Düsseldorf University Hospital

Fenestrated aortic arch prostheses represent a robust therapeutic option for select pathologies. The Najuta is a semicustomized stent graft designed to achieve reliable sealing zones for the supra-aortic vessels through a variable number of fenestrations. A defining aspect of the procedure is the creation of a through-and-through wire (TATW), which is executed through a transaxillary approach via the fenestration of the brachiocephalic trunk. The omission of the catheter rendezvous technique for safe removal of the TATW, as described herein, may result in severe complications, including damage to the fabric or secondary dislocation of the stent graft, potentially leading to catastrophic outcomes such as aortic dissection or stroke. During implantation, the Najuta prosthesis is introduced using a 4-m soft Terumo wire configured in a transaxillary-transfemoral TATW arrangement. A loop is then formed around the aortic valve, facilitating the safe advancement of the prosthesis into the aortic arch. This loop configuration must be untied after implantation. If this is performed carelessly, excessive tension may be exerted on the medial edge of the brachiocephalic trunk fenestration, which may potentially lead to fabric damage or secondary dislocation of the entire prosthesis. To avoid this, catheters are inserted via both the transaxillary and transfemoral access points. These catheters meet at the loop area in a controlled "rendezvous" maneuver, enabling the safe removal of the TATW via the transaxillary access. The catheter rendezvous technique ensures the safe extraction of the loop TATW during the implantation of the Najuta prosthesis, thereby enhancing procedural safety and minimizing patient risk.

This study aimed to validate the German version of the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) measure by evaluating its psychometric properties. Our study was a prospective cohort study of German speaking AAV patients, recruited in the rheumatology outpatient clinics at the University Hospital Düsseldorf. The questionnaire includes 29 items across six domains, each rated from 0 to 4 points. Participants completed the AAV-PRO (German) at three time points. They also completed the EuroQol-5D-5L (EQ-5D-5L) and self-reported their vasculitis status. The Birmingham Vasculitis Activity Score version 3 (BVASv3) and Vasculitis Damage Index (VDI) were completed by the treating physicians. 70 AAV patients (48.5% female) participated. Overall, fatigue was the most prevalent symptom. Female AAV patients reported higher symptom burden across all domains and had a higher total score (Z=-2.55, p=0.011). The AAV-PRO (German) demonstrated good internal consistency in the domains "social and emotional impact", "concerns about the future" and "physical function" (Cronbach's alpha≥0.83). The domain "systemic symptoms severity" demonstrates acceptable to good consistency. The other domains demonstrated insufficient consistency. All domains showed high test-retest reliability (Pearson r≥0.8). BVASv3 and VDI showed limited correlations with the AAV-PRO (German) domains. Construct validity was supported by moderate to strong correlations with the EQ-5D-5L in five domains. Patients with self-reported active disease had statistically significantly higher mean scores than those with self-reported inactive disease in three domains. Our study supports the use of the AAV-PRO (German). However, two domains need to be interpreted carefully.

The complex spatial organization and deeply embedded position of the cerebral ventricular system present substantial difficulties for anatomic comprehension, particularly among neurosurgical trainees and residents. These challenges are most pronounced in understanding the supratentorial ventricular system's orientation and its projection to superficial cortical and cranial structures. To investigate how advanced three-dimensional (3D) anatomic reconstructions, using photogrammetry and virtual reality (VR) technologies, may offer an educational tool-providing interactive, high-fidelity visualization that enhances the understanding of the supratentorial ventricular system. Three brain specimens and one head specimen were used. Window craniotomies were performed to expose superficial brain anatomy in relation to cranial landmarks. Each brain was sequentially dissected to expose the anatomy of the lateral and third ventricles. The specimens were photogrammetrically scanned to generate photorealistic 3D models, which were subsequently imported into VR. A segmented ventricular system from an open-access database was fused with a photogrammetric whole brain and a model highlighting craniometric key points to better present the projection of the ventricles to superficial structures. Nine photogrammetric models were created, enabling visualization of the ventricular system in all 3 anatomic planes in relation to superficial cortical and skull landmarks. 3D interaction in VR allowed for better observation of the deep ventricular anatomy sequentially with their corresponding superficial brain structures. In addition, semitransparent renderings of craniometric landmark models, incorporating the segmented ventricle data, allowed for clear identification of their projections over the overlying cortical structures and VR simulation of ventricular entry trajectories. This study integrates traditional dissection techniques with 3D photogrammetry and VR to investigate the cortical projections of the supratentorial ventricular system and its related structures. These photorealistic anatomic models offer a novel, reproducible platform to enhance spatial understanding of the (peri-)ventricular anatomy, with direct implications for neurosurgical training.

