Background: Despite the dominance of the Model for End-Stage Liver Disease (MELD) in liver transplantation (LTx) prognosis, its ability to predict early post-transplant survival remains debated. Furthermore, the current critical donor shortage has expanded the use of extended criteria donor (ECD) grafts, which still lack effective prognostic models. To address this, we developed an innovative series of albumin-bilirubin (ALBI)-based multivariable models (MVMs) for predicting perioperative mortality and identifying super high-risk patients. Methods: Among a total of 2,040 recipients included from multicenter, 1,310 recipients were enrolled in the training cohort to develop an MVM for predicting perioperative mortality using logistic regression. Model performance was assessed by receiver operating characteristic (ROC) curve, with the risk threshold defined by decision curve analysis (DCA). External validation was performed in a cohort of 730 patients. For subgroup analyses, the model's discriminatory power, quantified by the area under the ROC curve (AUC), was compared with that of the MELD score. Results: We developed and externally validated two ALBI-based models (ALBI-MVM and ALBI-MVM plus). The ALBI-MVM showed higher predictive power (AUCs: 0.736 and 0.714), identifying a very high-risk group (45.5% mortality; P<0.001) from the ALBI-defined medium/high-risk population. With added variables, performance improved sequentially (AUCs: 0.792 and 0.704), and the ALBI-MVM plus further isolated a super high-risk group (73.3% mortality; P<0.001). Notably, across ECD subgroups-including small-for-size, elderly, and ABO-incompatible (ABOi) grafts-both models showed significantly superior predictive performance over the MELD score. Conclusions: This large multicenter study established and validated ALBI-based MVMs that effectively predicted perioperative mortality and identified super high-risk patients. Especially in major ECD transplantation types, it demonstrated superior predictive performance over traditional systems.

Background Bailout valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is a critical rescue strategy for procedural failure, yet evidence regarding its outcomes in bicuspid aortic valve (BAV) anatomy remains limited.Methods This retrospective, single-centre study analysed 1597 patients (48.3% BAV) undergoing TAVR. Patients were stratified by the requirement for bailout ViV, which was conducted for significant residual aortic regurgitation (AR) or valve embolisation. Predictors were identified via multivariate logistic regression. Early- and mid-term survival outcomes were compared using Inverse Probability of Treatment Weighting (IPTW) via entropy balancing.Results Bailout ViV was required in 6.20% of patients (BAV: 6.87%; tricuspid aortic valve (TAV): 5.57%). Larger annulus perimeter and significant residual AR after initial deployment were identified as consistent independent predictors of bailout ViV across all cohorts. Additionally, lower annulus calcification volume, non-repositionable self-expanding valves and the learning phase were predictors in the overall cohort. Significant mitral regurgitation and lower calcification volume in BAV and male sex in TAV cohorts were independent risk factors. IPTW-adjusted analysis revealed significantly higher 30-day all-cause (HR 3.09, p=0.019) and cardiovascular mortality (HR 3.49, p=0.021) in the bailout ViV group. However, no significant differences were observed in mid-term all-cause or cardiovascular mortality between groups.Conclusions Bailout ViV was associated with elevated early mortality but offered satisfactory mid-term survival. Key predictors include anatomical challenges (large annulus and insufficient calcification) and procedural factors (non-repositionable self-expanding valve, learning phase TAVR and significant residual AR after the first prosthesis).

