Temporary mechanical circulatory support (t-MCS) is increasingly used in fulminant myocarditis (FM), yet long-term outcomes and risk factors remain poorly defined. From the FULLMOON international cohort (419 adults with suspected FM across 36 centers in 15 countries), 295 patients treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO) and/or Impella were analyzed. The primary endpoint was mortality at 1 year, heart transplantation (HTx), or left-ventricular assist device (LVAD). Multivariate Cox regression identified predictors of adverse outcomes. A propensity score-weighted analysis assessed outcomes based on timing of endomyocardial biopsy (EMB): early (≤ 2 days), delayed (> 2 days), or none. The median age was 39 years (IQR 28–60), and 55
While most relatives of TRG-variant carriers report exposure to inhaled toxics, few make behavioural changes within a year of genetic counselling https://bit.ly/4iEGBBN.
We aimed to characterize the outcomes of patients with severe meningoencephalitis requiring intensive care. We conducted a prospective multicenter international cohort study (2017–2020) in 68 centers across 7 countries. Eligible patients were adults admitted to the intensive care unit (ICU) with meningoencephalitis, defined by an acute onset of encephalopathy (Glasgow coma scale (GCS) score ≤ 13), a cerebrospinal fluid pleocytosis ≥ 5 cells/mm3, and at least two of the following criteria: fever, seizures, focal neurological deficit, abnormal neuroimaging, and/or electroencephalogram. The primary endpoint was poor functional outcome at 3 months, defined by a score of three to six on the modified Rankin scale. Multivariable analyses stratified on centers investigated ICU admission variables associated with the primary endpoint. Among 599 patients enrolled, 589 (98.3 ≤ 3 (OR 2.23, 95
4000 Background: At 24.4-month (mo) median follow-up, adjuvant nivolumab demonstrated a statistically significant and clinically meaningful improvement in disease-free survival (DFS) vs placebo with a well-tolerated safety profile in patients (pts) with resected EC/GEJC with residual pathologic disease following neoadjuvant CRT and surgery in the primary analysis from the global, phase 3 CheckMate 577 study (NCT02743494). We report the final analysis of the hierarchically tested secondary endpoint of OS along with longer follow-up of DFS. Methods: Adults with resected (R0) stage II/III EC/GEJC who received neoadjuvant CRT and had residual pathologic disease were randomized 2:1 to nivolumab 240 mg or placebo Q2W for 16 weeks, followed by nivolumab 480 mg or placebo Q4W. Maximum treatment duration was 1 year. The primary endpoint was DFS. OS was a secondary endpoint, and exploratory endpoints included safety, distant metastasis-free survival (DMFS), and progression-free survival on subsequent systemic therapy (PFS2). Results: 794 pts were randomized (nivolumab, n = 532; placebo, n = 262). With a median follow-up of 78.3 (range, 60.1–96.6) mo, adjuvant nivolumab continued to show DFS benefit vs placebo (HR 0.76 [95% CI 0.63–0.91]; Table). Median OS was numerically longer with nivolumab vs placebo (51.7 vs 35.3 mo), although the difference was not statistically significant (HR 0.85 [95.87% CI 0.70–1.04]; P = 0.1064; Table). OS rates at 3 and 5 years with nivolumab vs placebo were 57% vs 50% and 46% vs 41%, respectively. OS subgroup analyses will be presented. Clinically meaningful improvement in DMFS with nivolumab vs placebo was maintained (Table). PFS2 favored nivolumab vs placebo (HR 0.81 [95% CI 0.67–0.98]). In the nivolumab group, 46% of pts received subsequent therapy vs 60% in the placebo group; 5% vs 15% received subsequent immunotherapy. No new safety signals were identified. Conclusions: Adjuvant nivolumab demonstrated sustained long-term DFS benefit and numerical improvement in OS vs placebo in pts with resected EC/GEJC and residual pathologic disease following neoadjuvant CRT. The safety profile of adjuvant nivolumab remained well-tolerated with longer follow-up. These results further support the use of adjuvant nivolumab in this pt population. Clinical trial information: NCT02743494 . Efficacy Nivolumab(n = 532) Placebo(n = 262) Median DFS (95% CI), mo 21.8 (16.6–29.7) 10.8 (8.3–14.3) HR (95% CI) 0.76 (0.63–0.91) Median OS (95% CI), mo 51.7 (41.0–61.6) 35.3 (30.7–48.8) HR (95.87% CI; P value) 0.85 (0.70–1.04; P = 0.1064) Median DMFS (95% CI), mo 27.3 (21.4–36.0) 14.6 (10.9–20.3) HR (95% CI) 0.75 (0.62–0.90) Safety, n (%) n = 532 n = 260 Any-grade/grade 3–4 TRAEs 379 (71)/75 (14) 124 (48)/17 (7) Any-grade/grade 3–4 TRAEs leading to discontinuation 48 (9)/26 (5) 8 (3)/7 (3) TRAE, treatment-related adverse event.
Neurofeedback (NF), an advanced technique enabling self-regulation of brain activity, was used to enhance upper limb motor recovery in chronic stroke survivors. A comparison was conducted between the efficacy of NF versus motor imagery (MI) training without feedback. We hypothesized that employing a bimodal EEG-fMRI based NF training approach would ensure precise targeting, and incorporating progressive multi-target feedback would provide a more effective mean to enhance plasticity. Thirty stroke survivors, exhibiting partial upper-limb motor impairment with a Fugl-Meyer Assessment Upper Extremity score (FMA-UE) > 21 and partially functional corticospinal tract (CST) were randomly allocated to the NF and MI groups. The NF group (n = 15) underwent a bimodal EEG-fMRI NF training focused on regulating activity in ipsilesional motor areas (M1 and SMA), while the MI group (n = 15) engaged in MI training. Demographic and stroke clinical data were collected. The primary outcome measure was the post-intervention FMA-UE score. Change in bold activations in target regions, EEG and fMRI laterality index (LI) and fractional anisotropy (FA) asymmetry of the CST were assessed after the intervention in both groups (respectively ΔEEG LI, ΔMRI LI and ΔFA asymmetry) and correlated with FMA-UE improvement (ΔFMA). Participants from both groups completed the 5-week training, with the NF group successfully modulating their brain activity in target regions. FMA-UE improvement post-intervention tended to be higher in the NF group than in the MI group (p = 0.048), and FMA-UE increased significantly only in the NF group (p = 0.003 vs p = 0.633 for MI). This improvement persisted at one-month in the NF group (p = 0.029). Eight out 15 patients in the NF group positively responded (i.e., improved by at least for 4 points in FMA-UE) compared to 3 out 15 in the MI group. No significant between-group differences were found in the evolution of ipsilesional M1 (t = 1.43, p = 0.16) and SMA (t = 0.85, p = 0.40) activation maps. The NF group exhibited a more pronounced lateralisation in unimodal EEG LI (t = − 3.56, p = 0.0004) compared to the MI group, but no significant difference was observed for MRI LI. A non-significant difference in ΔFA asymmetry of the CST between the two groups was found (t = 25; p = 0,055). A non-significant correlation between unimodal ΔEEG LI and ΔFMA (r = 0.5; p = 0.058) was observed for the NF group. Chronic stroke survivors can effectively engage themselves in a NF task and can benefit from a bimodal EEG-fMRI NF training. This demonstrates potential for NF in enhancing upper-limb motor recovery more efficiently than MI training.
