AZ Sint-Jan

CHRONOS is a multicenter, retrospective, cohort study involving acute graft-versus-host disease (aGvHD) adult patients with gastrointestinal (GI) symptoms, steroid- and ruxolitinib refractory, who initiated third-line therapy between 30 May 2019 and 30 September 2024. Primary endpoints were all-organ overall response rate (ORR) and GI-specific ORR (GI-ORR) around 28 days after treatment initiation. Secondary endpoints included duration of response, real-world progression-free survival (rwPFS) of underlying malignancy, and overall survival (OS). Fifty-nine patients from 16 sites in Europe were included. On Day 28, ORR was 36% (95% CI: 24-49%), GI-ORR was 37% (95% CI: 25-51%); 29% (95% CI: 11-49%) of responders lost response within 30 days, and 52% (95% CI: 29-72%) within 90 days. Median rwPFS and median OS were both 86 days (95% CI: 54-128 days). Median OS was higher in responders than in non-responders (186 versus 45 days). Over the 12-month follow-up period, 41 patients died, mainly due to aGvHD progression (n = 25), and infectious complications (n = 9). Within 3 months, Grade ≥ 2 infectious events occurred in 51% of patients; Grade 3-4 thrombocytopenia and neutropenia in 64% and 32%, respectively. These findings demonstrate limited effectiveness of third-line therapy in this cohort of steroid- and ruxolitinib-refractory aGvHD patients with GI symptoms.

To evaluate the feasibility, radiological accuracy, and early clinical outcomes of robotic-assisted conversion of partial knee arthroplasty (PKA) to total knee arthroplasty (TKA) using the ROSA system. Feasibility was defined as successful robotic registration and completion of the procedure using standard primary components without femoral components or augments. A retrospective cohort of 23 consecutive conversions (medial or lateral unicompartmental and patellofemoral arthroplasties) was analyzed. The minimum follow-up was 12 months. Clinical outcomes were assessed with the Oxford Knee Score (OKS), visual analogue scale (VAS) for pain, and patient satisfaction. Radiological accuracy was evaluated by comparing planned with achieved component alignment (medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and hip-knee-ankle (HKA)) using paired t-tests, two one-sided tests for equivalence (SD 1.5°), and Bland-Altman analysis. All cases were successfully registered with the robot and completed without femoral components or augments; 22 of 23 used standard primary components. The mean OKS improved from 17.2 (SD 5.5) to 40.0 (SD 5.0) and VAS pain decreased from 6.7 (SD 1.5) to 1.6 (SD 1.6) (p < 0.001). The mean absolute error between planned and achieved alignment was 0.8° for MPTA and 0.3° for LDFA, confirming accurate restoration, while HKA showed greater variability (mean bias 1.37°; limits -4.1° to 6.9°). One secondary patellar resurfacing was required; no other complications occurred. Robotic-assisted conversion of PKA to TKA was feasible, bone-preserving, and resulted in significant clinical improvement at 12 months, with precise component alignment but slightly more variation in overall mechanical axis restoration.

The evolution of publishing has moved from print to digital formats and now to continuous publication. For the Oncology Nursing Forum (Forum), this means that, except for this print issue to coincide with Oncology Nursing Soc.

The purpose of this study was to ascertain how long raw chicken meat and beef meat kept at 4°C in a typical home refrigerator would last. Researchers from Chattogram Veterinary and Animal Sciences University performed an extensive examination over five days, assessing 10 meat samples (five chicken meat and five beef meat) obtained from local markets in Chattogram (Jhawtola, Bahaddar Hat, and Chawk Bazar). The quality assessment encompassed physico-chemical, microbiological, and sensory criteria, including pH, water holding capacity (WHC), extract release volume (ERV), protein degradation (tyrosine value), fat oxidation (TBARS), total viable microbial count (TVC), and aroma. Significant data indicated a gradual deterioration in quality for both types of meat. Sensory evaluation indicated a significant escalation in offodours, becoming especially evident by the fifth day. Physicochemical research revealed a steady decrease in pH for chicken, whereas beef pH exhibited greater variability. The water-holding capacity was minimal for both meats on the penultimate day. Moreover, elevated tyrosine and TBARS levels indicated continuous breakdown of proteins and lipids, respectively. Microbiologically, beef had a greater overall viable count compared to chicken. The study revealed that whereas beef demonstrated a more rapid decomposition rate, both meats underwent considerable quality degradation by the fifth day of refrigerated storage. These findings point out the importance of appropriate raw meat handling and timely storage techniques for preserving domestic food safety and quality.

Quantitative neuromuscular monitoring (NMM) is widely recommended, yet its clinical adoption remains limited, partly due to usability issues. This study aimed to compare the clinical performance of two electromyography (EMG)-based NMM devices—the Datex-Ohmeda E-NMT module and the Stimpod NMS450X—under real-world operating room conditions. Twenty-four adult patients undergoing elective non-cardiac surgery were monitored simultaneously with both devices, applied contralaterally. Train-of-four (TOF) counts and TOF ratios were recorded at one-minute intervals. Agreement between devices was assessed using Bland–Altman analysis, repeatability coefficients, and the concordance correlation coefficient (CCC). The Datex-Ohmeda recorded an average of 121 TOF-count and 71 TOF-ratio values per patient, compared with 56 and 39, respectively, for the Stimpod. Inter-device correspondence was low, with numerous missing or physiologically implausible values on the Stimpod stream. The repeatability coefficient was 0.81 (95% CI: 0.80–0.83), indicating poor precision. The CCC was 0.662, consistent with weak agreement. In routine clinical use, the Stimpod NMS450X and Datex-Ohmeda E-NMT demonstrated poor concordance and high variability, likelyinfluenced by device-specific artifacts, connectivity limitations and electrode sensitivity.These findings highlight the need for device-specific validation of EMG NMM, both for clinical practice and for research purposes.

