AZ Klina

Abstract PORCSE studygroup: Anneline Cremer (Erasme University Hospital Department of Gastroenterology Brussels Belgium) João A. Cunha Neves (ULS-Algarve Department of Gastroenterology Portimão Portugal) Andreas Kapsoritakis (University Hospital of Larissa IBD unit- Department of Gastroenterology Larissa Greece) Mircea Diculescu (Faculty of Medicine- Carol Davila University of Medicine and Pharmacy- Fundeni Clinical Institute Department of Gastroenterology Bucharest Romania) Lieven Pouillon (Imelda Hospital Bonheiden Department of Gastroenterology and Hepatology Bonheiden Belgium) Ioannis E. Koutroubakis (University Hospital Heraklion Department of Gastroenterology Heraklion- Crete Greece) Laura Nieto (Hospital Clinico Universitario de Santiago de Compostela- Health Research Institute of Santiago de Compostela IDIS Gastroenterology Compostela Spain) Sophie Claeys (AZ Sint-Lucas Department of Gastroenterology Ghent Belgium) Iago Rodríguez-Lago (Hospital Universitario de Galdakao- Biobizkaia Health Research Institute Department of Gastroenterology Galdakao Spain) Pauline Rivière (Bordeaux University Hospitals Department of Gastroenterology Bordeaux France) Serkan Dumanli (Gazi University Department of Gastroenterology Ankara Turkey) Francisco Portela (ULS de Coimbra Department of Gastroenterology Coimbra Portugal) Ian Arnott (Western General Hospital IBD unit Edinburgh United Kingdom) Pinelopi Nikolaou (Venizeleio General Hospital Department of Gastroenterology Heraklion Greece) Joana Revés (Hospital Beatriz Ângelo Division of Gastroenterology- ULS Loures-Odivelas Loures Portugal) Inês Botto (Unidade local de saúde de santa maria- Clinica Universitária de Gastroenterologia- Faculdade de Medicina de Lisboa Servico Gastroenterologia e Hpatologia Lisbon Portugal) Margalida Calafat (Hospital Universitari Germans Trias i Pujol and CIBEREHD Gastroenterology Badalona Spain) Background The retrospective, multicentric, observational PORCSE study evaluated postoperative recurrence of Crohn’s disease after ileocaecal resection. Early medical prophylaxis (proactive strategy, cohort1) was found to have lower rates of endoscopic (Rutgeerts >i1) and clinical postoperative recurrence compared to expectant management (reactive strategy, cohort2) at first endoscopic evaluation. In this analysis from a subgroup of the PORCSE population, long term outcomes of these 2 strategies are explored. Methods A subgroup analysis was performed in patients with extended follow-up beyond the timeframe of the original PORCSE study (Fig1). Primary endpoints were surgical (sPOR) and clinical (cPOR) recurrence. Endoscopic disease activity and progression were evaluated as secondary endpoints. Progression was defined as an increase in Rutgeerts score (>i1) and/or development of colon inflammation from first to consecutive postoperative endoscopies. Logistic regression models with propensity score matching were fitted to adjust for confounding factors in comparing the proactive and reactive strategy. Results For 92.2% of the 346 originally included patients, a mean additional follow-up duration of 38.5months (SD24.5) was available (mean total follow-up 110.9months, SD44.8). sPOR and cPOR rate was numerically higher with the reactive strategy. However these differences were not statistically significant (sPOR: cohort1:13.2%, cohort2:18.2%; OR1.78, 95%CI 0.73-4.34, P = 0.202 - cPOR: cohort1: 39.3%, cohort2:49.7%; OR1.73, 95%CI 0.92-3.24, P = 0.089). No difference was found in IBD-related hospitalisation rate (cohort1: 10.8%, cohort2: 10.1%; OR 1.48, 95%CI 0.53-4.18, P = 0.457). Survival analysis did not show a significant difference for time to sPOR (HR1.34, 95% CI 0.59-3.06, P = 0.485) nor in time to cPOR (HR1.28, 95%CI 0.35-4.66, P = 0.713). Rates of endoscopic disease activity (Rutgeerts>i1 and/or colonic inflammation) at consecutive endoscopies after initial postoperative endoscopy did not differ (cohort1:59.2%, cohort2:57.8%, OR0.70, 95%CI 0.31-1.57, P = 0.381). Univariate analysis revealed a higher rate of endoscopic progression with a proactive strategy (cohort1: 20.6%, cohort2: 10.6%, P = 0.041). However, after correction for confounders this difference was no longer significant (OR2.44, 95%CI 0.92-6.48, P = 0.073). Conclusion In this large subgroup of patients with extended follow-up from the original PORCSE study, proactive medical prophylaxis after ileocaecal resection showed no statistically significant differences compared with a reactive approach in reducing the rate of surgical and clinical posoperative recurrence, despite a numerical trend. Further prospective studies and larger cohorts are required to confirm these findings.

