St.-Johannes-Hospital Dortmund

PurposeTo assess the association of systemic immune-inflammation biomarkers (SIIBs) and other clinical parameters with objective response rate (ORR), progression-free survival (PFS), overall survival (OS), disease-specific survival (DSS), and immune-related adverse events (irAEs) in patients with advanced cSCC treated with cemiplimab, and to compare baseline SIIBs levels between early-stage and advanced-stage disease.MethodsA retrospective multicenter cohort of 110 immunocompetent advanced cSCC patients treated with cemiplimab was analysed. ORR was assessed using logistic regression; PFS and OS were evaluated using Cox models, and DSS using cause-specific hazards. ROC analyses assessed biomarker discrimination. Baseline SIIBs (LMR, NLR, SIRI) were compared between early-stage (AJCC I/II, non-ICI cohort, n = 59) and advanced-stage disease. Tumor characteristics, body mass index (BMI), and Charlson comorbidity index were evaluated.ResultsAmong 110 patients, 79 (71.8%) achieved an objective response. Baseline LMR showed modest discrimination for ORR (AUC 0.64, 95% CI 0.53–0.75; p = 0.015) but did not retain statistical significance after adjustment for baseline clinical covariates (OR 1.35, 95% CI 0.95–1.91; p = 0.096). Higher BMI was associated with improved PFS (HR 0.94 per kg/m2, 95% CI 0.89–1.00; p = 0.035) and showed a borderline association with OS (HR 0.92 per kg/m2, 95% CI 0.85–1.00; p = 0.051). AJCC stage IV strongly predicted DSS (HR 14.03, 95% CI 1.80–109.67; p = 0.012). Baseline LMR was higher in early-stage than in advanced-stage disease (Hodges-Lehmann difference 0.43; p = 0.011), whereas NLR did not differ significantly between stage groups; SIRI was modestly higher in advanced-stage disease (p = 0.029).ConclusionsIn immunocompetent patients with advanced cSCC receiving PD-1 inhibition, BMI was prognostic for survival and AJCC stage remained the key driver of cSCC-specific mortality. Baseline LMR showed a modest association with response and differed between early- and advanced-stage disease, whereas other SIIBs were not consistently linked to tumor progression. Prospective validation is warranted.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00432-026-06423-x.

There is a paucity of data regarding the longer-term durability of transcatheter heart valves. This analysis aimed to describe the 5-year clinical outcomes and valve durability for patients treated with the Portico transcatheter heart valves across 3 studies harmonized in their prospective enrollment, inclusion/exclusion criteria, centralized independent core laboratory echocardiographic analysis, and independent clinical events committee adjudication. Patient-level data from the PORTICO IDE randomized controlled trial, the PORTICO I postmarket study, and the PORTICO continued access protocol were pooled using a random-effects meta-analysis model. All 3 studies collected follow-up data at discharge, 30 days, and annually through 5 years. Adverse events and pooled echocardiographic data were assessed using Valve Academic Research Consortium-2 definitions. Durability definitions were adapted from Valve Academic Research Consortium-3 and European Association of Percutaneous Cardiovascular Interventions/European Society of Cardiology/European Association for Cardio-Thoracic Surgery consensus guidelines. A total of 1464 patients with severe symptomatic aortic stenosis and high or extreme surgical risk were included. Median age was 83 years, 61.7% were women, and the median Society of Thoracic Surgeons score was 4.9%. At 5 years, all-cause mortality and stroke rates were 49.4% and 12.3%, respectively. Transvalvular gradient and effective orifice area at 5 years were 6.2 mm Hg and 1.83 cm2, respectively, with paravalvular leak ≥moderate severity occurring in 1.9%. The 5-year bioprosthetic valve failure rate was 2.7%, including a 0.7% valve-related death rate and a 2.0% valve reintervention rate, but no patients with severe hemodynamic structural valve deterioration. Moderate hemodynamic structural valve deterioration occurred in 0.9% of the patients at 5 years. Hemodynamic performance and transcatheter heart valve durability remained stable irrespective of annular size. The use of the Portico transcatheter heart valve system in patients at high or extreme surgical risk demonstrated favorable clinical outcomes and hemodynamic performance with low transvalvular gradients and greater than mild paravalvular leak. Furthermore, bioprosthetic valve failure rates were low with no incidence of severe hemodynamic structural valve deterioration at 5 years, irrespective of annular size. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02000115 and NCT01802788.