BACKGROUND:Although sarcopenia is a known predictor of outcomes in cardiovascular diseases, its disease trajectory, including improvement, stability, or worsening, following transcatheter aortic valve replacement (TAVR) remains insufficiently explored. This study pioneered using pectoralis muscle index (PMI) from routine thoracic computed tomography angiography (CTA) to track sarcopenia changes post-TAVR and determine prognostic value. METHODS:This single-center cohort included consecutive TAVR patients with serial thoracic CTA at baseline and 1 year. PMI was calculated as pectoralis muscle area at the fourth thoracic vertebra normalized to height2. Using sex-specific PMI thresholds, patients were stratified into four phenotypes: non-sarcopenic, early-onset, late-onset, or persistent sarcopenia. Multivariate Cox regression identified mortality predictors. RESULTS:Among 258 patients (median age 72.86; 56.59% male), both baseline PMI (median 1,067.19 mm2/m2, p = 0.038) and 1-year PMI (median 1,145.95 mm2/m2, p = 0.016) independently predicted survival during a median 1,495-day follow-up (mortality 12.79%). Compared to non-sarcopenic patients, those with persistent sarcopenia (17.83% of cohort) had significantly elevated mortality risk (Hazard ratio = 3.94, 95% CI = 1.44-10.80, p = 0.008). CONCLUSIONS:This study suggests the potential of PMI quantification via thoracic CTA as a clinically integrable tool for prognostic stratification in TAVR recipients through sarcopenia monitoring, which warrants further randomized investigation for potential generalization to other cardiac interventions. The identification of persistent sarcopenia as a modifiable risk factor mandates the implementation of protocolized nutritional optimization and structured rehabilitation programs in high-risk subgroups.

RATIONALE AND OBJECTIVES:Evidence suggests that body composition is a predictor of poor prognosis in pancreatic ductal adenocarcinoma (PDAC), but its association with early recurrence remains undetermined. This study investigated whether body composition parameters were associated with early recurrence after surgery in patients with resectable PDAC. MATERIALS AND METHODS:A total of 451 patients (376 in the training cohort, 75 in the external validation cohort) from two centers were retrospectively analyzed. Body composition parameters included skeletal muscle index (SMI) and density (SMD), subcutaneous and visceral adipose tissue (SAT and VAT) area and density. Cox proportional hazards regression was used to identify independent prognostic factors of early recurrence, and a weighted scoring system was developed and externally validated. RESULTS:Multivariable analysis revealed that concomitant pancreatitis (HR:1.51, 95%CI:[1.02-2.24],P=0.041), peripancreatic infiltration (HR:1.70, 95%CI:[1.25-2.28], P<0.001), tumor grade (III vs. I-II) (HR:1.75, 95%CI:[1.33-2.29], P<0.001), adjuvant chemotherapy/concurrent chemoradiotherapy (CCRT) (HR:0.63, 95%CI:[0.47-0.86], P=0.003), CA19-9>500 U/mL (HR:2.03, 95%CI:[1.49-2.61], P<0.001), and myosteatosis (HR:1.65, 95%CI:[1.26-2.18], P<0.001) and high VAT (HR:1.48, 95%CI:[1.09-2.01], P=0.022) were independent prognostic factors for early recurrence. The scoring system demonstrated moderate to good discrimination in the training cohort (AUC=0.724, 95% CI:0.677-0.768) and external validation cohort (AUC=0.708, 95%CI: 0.591-0.807). Patients with scores ≥2.5 had significantly higher early recurrence rates (76% vs. 43%; P<0.001). SMD was correlated with apolipoprotein A1, albumin and neutrophil-to-lymphocyte ratio (NLR) (all P<0.010). Baseline NLR was independently associated with SMD reduction (P<0.001) in the availability-based subgroup with 6-month postoperative CT (n = 129). CONCLUSION:Myosteatosis and high VAT were independently associated with early recurrence after surgery. Incorporating body composition analysis into postoperative assessments may improve risk stratification for early recurrence.