Atrial tachycardias (AT) represent an increasingly common cause of morbidity and mortality. Driven by substantial advances in mapping and ablation technologies, the mechanistic understanding and therapeutic strategies for AT management have evolved rapidly in recent years, and catheter ablation is now regarded as the most effective strategy for maintaining sinus rhythm. Against this background, the recently published international clinical consensus statement on the management of patients with AT introduces, for the first time, astructured 10-point plan for "SMART-AT care" as aframework for the diagnosis and treatment of regular AT. This review highlights key developments and clinical implications, taking into account recent changes within the healthcare system.

Abstract Atypical social functioning is a core feature of autism, yet findings remain fragmented across components and development. We aimed to systematically integrate this literature and characterize the organization, development, and moderators of social functioning in autism. We conducted a systematic review and meta-analysis of behavioral studies published between January 1990 and August 2025, identified through PubMed, Web of Science, and prior reviews, including studies with clinically diagnosed autistic individuals and neurotypical controls. A qualitative synthesis and two complementary quantitative meta-analyses were performed, with risk of bias evaluated through study-level characteristics. A total of 2,622 studies (94,114 autistic and 172,847 neurotypical individuals across 32 countries) were included, covering 22 social components that clustered into five domains. Overall group differences were substantial (Hedges’ g = -0.744, 95% CI [-0.797, -0.690]). Differences emerged earliest in motivation-based processes (∼6 months), followed by motor, emotion, and inference domains, and showed age-related divergence alongside improvement in some skills. Cross-domain analyses revealed stronger interdependencies in autism and an organizational pattern most consistent with serial relationships among domains. These findings should be interpreted in light of methodological heterogeneity, underpowered samples, and uneven cultural representation. Together, the results provide an integrative framework for understanding the organization and development of social functioning in autism, with implications for precision subtyping, developmentally timed interventions, and neurodiversity-informed research and policy. This study was pre-registered (PROSPERO: CRD42024566141).

Abstract Motivation In prokaryotic genomes, methylation is an important epigenetic modification that regulates the uptake of foreign DNA; it can also contribute to replication or virulence. We present MPore, a novel method for the database-driven detection of active methyltransferases and their associated target site recognition motifs from Nanopore R10 sequencing data of prokaryotic isolates. In contrast to existing methods, which typically start with the de novo identification of differentially methylated sequence motifs, MPore starts by identifying potential methyltransferase genes by homology search against REBASE; activity is then assessed through a regularized logistic regression model of observed genome-wide methylation patterns, integrating motif and genomic sequence context information. Results On two benchmarking datasets 10 bacterial monocultures and two H. pylori genomes with complex methylation patterns, MPore achieved a combined recall of 93% and a combined PPV of 96%, outperforming Nanomotif (81%/91%), Modkit (66%/4%), and Snappy (89%/50%). Further validation on a well-characterized dataset of Mycoplasma hominis isolates showed perfect agreement with wet-lab-based validation results and demonstrated that MPore could complement REBASE information by disambiguating the specific methylated base in a motif with multiple potential methylation sites. MPore automatically produces integrated visualizations of the identified methyltransferases and observed methylation patterns; the tool is implemented as a user-friendly Snakemake pipeline. Availability MPore is freely available under the MIT license at https://github.com/DiltheyLab/MPore.