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In the era of immune checkpoint inhibitors for cancers, the need for prognostic biomarkers to identify patients most likely to achieve a durable response has become increasingly more relevant. Tumour‐infiltrating lymphocytes (TILs) have gained significant interest, as they can be evaluated using standard haematoxylin and eosin‐stained slides, making it a widely accessible and cost‐effective biomarker. In addition to their practicality, TILs provide prognostic insights into the interplay between the immune system and tumour cells. While the morphological assessment of TILs has been standardised in breast cancer, comprehensive guidelines for their evaluation in gastro‐oesophageal carcinomas (GEC) are still lacking. This narrative review examines the current literature on the composition, clinical implications and therapeutic utility of TILs in GEC. These insights are used to propose a framework with recommendations for standardised evaluation and reporting of TILs in GEC, while also highlighting pitfalls specific to GEC pathology. These recommendations serve as a vital first step towards the widespread use and validation of TILs as a biomarker.

Abstract Internal herniation (IH) is a common but potentially fatal complication (up to 10%) of gastric bypass which is often lately or misdiagnosed during pregnancy. While in non-pregnant bariatric patients, nausea, vomiting, and abdominal pain are red flags, these symptoms are frequently reported in normal pregnancies, therefore leading to serious treatment delays and possible life-threatening complications. Intestinal obstruction and volvulus can lead to necrosis and perforation within 8-16 hours. Previous reviews report higher risk of maternal (9%) and fetal (13.6%) death when diagnosis is delayed over 48 hours. The lack of clear clinical or laboratory findings and the reticence for radiologic imaging techniques during pregnancy delays diagnosis even more. If bowel necrosis is extended, bowel resection may be indicated, possibly leading to short bowel syndrome for life. Here, a rare case of short bowel syndrome is presented, requiring home parenteral nutrition (HPN) after extremely severe internal hernia at 39 weeks of pregnancy and several practical challenges encountered in the recognition and management of IH during pregnancy.

Abstract Background Rigorous donor preselection on microbiota level, strict anaerobic processing, and repeated FMT administration were hypothesized to improve FMT outcomes for induction of remission in UC in the RESTORE-UC trial, for which we here report on the clinical results and observed microbial changes. Methods The RESTORE-UC trial was a multi-centric double-blind, sham-controlled randomized trial. Patients with moderate to severe UC (total Mayo 4-10, endoscopic subscore ≥2) were randomly allocated to receive 4 weekly anaerobic-prepared allogenic or autologous donor FMT. Allogenic healthy donors were selected after a rigorous screening by microbial cell count, enterotype, and the abundance of specific genera. The primary endpoint was steroid-free clinical remission (total Mayo ≤2, no subscore >1) at week 8. A pre-planned futility analysis was performed after 66% (n=72) of intended inclusions (n=108). Quantitative microbiota profiling (n=44) was performed at weeks 0 and 8. Results In total, 72 patients were included of which 66 received at least one FMT (allogenic-FMT n=30 and autologous-FMT n=36, Fig. A). At week 8, resp. 3 and 5 patients reached the primary endpoint (p=0.72), indicating no treatment difference of at least 5% in favour of allogenic-FMT. Hence, the study was stopped due to futility. The procedure was well tolerated, and only 2 SAE were observed. Microbial analysis showed no significant differences in baseline microbiome composition between treatment groups. However, numerically more enterotype transitions upon allogenic-FMT compared to autologous-FMT (Fig. B), and more transitions were observed when patients were treated with a different enterotype than their own at baseline (p=0.01). Primary response was associated with lower total Mayo scores, lower bacterial cell counts (Fig. C,D) and a tendency to more Bact 2 prevalence at baseline, independently from FMT origin. At the allogenic donor side, a positive association was suggested between stool moisture and treatment success (Wilcoxon test, p=0.057; Fig. F). However, no indications pointed towards a highly effective ‘superdonor’ profile. Conclusion The RESTORE-UC trial comparing preselected allogenic to autologous FMT did not meet its primary endpoint of steroid-free clinical remission at week 8. Notably, participants exhibited more severe disease, aligning with recent guidelines recommending FMT for mild to moderate cases (Lopetuso & Deleu et al., 2023). In addition, our findings support adding microbial load and dysbiosis to the patient inclusion criteria based on a pre-treatment microbiome screening. Next to patient-selection, further research should additionally consider sterilized sham-control, increased frequency, density, and viability of FMT prior to administration.

Teaching point: Angioleiomyoma is defined on MR by a peripheral T1- and T2-hypointense rim, adjacent tortuous vascular structures, and a dark reticular sign.

ABSTRACT Introduction Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. Objectives The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. Methods A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. Results A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. Conclusion Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.

Journal Article Answer: Overthrowing the Harlequin Get access Simon De Ridder, Simon De Ridder Department of Intensive Care, University Hospitals Brussels, Laarbeeklaan 101, 1090 Jette, Belgium Search for other works by this author on: Oxford Academic Google Scholar Matthias Raes, Matthias Raes Department of Intensive Care, University Hospitals Brussels, Laarbeeklaan 101, 1090 Jette, BelgiumDepartment of Anesthesiology, University Hospitals Brussels, Laarbeeklaan 101, 1090 Jette, Belgium Search for other works by this author on: Oxford Academic Google Scholar Tim Balthazar Tim Balthazar Department of Intensive Care, University Hospitals Brussels, Laarbeeklaan 101, 1090 Jette, BelgiumCenter of Cardiovascular Diseases, University Hospitals Brussels, Laarbeeklaan 101, 1090 Jette, Belgium Corresponding author. Tel: +324763101, Fax: +324775179, Email: tim.balthazar@gmail.com https://orcid.org/0000-0003-2129-5891 Search for other works by this author on: Oxford Academic Google Scholar European Heart Journal. Acute Cardiovascular Care, Volume 12, Issue 5, May 2023, Page 354, https://doi.org/10.1093/ehjacc/zuad037 Published: 04 May 2023 Article history Editorial decision: 03 April 2023 Received: 03 April 2023 Accepted: 04 April 2023 Published: 04 May 2023