Background:Early cerebrovascular events (CVEs) following transcatheter aortic valve replacement (TAVR) are severe complications, but effective methods for predicting and preventing these events have not been well established. A systematic review and meta-analysis were performed to identify significant predictors of early CVEs post-TAVR. Methods:MEDLINE/Embase databases were searched for articles published between December 2015 and April 2023. Original studies evaluating predictors of CVEs within 30 days post-TAVR after adjusting for confounders were included. Two investigators independently extracted data following the PRISMA statement. Meta-analyses of multivariable data were performed using DerSimonian and Laird random-effects models, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Robustness was assessed via Harbord's test, nonparametric trim-and-fill analysis, leave-one-out sensitivity analysis, the QUIPS quality assessment tools, meta-regression, and subgroup analyses. Results:Among the 74 included studies, multivariate meta-analyses identified 11 predictors of early CVEs, including 9 patient-level predictors-a CHA2DS2-VASc ≥ 5, no prior heart failure, diabetes, isolated aortic stenosis, carotid artery stenosis, peripheral artery disease, advanced age, New York Heart Association class ≥ III, and significant left ventricular outflow tract calcification-and 2 procedure-level predictors: the absence of cerebral embolization protection and post-dilation. Additionally, 10 patient-level factors and 5 procedure-level factors were not associated with early CVEs, although significant heterogeneity was observed in most analyses. Conclusions:This study identified multiple patient-level and procedure-level factors associated or not associated with early CVEs after TAVR. These findings support the development of a comprehensive risk prediction model that can accommodate diverse patient populations and evolving procedural techniques, thereby enhancing clinical risk management strategies.

Cancer immunotherapy, exemplified by immune checkpoint blockade (ICB), remains strongly influenced by the pre-existing immune organization of the tumor microenvironment. Tertiary lymphoid structures (TLSs) are ectopic lymphoid aggregates whose density, maturation state, and spatial localization correlate with clinical prognosis and ICB response across several malignancies. Radiotherapy (RT) can reshape this immune context in opposing directions. By inducing immunogenic cell death, antigen release, cGAS-STING/type I interferon signaling, vascular remodeling, and lymphocyte recruitment, RT can create conditions that support TLS-associated antitumor immunity in selected settings. Conversely, high-dose or large-volume irradiation, poorly timed nodal exposure, and collateral injury to lymphocytes, tumor-draining lymph nodes, stromal scaffolds, and high endothelial venules can disrupt established TLSs or prevent their maturation. This review summarizes current evidence on the bidirectional relationship between RT and TLS biology, differentiating validated mechanisms from indirect evidence and hypothesis-generating translational concepts. We expound on how dose, fractionation, timing, irradiated volume, nodal management and radiation modality may influence antigen presentation, lymphocyte availability, and local immune architecture. Potential strategies such as lymph-node-aware planning, proton or heavy-ion therapy, FLASH RT, vascular normalization, STING or LTβR agonism, and ICB combinations are evaluated as investigational approaches rather than established TLS-directed clinical interventions. Future studies should evaluate whether optimized RT regimens can preserve or promote the functional maturation of TLSs, integrating paired tissue biopsies, spatial transcriptomics, advanced imaging, and circulating biomarkers to definitively correlate TLS remodeling with clinical outcomes. Tertiary lymphoid structures (TLSs) function as clinically relevant immune-organizing niches whose prognostic and predictive value depends on maturation state, density, and spatial localization. Radiotherapy can promote TLS-associated immunity via antigen release, cGAS-STING/type I interferon signaling, and vascular remodeling, but may impair TLSs through lymphopenia, nodal injury, and stromal damage. The immunological impact of radiotherapy on the tumor microenvironment is determined by the dose, fractionation, timing, irradiated volume, nodal exposure, radiation modality, and baseline immune context. Lymph-node-sparing, volume-conscious, and vascular-preserving radiotherapy strategies can minimize collateral immune damage where oncologically feasible. Proton, heavy-ion, and FLASH radiotherapy offer plausible immune-preserving advantages, though direct evidence linking these modalities to TLS induction or maintenance remains limited. Combining radiotherapy with ICB, STING or LTβR agonism, vascular normalization, or stromal reprogramming must be investigated as stratified translational hypotheses with prespecified TLS endpoints.