Voriconazole (VRC), a triazole antifungal agent, is recommended as primary treatment for invasive aspergillosis. Due to its unpredictable dose-exposure relationship, therapeutic drug monitoring (TDM) is recommended. Despite TDM, the probability of achieving therapeutic targets is only approximately 50%. This highlights the need for new dosing strategies. Calculating the metabolic ratio (MR) of NOX, the principal N-oxide metabolite of voriconazole primarily formed by the genetically polymorphic CYP2C19 enzyme, to VRC concentrations could serve as a surrogate for phenotype information. This is particularly relevant since the CYP2C19 genotype is often unavailable in acute clinical settings. Moreover, genotype may be less informative during inflammation due to a phenomenon known as 'phenoconversion', where inflammation masks genotype effects through downregulation of CYP450 enzymes. However, before integrating NOX in population PK models and/or as an adjunct in voriconazole TDM flowcharts, it is important to understand the factors impacting NOX exposure, and hence the MR. The objective of this narrative review is therefore to summarise recent literature on patient- and drug-related covariates impacting NOX exposure. A comprehensive search was conducted in PubMed and Embase for articles published from 2003 to 2025 focusing on factors impacting NOX or the MR. Twenty-one articles were included, predominantly involving adult patients from an Asian or white ethnicity. Studies were mainly set up as pharmacokinetic (PK) studies, in which associations between NOX or MR were assessed in uni- or multivariate analyses. Key covariates identified were as follows: (1) voriconazole dose (6/11 studies)-higher doses increasing NOX, although this relationship was complicated by saturated metabolism; (2) C-reactive protein (CRP) (8/9)-higher inflammation levels correlated with reduced metabolic capacity due to CYP450 enzyme downregulation; (3) age (7/12)-children exhibited higher MR, probably driven by higher clearance due to increased CYP2C19 and FMO3 expression, while older adults (> 60 years) showed decreased MR due to a decline in CYP2C19 activity; (4) CYP2C19 genotype (10/13)-poor metabolizers had lower MR and lower NOX, supporting the utility of genotyping, if available with acceptable turnaround time. A CRP threshold of 100 mg/L has been found in some studies and may serve as a crucial indicator for clinicians in optimising dosage adjustments. Although hepatic impairment is recognised as a significant covariate for voriconazole, its influence on NOX or the MR was found limited in this review. This is likely due to the exclusion of patients with hepatic impairment from most studies, which resulted in lower interindividual variation in liver function test results. While renal function does not affect voriconazole exposure, it may impact NOX or MR, as some studies suggest a higher renal clearance of NOX compared to voriconazole. However, only one of the included studies suggested that impaired renal function resulted in a higher MR, indicating NOX accumulation. Further research is however needed. VRC dose, CRP, age and CYP2C19 genotype are the primary covariates affecting NOX or MR, and renal and liver function should also be considered in future population pharmacokinetic models and TDM protocols.

Introduction: Since the first description of Turner syndrome (TS), both genotypic spectrum and phenotypic presentation have evolved. This study aimed to examine trends in this evolution over the past three decades and provides an overview of current genetic and clinical features in a large nationwide multicenter cohort of girls with TS. Methods: We analyzed data from growth hormone (GH)-treated girls with TS included in BELGROW, the national GH registry of the BELux Society for Pediatric Endocrinology and Diabetology, between 1985 and 2022. Karyotype, age at diagnosis, and phenotype were studied in 716 girls. Two periods were compared: 1991–2002 (group 1, n = 250) and 2003–2017 (group 2, n = 270). Results: The annual number of girls with TS starting GH remained stable (mean n = 19/year). In the entire cohort, monosomy 45,X was the most frequent karyotype (44%), followed by structural anomalies of the X chromosome (27%), 45,X/46,XX mosaicism (13%), triple X mosaicism (4%), 45,X/46,XY or complex Y anomalies (6%), and others (6%). The proportion of 45,X decreased between the two periods (46%–38%, p < 0.05). Overall, median age at diagnosis was 6.4 years with 7.6% of girls diagnosed prenatally, 24% before age 1, 49% in childhood, and 19% after 12 years. Prenatal diagnoses increased from 2.5% (group 1) to 15% (group 2) (p < 0.001). Girls with a 45,X karyotype were diagnosed earlier than girls with other genotypes (median 2.2 vs. 8 years, p < 0.001). Skeletal (73%), neurosensory (60%), and cardiac (29%) systems were most affected. Skeletal and cardiac malformations were more frequent in girls with a 45,X karyotype (p < 0.05 and p < 0.01, respectively). Conclusion: Genotype distribution and timing of TS diagnosis have significantly changed since 1991, while the annual number of girls starting GH therapy has remained stable. A 45,X karyotype is associated with earlier diagnosis and more comorbidities.

Current guidelines recommend complete removal of a cardiac implantable electronic device (CIED) in infective endocarditis (IE), with surgical extraction indicated for large vegetations (>20-25mm). We report a 68-year-old patient with CIED-related IE and a 3×3.5cm lead vegetation successfully treated by percutaneous mechanical aspiration (PMA) using the FlowTriever system, followed by transvenous lead extraction (TLE). The combined approach achieved complete removal without complications or recurrence. This case highlights PMA as a feasible, less invasive alternative to surgery in selected high-risk patients, enabling safe TLE by reducing vegetation size and embolic risk.