Carpal coalitions may alter intercarpal kinematics and load transfer. Reported coalition-associated scaphoid fractures show an exclusive predilection for the scaphoid waist, raising the possibility of a non-random biomechanical mechanism with focal stress concentration. These injuries have been associated with delayed union and nonunion. This pattern may justify CT-based assessment and consideration of a lower threshold for early surgical stabilization, including percutaneous screw fixation even in selected nondisplaced waist fractures. However, the currently available evidence is limited to case reports and does not allow firm treatment recommendations. Awareness of coalition anatomy and careful follow-up may be reasonable.
Background and purpose:Stereotactic radiotherapy (SRT) is a standard approach for treating multiple brain metastases. However, variation in planning practices may impact treatment quality. This study assessed planning consistency and dose-volume-based outcomes across radiation oncology centers. Materials and methods:A Computed Tomography (CT) scan of an anthropomorphic phantom with structure set was distributed to participating centers. Each center created SRT plans as for a clinical case. Dose distributions were evaluated based on Planning Target Volume (PTV) coverage (V100% (PTV)), dose to 95% of Gross Target Volume (GTV) volume (D95% (GTV)), maximal PTV dose (Dmax), conformity index (CI), gradient index (GI), brain volume receiving different percentages of the prescribed dose, and doses delivered to 0.035 cm3 and 0.5 cm3 of the brainstem. Results:Twenty-four centers, using 30 treatment units, submitted plans. The V100% (PTV) ranged from 95% to 100%, with Dmax between 110% and 150% of the prescribed dose. Mean GTV dose ranged from 110% to 135%, and 81% of GTVs had D95% between 110% and 120%. High conformity was achieved in 74% of plans (CI < 1.1), while 67% had a GI between 3.4 and 5. All plans met clinical dose constraints for the brainstem and uninvolved brain. Conclusion:This interinstitutional comparison demonstrated high plan quality and adherence to critical organ constraints, despite variability in planning strategies. These findings support nationwide planning and quality assurance standards to ensure consistently high-quality SRT.
To evaluate the oncological outcomes of second-look transurethral resection of bladder tumor (TURBT) in patients with a high grade (HG) Ta non-muscle invasive bladder cancer (NMIBC). We conducted a real-life multicenter study including all consecutive patients with HG Ta NMIBC, with or without second TURBT. Oncological outcomes included disease recurrence and progression. Multivariable Cox regression analyses were used to identify the independent predictors of bladder recurrence and progression. Of the 447 patients with HG Ta NMIBC, 240 (53.7
BACKGROUND & AIMS:Acute-on-chronic liver failure (ACLF) is characterised by multiorgan failure and high short-term mortality in hospitalised patients with acute decompensation of cirrhosis. Although the EASL-CLIF criteria are widely used for diagnosis and prognostication, evolving definitions of organ dysfunction and emerging therapies require updated, tailored criteria to improve diagnostic accuracy, treatment assessment, and applicability in clinical trials. We aimed to develop and validate the A-TANGO organ failure (OF) score to refine ACLF diagnosis and enhance its utility for treatment response evaluation and risk stratification. METHODS:We performed a retrospective analysis of prospective observational cohorts. The derivation cohort comprised three EF-CLIF consortium studies conducted in Europe and Latin America (CANONIC, PREDICT, ACLARA; n = 3,896). Validation cohorts included one study from India (Ambi-spective study n = 2,055) and one from China (CATCH-LIFE; n = 2,568). Patients were enrolled between 2011 and 2023, with follow-up completed in 2023. The primary objective was to redefine thresholds for organ dysfunction and failure using three subscores per organ, with subscore 3 corresponding to ≥15% 28-day mortality and defining organ failure. RESULTS:Compared with the CLIF-C OF score, the A-TANGO OF score introduced revised thresholds for organ failure and added an ACLF grade 4 to address the wide mortality variation within CLIF-C OF grade 3. A-TANGO identified more organ failures, increasing ACLF diagnosis from 24% to 36% and improving the net reclassification index by 16%, while maintaining similar predictive accuracy for 28- and 90-day mortality. Two additional prognostic models (A-TANGO ACLF-WBC and A-TANGO ACLF-CRP) demonstrated strong associations with 28- and 90-day mortality and improved prognostic performance. Findings were confirmed in external validation cohorts. CONCLUSIONS:The A-TANGO OF score is a reproducible and comprehensive tool for ACLF diagnosis with preserved prognostic performance, validated across large international cohorts. It provides a robust framework for clinical trials by enabling more accurate diagnosis, reducing required sample sizes, and offering clinically meaningful endpoints such as ACLF resolution for treatment response assessment. IMPACT AND IMPLICATIONS:The A-TANGO organ failure (OF) score provides a scientifically justified advancement in ACLF research by refining organ-specific dysfunction thresholds and introducing a new grade 4, thereby addressing limitations in current EASL-CLIF criteria and improving identification of high-risk patients. These findings are important for clinicians, researchers, and healthcare systems globally, as they increase detection of organ failure, enhance risk stratification, and enable more accurate prediction of short-term mortality in hospitalized patients with cirrhosis. The A-TANGO OF score and its associated prognostic scores (ACLF-WBC and ACLF-CRP) can be applied in clinical practice to guide treatment decisions, and serve as reliable, measurable endpoints in clinical trials evaluating emerging therapies. Although limitations such as missing data, cohort-specific recruitment differences, and historical classification criteria exist, the consistent and robust performance of the A-TANGO scores across large, multinational cohorts highlights their potential applicability and utility on a global scale.
Direct visual internal urethrotomy (DVIU) for short anterior urethral strictures is associated with a high rate of stricture recurrence. Optilume™ drug-coated balloon (ODCB) has recently emerged as a minimally invasive treatment alternative. However, comparative data between ODCB and DVIU are limited. This multicenter study aims to compare the two procedures in terms of functional outcomes and stricture-free survival (SFS) in patients with anterior urethral strictures. This multicenter retrospective study included 140 patients treated for anterior urethral stricture under 3 cm in length with either ODCB dilatation or internal urethrotomy. Data were collected from five European tertiary referral centers between November 2010 and April 2026. Stricture length was assessed by either cystoscopy, retrograde urethrography, or both. Stricture recurrence during follow-up was defined as symptomatic restenosis requiring reintervention. Multivariable Cox regression analysis was performed to identify predictors of recurrence. SFS was estimated using Kaplan-Meier estimates, with group comparisons assessed using the log-rank test. A total of 68 (48