Pancreatic ductal adenocarcinoma (PDAC) remains highly lethal due to intrinsic and acquired chemotherapy resistance, particularly after neoadjuvant therapy (NAT). To uncover therapy-induced vulnerabilities, we established matched patient-derived organoids from PDAC tissues obtained before and after NAT, creating a unique platform to track treatment-driven evolution. Comparative analysis of these organoids revealed negligible variation in key driver gene mutations but identified a transition from classical to basal-like subtype in one patient after neoadjuvant therapy. Notably, albumin-bound paclitaxel and gemcitabine (AG) treatment induced the resistance to paclitaxel, accompanied by elevated KRAS and MAPK signaling, which was confirmed by transcriptomic comparison of PDAC patient samples with (30 cases) and without (60 cases) AG treatment. Single-cell RNA sequencing of the organoid-derived xenografts revealed AG treatment promoted the emergence of resistant cell clusters characterized by KRAS and MAPK signaling activation. Importantly, EGFR/KRAS/BRAF signaling inhibitors effectively suppressed the growth of AG-resistant PDAC organoids. In a validation cohort of 29 organoids, pan-KRAS inhibitors exhibited superior efficacy against the residual organoids after AG treatment. These results provided insights into molecular changes in PDAC during treatment process and demonstrate that AG chemotherapy can activate the KRAS and MAPK signaling, presenting a potential target for therapeutic intervention.

Background:Desmoplastic infantile astrocytomas/ganglioglioma (DIA/DIG) arising in the suprasellar region are extremely rare, and their clinical features, optimal management, and outcomes remain unclear. We aimed to summarize the clinical manifestations, treatment strategies, and prognosis of this rare tumor entity. Patients and methods:This retrospective case series included 5 institutional cases and 13 literature cases of suprasellar DIA/DIGs. The clinical and radiological characteristics, therapies, and outcomes of this rare tumor were examined. Results:Our case series comprised 2 males and 3 females, with a median age of 6 months. Three patients underwent partial resection, and 2 had subtotal resection. During follow-up, the residual tumors in 2 patients showed spontaneous regression, 1 tumor progressed, and 2 remained stable. The literature review, including our cases, yielded 18 suprasellar DIA/DIG. Of these, 10 were male and 8 were female, with a median age of 4 months (range, 1-85 months). Ten patients had solitary suprasellar tumors and 8 had multifocal lesions. Over a median follow-up of 25 months, tumor progression of the suprasellar lesions was seen in 9 patients. Notably, spontaneous regression of the suprasellar tumors occurred in 2 patients. Conclusions:Despite being WHO grade I, suprasellar DIA/DIG can demonstrate multifocal CNS disease and high risk of progression after subtotal resection. DIA/DIG should be considered in the differential diagnosis of suprasellar lesions in infants and long-term close monitoring is warranted.

BackgroundsThe relationship between red blood cell (RBC) transfusion volume and long-term survival outcomes following transcatheter aortic valve replacement (TAVR) remains inadequately characterized. This study sought to investigate the clinical impact of perioperative transfusion and identify critical thresholds for transfusion volume in predicting mortality risk after TAVR.MethodsIn this retrospective cohort analysis, patients undergoing TAVR at a tertiary cardiac center between April 2012 and September 2023 were consecutively enrolled and stratified by transfusion status. Multivariate Cox regression models were employed to identify prognostic factors for mortality. The primary outcome was all-cause mortality at 1-year post-TAVR.ResultsOf 1,758 included patients, 141 (8.02%) required RBC transfusions. Transfused patients exhibited higher risk profiles, female predominance, advanced age, anemia, chronic kidney disease at baseline, and increased rates of life-threatening/major bleeding, stroke, and stage 3 acute kidney injury. These patients also demonstrated elevated 30-day and 1-year mortality rates. While transfusion status (P = 0.690) and anemia (P = 0.188) showed no independent association with 1-year mortality, total transfusion volume emerged as a significant independent predictor (adjusted hazard ratio 1.07, 95% CI: 1.02–1.12; P = 0.008), with 4.5 units identified as the optimal threshold for mortality risk stratification. Life-threatening/major bleeding events constituted the sole independent predictor of transfusion volumes exceeding 4.5 units (P = 0.039).ConclusionsElevated transfusion volumes significantly correlate with increased long-term mortality risk in transfused TAVR recipients, primarily mediated by life-threatening hemorrhagic complications. These findings underscore the importance of implementing bleeding mitigation strategies to minimize transfusion requirements and improve clinical outcomes.