Extra-pulmonary tuberculosis can affect any part of the digestive system, including the esophagus. Esophageal involvement in tuberculosis is considered rare and its atypical manifestation can lead to delayed or misdiagnosis. Primary esophageal tuberculosis (ET) occurs when the esophagus is directly affected by tuberculosis while secondary ET arises from infiltration by surrounding structures. We report the case of a 44-year-old immunocompetent Tibetan patient who presented with dysphagia, in whom gastroscopy revealed a subepithelial lesion (SEL). The patient was diagnosed with secondary esophageal tuberculosis by tissue acquisition with endoscopic ultrasound (EUS) and successfully treated with tuberculostatic drugs. Esophageal tuberculosis must be considered when a subepithelial lesion of the esophagus is found, especially in patients originating from endemic areas.

Abstract Background and Objective: Urolithiasis clusters with metabolic and cardiovascular disorders. We estimated nationwide prevalence of urolithiasis in Colombia and quantified its association with cardio-metabolic comorbidities and major cardiovascular events. Methods: Descriptive, cross-sectional analysis of Individual Health Service Provision Records (RIPS), 2010–2024. Urolithiasis identified by ICD-10. Prevalence reported as % and stratified by sex and age. Associations summarized as prevalence ratios (PRs) comparing association with cardio-metabolic comorbidities in individuals with vs without stones; chi-squared tests with 95% CIs. Results and Limitations: Among 65.4 million encounters, 1,838,661 carried a urolithiasis diagnosis (2.8%). Men slightly higher than women (2.9% vs 2.6%). Metabolic disorders were enriched in stone formers: hypertension 6.6% vs 2.2% (PR≈3.0), dyslipidemia 7.3% vs 2.5% (PR≈2.9), obesity 6.3% vs 2.6% (PR≈2.5), diabetes 7.3% vs 2.6% (PR≈2.8). Cardiovascular events were more frequent: ischemic heart disease 7.4% vs 2.7% (PR≈2.7); stroke 5.5% vs 2.8% (PR≈2.0). Renal involvement showed the largest disparity: CKD 8.9% vs 2.7% (PR≈3.3). In children <10 years, CKD occurred in 3.7% with stones. Limitations: reliance on administrative data (selection/misclassification), no verification of diagnoses, cross-sectional design (no temporality/causality), absence of clinical, behavioral, and socioeconomic covariates, no stone type/severity/recurrence or treatment detail; residual confounding likely. Conclusions In Colombia, kidney stones mark a broader cardio-renal-metabolic phenotype. Routine care for stone formers should include blood pressure, glycemia, lipids, adiposity, and kidney-function assessment plus lifestyle counseling. Health systems may consider urolithiasis as a cardiovascular risk-enhancing factor. Longitudinal studies are needed to define causal pathways, risk trajectories, and cost-effective interventions.

BackgroundPatients with pancreatic ductal adenocarcinoma face a poor prognosis, with radical resection being the only potential cure. Because symptoms typically appear late, many patients are diagnosed with advanced disease. Locally advanced pancreatic tumours are characterised by extensive vascular involvement, which precludes R0 resection. Systemic therapy is therefore indicated, not only for palliation but also for reducing the risk of metastatic disease. Locoregional control remains paramount, irrespective of distant metastases as progressive tumours can cause considerable morbidity, negatively affecting patients’ quality of life. Previous studies investigating conventionally fractionated (chemo)radiotherapy have yielded mixed results, indicating opportunities for further research to optimise treatment outcomes. The TORPEDO study aims to prospectively assess whether adding stereotactic body radiation therapy (SBRT) to standard chemotherapy can improve outcomes in patients with initially inoperable, non-metastasized pancreatic ductal adenocarcinoma.MethodsThis study is a multicentre randomised phase II trial. While it primarily targets locally advanced lesions, patients with borderline resectable tumours who are either medically inoperable or decline surgery are also eligible. After twelve weeks of induction chemotherapy (modified FOLFIRINOX or gemcitabine/nab-paclitaxel), patients without development of distant metastases are randomised 1:1 to receive either continued chemotherapy alone (arm A) or one month of chemotherapy followed by SBRT (5 × 8 Gy) (arm B). Resectability is evaluated through a multidisciplinary tumour board. The primary endpoint is the 2-year progression-free survival. Secondary endpoints include overall survival, local progression-free survival, metastasis-free survival, objective response rate, resectability, R0 resection rates, surgical morbidity, toxicity, quality of life, and the impact of radiation doses on outcomes.DiscussionWe evaluate the efficacy and safety of SBRT following induction chemotherapy in patients with inoperable, non-metastasized pancreatic ductal adenocarcinoma. We hypothesize that adding SBRT enhances outcome by improving local control and increasing overall survival. Effective control of the pancreatic primary tumor may help reduce pain and thereby improve quality of life.Trial registrationThe ethics committee of the GZA Hospitals approved this study on April 8, 2024. It was registered on ClinicalTrials.gov (NCT06691425) on November 15, 2024.

