, careful surgical planning and cardiovascular risk assessment are crucial. Further prospective data are needed to guide long-term management as the population ages. Level of Evidence: no gradable.
Endometrial carcinoma (EC) is a common gynecological cancer with rising incidence driven by obesity and aging populations. Accurate and timely molecular classification is critical for guiding personalized oncology treatment, especially in early-stage high-grade endometrioid carcinoma. Here we present a large scale, retrospective multicenter validation of a novel POLE-POLD1 mutation assay for use in molecular characterization of EC. We evaluated the analytical performance and robustness of the novel Idylla™ POLE-POLD1 Mutation Assay, a cartridge-based PCR platform optimized for FFPE tissue. Performance comparators were established NGS reference methods. Overall, 544 formalin-fixed, paraffin embedded (FFPE) EC cases from diagnostic pathology of ten centers in Europe and North America were included. Of 544 samples, 520 revealed POLE-POLD1 test and comparator results, yielding an overall concordance of 97
BACKGROUND:The structured implementation of fast-track or Enhanced recovery after surgery protocols (ERAS) in elective colorectal resections is associated with benefits for patients in German hospitals; however, long-term experiences regarding continuous fast-track treatment in the routine clinical practice of German hospitals are not yet available. This manuscript summarizes the experiences of 11 hospitals with up to 4 years of fast-track application. MATERIAL AND METHODS:Analysis of prospectively collected data during and after the implementation of a structured fast-track program was performed. The study included all patients aged ≥ 18 years who were scheduled for elective colorectal resection and had given their consent. The outcome criteria were fast-track adherence, postoperative complications, functional recovery, postoperative length of hospital stay and the frequency of textbook-defined outcomes. RESULTS:Among 1751 (48.3%) women and 1878 (51.8%) men with a median age of 68 years (interquartile range, IQR: 58-77 years), 2631 (72.5%) colon and 999 (27.5%) rectal resections were performed. Of the procedures 2973 (81.9%) were performed using minimally invasive techniques of which 670 (18.7%) were robotic and 657 (18.1%) were open procedures. Fast-track adherence was 82% (preoperative 89%, intraoperative 88% and postoperative 82%). The median postoperative length of stay was low at 5 (IQR: 4-8) days. Fast-track adherence increased from 79% during implementation to 86% after implementation (p < 0.0001). The postoperative length of stay decreased from 6 to 5 days (p < 0.0001). The postoperative complication rates were 35.5% during and 28.8%-29.7% after implementation (p = 0.003). While reoperations (8.6-9.7%) and inpatient readmissions (7.4-8.2%) did not differ, the achievement of textbook-defined outcomes significantly increased from 55.2% to 63.2% (p = 0.0005). CONCLUSION:A structured fast-track program for elective colorectal resections continuously achieves good results in clinical practice, even several years after its implementation. Significant improvements were also achieved after the implementation phase had been completed.
MR-guided radiotherapy (MRgRT) offers superior soft-tissue contrast and enables adaptive treatments which improve tumor targeting and organ-at-risk sparing. However, integrated MR-Linac systems remain financially and logistically inaccessible for many hospitals. To address this gap, we implemented a modular MRgRT workflow — termed the “Virtual MR-Linac”— which decouples MR imaging and treatment delivery, enabling daily adaptive radiotherapy (ART) using diagnostic-quality MRI. Between November 2023 and January 2025, 31 male patients with pelvic lymph node metastases were treated using this workflow. Daily MR scans were acquired in treatment position using a 1.5T MR scanner. Contours were adapted on 2D T2 turbo-spin-echo images, while synthetic CTs generated from T1 DIXON sequences were used for dose calculation. Adapted plans were delivered on a C-arm Linac using CBCT imaging for positioning. Quality assurance included independent Monte Carlo dose recalculations, automated plan parameters verification and a plan complexity check using in-house scripting. Across 99 adapted fractions, plan adaptation improved dosimetric outcomes, with a median 14
Deficiency of adenosine deaminase 2 (DADA2) is an autoinflammatory disease with diverse phenotypes. We describe the genetics, phenotypes, and treatment of n = 48 DADA2 patients from Germany, Austria, and Switzerland. We report a high incidence of hematological (83%) and immunological features (85%), a comparatively low anti-tumor necrosis factor full-response rate (58%), and a high decision probability (21%) for hematopoietic cell transplantation (HCT). We establish a correlation between genetic variant ADA2 activity and patient ADA2 activity. Remarkably, lower patient ADA2 activity is predictive of neutropenia and shows a trend toward HCT decision, whereas higher patient ADA2 activity is predictive of vasculitis symptoms. Genetic variants with low residual ADA2 activity are significantly more common among patients receiving HCT. Our study corroborates previous observations connecting ADA2 activity and clinical phenotype, which up to now have been mainly based on in vitro data.