BACKGROUND:Transcatheter tricuspid valve replacement (TTVR) is a promising therapy for tricuspid regurgitation (TR), but comprehensive comparison of clinical outcomes stratified by annular size remains understudied. OBJECTIVES:The aim of this study was to evaluate and compare early outcomes in patients treated with transjugular TTVR stratified by annular size. METHODS:Patients with grade ≥3 TR undergoing LuX-Valve Plus TTVR were enrolled across 13 centers from May 2022 to March 2024. They were stratified into a large-annulus group (LAG) (perimeter-derived annular diameter ≥51 mm or maximal annular diameter ≥55 mm) and a small-annulus group (SAG). Early outcomes included device, procedural, or intraprocedural success; TR reduction; and 30-day primary endpoints or clinical success. RESULTS:Among 159 patients, baseline TR severity was greater in the LAG (n = 42) than the SAG (n = 117). Superior trial-defined device or procedural success (81.0% vs 97.4%; P = 0.001) and Tricuspid Valve Academic Research-defined intraprocedural success (78.6% vs 96.6%; P = 0.001) were observed in the SAG. At 30 days, primary endpoint rates were similar (trial defined, 16.7% vs 14.5% [P = 0.936]; TRISCEND II [Edwards EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device] defined, 21.4% vs 22.2% [P = 1.000]), but Tricuspid Valve Academic Research Consortium clinical success favored the SAG (73.8% vs 94.9%; P = 0.001). Severe paravalvular regurgitation (7.1% vs 0.0%; P = 0.017) occurred only in the LAG, while new-onset third-degree atrioventricular block or pacemaker implantation (0.0% vs 9.4%) was exclusive to the SAG. Severe bleeding was comparable between the groups (14.3% vs 9.4%; P = 0.391). CONCLUSIONS:LuX-Valve Plus TTVR appears to be safe and effective in TR patients regardless of annular size, but TR reduction was more significant in the SAG, with specific differences in some major adverse events between groups.

BACKGROUND:Continuing to use the 8th edition criteria, the current American Joint Committee on Cancer (AJCC) 9th staging system has been demonstrated to fail to distinguish prognosis in Stage I between Stage II for patients with G1/G2 pancreatic neuroendocrine tumors (p-NETs). A modified tumor-node-metastasis (mTNM) system with revised nodal classification was previously proposed, but hasn't been comprehensively validated by large-scale institutional studies. METHODS:Data of eligible patients was retrospectively collected and distributed by the proposed mTNM staging system and the current AJCC 9th staging system. The staging characteristics for G1/G2/G3 p-NETs were respectively performed and compared by two systems. RESULTS:Our study enrolled 310 patients with well-differentiated p-NETs, including 122 ones with G1, 132 with G2 and 56 with G3. The 5-year overall survival (OS) from AJCC Stage I to Stage IV was respectively 79.0 %, 88.8 %, 39.5 % and 15.8 %, in which survival comparison between Stage I and Stage II wasn't significant (P = 0.114). The OS at 5 years from mTNM Stage I to Stage IV was respectively 93.4 %, 75.5 %, 34.1 % and 15.8 %, in which notable survival differences were offered among each stage (P < 0.05). Moreover, consistent with the results of Akaike information criteria and Harrell's concordance index, the 95 % confidence intervals in multivariate analysis for proposed mTNM staging system were smaller than that of AJCC 9th staging system, indicating a more accurate predictive ability for the OS of G1/G2/G3 p-NETs. CONCLUSION:The proposed mTNM staging system was superior to the current AJCC 9th system for well-differentiated p-NETs.