Optimal treatment duration is unknown in metastatic renal cell carcinoma (mRCC) responding to immune checkpoint inhibitors (ICPIs). Prolonged treatment can lead to late toxicity, burden for day clinics and financial impact. This multicenter retrospective study included mRCC patients responding to ipilimumab/nivolumab in first-line or nivolumab in later lines, who were treated for at least 21 months and did not stop for toxicity. Progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were modeled non- and semi-parametrically. The effect of elective ICPI discontinuation (i.e. treatment interruption at the clinician's discretion) between 21 and 25 months on PFS was assessed by a causal inference approach using artificial censoring along with inverse probability of censoring weighting. Ninety-five patients were included with a median follow-up of 62.1 (95% confidence interval [CI]: 57.3-67.5) months. Fifty-four received ipilimumab/nivolumab, whereas 41 patients received nivolumab, for a median treatment duration of 33.8 (95% CI: 28.5-39.6) months. Fifty-seven patients discontinued ICPIs electively. Three-year PFS after discontinuation was 57.1% (95% CI: 34.3-95.1), 3-year OS 67.5% (95% CI: 37.0-100.0), and 3-year CSS 90.0% (95% CI: 73.2-100.0). Fifteen (15.8%) patients discontinued ICPIs between 21 and 25 months. Compared to 80 patients who were treated longer, they had more often a metachronous metastatic pattern (p=0.048) and a complete response (p=0.045). Elective ICPI stop between 21 and 25 months did not significantly impact the hazard for progression/death (adjusted HR 1.08, 95% CI: 0.64-1.84, p=0.766). Among mRCC patients responding to ICPI, elective therapy discontinuation approximately 24 months after initiation does not appear to compromise outcomes compared to continuing therapy.

Porto et al.'s systematic review and meta-analysis of transurethral resection of the prostate (TURP) outcomes across different regions reveals significant improvements in IPSS, Qmax, and postvoid residual (PVR) volume. However, the study is limited by high heterogeneity in PVR outcomes, with substantial variability in clot evacuation, irritative symptoms, and incontinence, suggesting inconsistencies in patient populations, methodologies, and surgical techniques. The study fails to address key confounders such as prostate size, age at surgery, and the use of antiplatelet or anticoagulant therapy, which could significantly influence TURP's outcomes. Additionally, the analysis overlooks the rise of newer treatment alternatives like endoscopic enucleation of the prostate (EEP), which offers better outcomes for high-risk patients. Despite presenting valuable data, the lack of standardization, the omission of emerging treatment options, and failure to consider clinical guidelines limit the generalizability and applicability of Porto et al.'s conclusions on TURP as the gold standard for benign prostatic obstruction.

In recent years, the overlay budget requirements have tightened significantly across various lithographic technologies. Both DUV multiple patterning and EUV lithography introduce unique alignment errors due to pattern shift. Traditionally, most overlay improvements have been achieved by hardware advancements. However, predicting on-device overlay using aberration fingerprints can provide valuable insights, as the projection optics module plays a key factor in determining the distortion of the overlay, in terms of pattern placement error control in lithography systems. In this paper, we demonstrate how computationally calculated overlay of the device pattern, using lens aberration fingerprints as an additional input, can be utilized to predict pattern shift and effects such as non-zero offset/overlay. This offset is a critical parameter in the field of semiconductor lithography, representing the residual misalignment between different layers of a semiconductor device after various processing steps. Non-zero offset acknowledges and quantifies the inevitable deviations that occur during manufacturing: such deviations can arise from multiple sources, including tool inaccuracies, process variations, and metrology. It is measured as the difference between on-target overlay after lithography vs. on-device measurement after etching. For enhanced process control required for the latest nodes, the objective is to characterize the non-zero offset, minimize its magnitude and variability, and identify potential excursions across tool fleet, layers, slit position and exposure conditions. This work focuses on characterizing non-zero offset through data collection and computational lithography. With the availability of wafer-fine aberration data, automating this process is feasible and detailed in this paper. Integrating such measurement into the overlay control loop allows for quantifying its benefits.