e16451 Background: Conversion therapy for locally advanced pancreatic cancer (LAPC) remains a challenging area, with the median overall survival of existing regimens less than 1 year. Patients with a significant response to chemotherapy may be considered for surgical resection. Following resection, these patients have similar survival rates as those initially determined to be resectable. But conversions are rare in patients with true locally advanced disease. Nimotuzumab has shown potential in pancreatic cancer treatment and previous studies have confirmed its chemosensitization effect when combined with gemcitabine or paclitaxel. This study aimed to evaluate the efficacy and safety of nimotuzumab combined with the AG regimen as conversion therapy for LAPC. Methods: This is an open-label, single-arm, and single-center phase II trial. Patients with pathologically and radiographically confirmed LAPC without prior anti-cancer treatment or severe morbidities were enrolled. All patients received Nimotuzumab (400mg per week) plus AG regimen (gemcitabine 1,000 mg/m 2 and nab-paclitaxel 125 mg/m 2 on days 1 and 8, every 3 weeks) as conversion therapy, and imaging assessments (according to RECIST V.1.1 criteria) were performed every two months of conversion therapy. The primary endpoint was R0 resection rate. Additional end points included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), tumor regression grade (TRG), pain relief rate and safety, etc. Results: Fifteen patients were enrolled at West China Hospital from September 2023 to January 2025. Median age was 60.38 (43-77) years, 73.3% were male and head of pancreas lesions were most common (53.3%). During the conversion treatment period, 53.3% (8/15) had a TRG score of 0-2 and 81.8% achieved pain relief. Among 14 evaluable patients, ORR was 21.4%, and DCR was 92.9%. Ten patients (66.7%) achieved conversion resection (all R0 resections) after a median of 3.5 months of treatment. As of January 25, 2025, with a median follow-up time of 8.21 months (95% confidence interval [CI], 3.64 - 12.78), survival analysis showed that the median PFS was 12.45 months (95% CI, 7.58 - 17.33) and the median OS was not reached. Regarding safety, 7 patients (46.7%) experienced adverse events (with 16 occurrences), most of which were grade 1-2. All adverse events were cured or effectively controlled after symptomatic treatment. Conclusions: Nimotuzumab combined with the AG regimen demonstrated certain efficacy and acceptable safety as conversion therapy for LAPC. Our interim analysis showed a significant effect of conversion surgery, which may be relevant to clinical practice, providing a potential option for this group of patients. However, further studies with larger samples are needed. Clinical trial information: ChiCTR2400084464 .

e16386 Background: Locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) combined with hepatic arteries invasion is usually considered unresectable. This study explores a new procedure with preoperative segmental hepatic arteries embolization and hepatic artery resection and evaluate its safety. Methods: All LA-PDAC patients received neoadjuvant chemotherapy and had stable or partially remission tumors as assessed by CT imaging. Before surgery, all patients underwent preoperative segmental hepatic arteries embolization, include right hepatic artery (RHA), left hepatic artery (LHA) and left gastric artery (LGA). Results: Pancreaticoduodenectomy was performed in 8 patients and distal pancreatectomy in 2 patients, combined with hepatic artery resection. No perioperative deaths occurred, and all patients achieved R0 resection. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were normal after hepatic arterial embolization. The average peak values of ALT and AST after surgery were 734.7 and 805.5 respectively, and the average time for ALT and AST levels to return to normal was 8.5 days. Two patients had localized hepatic ischemia after surgery, but no patient had liver abscess. Conclusions: The novel surgical approach of radical pancreatic cancer resection combined with preoperative hepatic artery embolization and hepatic artery resection is feasible and safe for LA-PDAC patients with hepatic artery invasion. This study provides evidence supporting the potential use of this procedure in such cases.

PURPOSE:Eye injuries are a leading cause of monocular vision impairment and disability in children and adolescents. Unlike adults, eye injuries in children exhibit significant age specificity, with worse visual outcomes due to immature vision, the risk of long-term damage, and amblyopia. However, research on the global distribution and trends of eye injury burdens in this population is limited. DESIGN:Retrospective population-based trend study. METHODS:This study analyzes the burden of eye injuries among children and adolescents aged 0 to 19 years globally, regionally, and nationally, using data from the 2021 Global Burden of Disease study. We evaluated the epidemiological characteristics of eye injuries by calculating incidence, years lived with disability (YLD), age-standardized incidence rates (ASIR), and age-standardized YLD rates (ASYR). Temporal trends in ASIR and ASYR from 1990 to 2021 were assessed using joinpoint regression analysis, expressed as average annual percentage changes. The analysis was further stratified by sex, age, and sociodemographic index (SDI) to explore trends in different subgroups. RESULTS:In 2021, the global ASIR and ASYR for children and adolescents were 434.24 per 100,000 (95% confidence interval [CI], 305.17-603.22) and 3.19 per 100,000 (95% CI, 0.96-6.99), respectively, indicating a decline since 1990. Regions with high SDI showed the highest incidence of eye injuries. Australasia, Southern Latin America, and Western Europe had the highest ASIRs and ASYRs in both 1990 and 2021. From 1990 to 2021, Afghanistan, Yemen, Libya, the Central African Republic, and Chile experienced the most significant increases in pediatric eye injuries. Global data show that boys have an eye injury incidence rate approximately 1.8 times higher than that of girls. In 2021, the incidence of eye injuries among children and adolescents increased with age. The primary causes include foreign bodies, exposure to mechanical forces, and falls. CONCLUSIONS:Despite observed declines in incidence and YLD, the burden of eye injuries in children and adolescents remains substantial. These findings underscore the urgent need for the development and implementation of targeted preventive education initiatives and ocular protection protocols on a global scale.

BACKGROUNDS:Significant mitral regurgitation (MR) is common worldwide, yet surgical correction rates remain low due to high-risk patient profiles. Transseptal mitral valve replacement (TSMVR) has emerged as a minimally invasive alternative, but its feasibility in Asian populations remains underexplored. AIMS:This study assessed the short-term feasibility of the HighLife TSMVR system for treating symptomatic MR in China. METHODS:This prospective study included seven centers in China, integrating data from multicenter and localized cohorts with identical inclusion criteria. Patients with symptomatic MR (≥ 3+) and high surgical risk were included, excluding those with unsuitable anatomy for the HighLife system. Preprocedural imaging was centrally adjudicated, and 30-day outcomes were analyzed using R software (version 4.4.0). RESULTS:Twenty-two patients (median age 70.5 years; 45.5% male) underwent the procedure. The predicted median mortality risk was 6.39%, with secondary MR in 81.8% of cases. Technical success was 95.5% (21/22). Median durations of valve delivery, ring closure, transseptal puncture, and looping were 4.00, 8.50, 22.25, and 42.75 min, respectively and 22.73% cases of tele-proctoring. One patient required conversion to transcatheter aortic valve replacement, and two deaths occurred within 30 days. Significant improvements were observed in New York Heart Association class (p = 0.033) and MR severity (p < 0.001). CONCLUSIONS:The HighLife TSMVR system demonstrated safety and efficacy in treating symptomatic MR in high-risk Chinese patients, supporting its potential clinical applicability.

Background:The Geriatric Nutrition Risk Index (GNRI) serves as a straightforward screening tool for predicting the likelihood of postoperative complications and mortality in elderly patients. This study aimed to investigate the association between GNRI and postoperative outcomes in elderly patients undergoing pancreaticoduodenectomy (PD). Methods:We enrolled patients aged 65 years or older who underwent PD between January 2018 and March 2023. Patients were dichotomized into at-risk (GNRI ≤98) or no-risk (GNRI >98) groups. Propensity score matching was used to compare the baseline differences and postoperative outcomes between these two groups. Logistic regression analysis was conducted to assess the association between GNRI and major morbidity (Clavien-Dindo scale with ≥ grade 3b complications). Results:There were 392 eligible patients included. Following propensity score matching, patients in the at-risk GNRI group had higher rates of major complication (13.2% vs. 5.4%, P=0.03) and pulmonary infection (17.8% vs. 9.3%, P=0.046). Based on the multivariate analysis, at-risk group was an independent prognostic factor for major morbidity (odds ratio =2.698, 95% CI: 1.062-6.856, P=0.04). Subgroup analysis revealed that high-risk patients (GNRI <82) exhibited higher rates of preoperative jaundice and longer operative time in comparison to the moderate (GNRI =82-91) and low-risk (GNRI =92-98) groups. However, there were no statistically significant disparities in morbidity and mortality among these three groups. Conclusions:We demonstrated that nutritional status evaluated by GNRI predicts postoperative complications after PD in elderly patients.

To develop a score system including CT features for predicting postoperative early (≤ 1 year) recurrence-free survival (RFS) in resectable pancreatic ductal adenocarcinoma (PDAC) patients who underwent radical resection and assess its performance. This dual-center, retrospective study included patients with resectable PDAC who underwent radical resection from September 2016 to April 2023. All CT features were independently evaluated by two blinded radiologists. An early recurrence score (ERS) based on CT and clinical features, for predicting early recurrence risk, was developed by Cox regression analysis in the developing cohort, and was validated in the testing and validation cohorts and compared with AJCC TNM staging system. This study included 210 patients in the development cohort (mean age ± standard deviation, 60 ± 10 years; 129 men), 92 patients in the testing cohort (60 ± 9 years; 60 men), and 31 patients in the validation cohort (62 ± 7 years; 20 men). CA19-9 (hazard ratio [HR], 1.57; p = 0.044), perineural invasion on CT (HR, 1.83; p = 0.037), tumor necrosis (HR, 3.20; p < 0.001), and lymph nodes metastasis on CT (HR, 1.84; p = 0.004) formed the ERS. Its AUC of 0.851 and 0.901, superior to AJCC TNM staging (AUC of 0.630 and 0.534) in the testing and validation cohorts, (p < 0.05), respectively. The high-risk patients predicted by ERS had significantly higher postoperative 1-year recurrence rates than their low-risk counterparts in both the testing cohort (81.4

Background:The tricuspid regurgitation (TR) syndrome, based on the extent of cardiac and extracardiac involvement, is a newly proposed staging method to evaluate the progression of TR. This study aimed to explore cardiac structural characteristics and the short-term prognosis after transcatheter tricuspid valve replacement (TTVR) in patients at different stages. Methods:A post-hoc analysis of patients enrolled in the first-in-man and confirmatory study and an investigator-initiated trial of the LuX-Valve Plus system was conducted. Patients with TR who underwent successful TTVR by the LuX-Valve Plus systems were staged according to systemic involvement. The baseline and one-month follow-up results among different stages were compared. Results:A total of 149 patients were included, of whom 23 were in stage 2, 49 were in stage 3, and 77 were in stage 4. Compared with patients in stages 2 and 3, patients in stage 4 had more severe TR (mean vena contracta width: 14.94±4.51 vs. 11.13±4.56 vs. 11.04±3.71 mm, P<0.001), greater right ventricular (RV) remodeling (RV anterior-posterior diameter, 35.63±6.04 vs. 32.35±4.95 vs. 33.56±4.43 mm, P=0.007) and annulus enlargement (tricuspid annulus, 44.87±5.41 vs. 41.54±6.21 vs. 42.13±5.26 mm, P=0.004), higher level of N-terminal pro-brain natriuretic peptide (NT-Pro-BNP) [1,063.50 (541.25, 1,791.25) vs. 631.50 (462.55, 1,409.50) vs. 587.50 (250.55, 908.55) pg/mL, P=0.03], and more extracardiac system damage [such as more lower limbs edema, higher bilirubin level and Model for End-Stage Liver Disease (MELD)-albumin score, lower hemoglobin, platelet count, and estimated glomerular filtration rate (eGFR)]. Regardless of staging, patients generally benefited from TTVR as evidenced by reverse RV remodeling, improved New York Heart Association (NYHA) classification, and improved Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Patients in stage 4 had a higher incidence of paravalvular leakage after the procedure and all deaths were presented in the stage 4 group. No heart failure readmission was observed during short-term follow-up. Conclusions:The staging of TR syndrome may help to quantify disease severity. Although all patients can gain short-term benefits from TTVR, an early intervention may help to reduce the incidence of complications.