ABSTRACT Purpose To provide insights into the presentation and management of uveitis in children, enhancing understanding and improving treatment strategies. Methods A retrospective evaluation of medical records was conducted to gather data on children diagnosed with uveitis in Uveitis Department of a tertiary care hospital in Turkey. Results The study included 153 children with uveitis, of which 84 (54.9%) were female and 69 (45.1%) were male. The mean age was 10.17 ± 4.14 years (2–16 years). The mean follow-up period was 32.04 ± 17.47 months (12–72 months). Eighty-eight children (57.5%) had anterior uveitis, 32 (20.9%) had intermediate uveitis, 2 (1.3%) had posterior uveitis, and 31 (20.3%) had panuveitis. The most common diagnosis was juvenile idiopathic arthritis (JIA)-associated uveitis, which occurred in 59 children (38.5%). Out of 260 eyes assessed, 25.7% (67/260) had at least one ocular complication at presentation. Of the 145 children with noninfectious uveitis, methotrexate (MTX) was prescribed to 131 (90.3%), azathioprine (AZA) to 35 (24.1%), mycophenolate mofetil (MMF) to 6 (4.1%), cyclosporine (CSA) to 5 (3.4%), adalimumab (ADA) to 87 (60%), and infliximab (IFX) to 26 (17.9%). At the end of follow-up BCVA was found to be significantly improved in all anatomic localizations (p < 0.05). Conclusion In our study, the collaboration between our clinic and the pediatric rheumatology referral center may have contributed to the higher number of JIA uveitis and different results. Early and aggressive treatment strategies are important in early and long-term control of ocular inflammation thus resulting in better visual prognosis in pediatric uveitis.

ObjectivesData from the German Aortic Valve Registry (GARY) were analysed to determine whether there are differences between patients with and without chronic lung disease (CLD) undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) and whether TAVI or SAVR is more beneficial in patients with preexisting CLD.MethodsFollow-up data from GARY registry patients treated from 2014 to 2015 and from 2018 to 2019 were incorporated in the analysis. Demographic results for each of the 2 treatment modalities were evaluated, and patients with and without CLD were compared. In a second step, variables that would have influenced the treatment decision in CLD patients in direction of either SAVR or TAVI were accounted for in the adjusted analysis. This led to a subgroup of 1385 patients with CLD that was subjected to propensity score weighted analysis to compare outcomes of TAVI and SAVR.ResultsAfter exclusion, 11 457 SAVR patients and 2378 TAVI patients were analysed. CLD patients were sicker than patients without CLD, although the observed 30-day mortality was lower than expected by 3 risk scores. Accordingly, long-term survival in CLD patients was lower in both treatment groups than in patients without CLD. Thirty-day mortality was similar in the 2 treatment groups (SAVR 2.3%, TAVI 3.8%, P = .964) in spite of a possible selection bias in favour of SAVR. During a 5-year follow-up, survival after TAVI (44.6%) was significantly lower than after SAVR (56.7%), P = .029.ConclusionsPatients with CLD undergoing SAVR or TAVI are generally at higher risk for complications or death after the procedure than patients without CLD. After 5 years, patient-reported outcomes were similar in TAVI and in SAVR patients.

The occurrence and clinical impact of transcatheter heart valve midframe underexpansion following transcatheter aortic valve replacement are not well understood. The aim of this study was to evaluate midframe underexpansion among patients treated with the self-expanding ACURATE neo2 device. This retrospective analysis included 604 patients (median age 82 years; Q1-Q3: 78-85 years; 61.4% women) from 2 European high-volume centers. Midframe underexpansion was assessed on postimplantation fluoroscopic images and defined as nonparallelism of commissure posts. The primary endpoint was a composite of all-cause mortality, stroke, or rehospitalization at 1 year. Midframe underexpansion was identified in 13.9% of patients (84 of 604) and was associated with higher rates of the primary endpoint (33 of 84 [39.3%; 95%CI: 28.8%-50.5%] vs 54 of 520 [10.4%; 95%CI: 7.9%-13.3%]; P<0.001) and each of its components. Furthermore, midframe underexpansion was independently associated with 1-year all-cause mortality (adjusted HR: 4.07; 95%CI: 2.26-7.33; P< 0.001). The only independent predictor of midframe underexpansion was the absence of postdilatation (adjusted OR: 5.76; 95%CI: 2.60-12.77; P< 0.001). Postdilatation significantly decreased the rate and extent of midframe underexpansion. In this European cohort of ACURATE neo2 recipients, midframe underexpansion occurred in a minor proportion and was associated with poorer clinical outcomes through 1 year. Postdilatation effectively reduced the rate and extent of midframe underexpansion.

The parallel wire technique (PW) is a classic part of the antegrade strategy to open chronic total coronary occlusions (CTO). With modern wires and dual-lumen catheters (DLC) the approach has evolved, but this progress had not been evaluated in a contemporary registry of CTO interventions. This analysis is based on 26,589 CTO procedures performed by 36 operators with > 50 procedures annually between 2015 and 2022. The different strategies and techniques were analyzed with respect to clinical and lesion characteristics, procedural resource use and periprocedural complications. Within the antegrade approach, PW was compared to antegrade wire escalation (AWE) and antegrade-dissection re-entry (ADR). The primary antegrade approach was used in 65.9%, primary retrograde in 16.9% and a strategy change in 17.2% with a wide inter-operator variability. In primary antegrade approach, PW was applied in 10.8% and ADR in 5.3%. Lesion complexity was higher in AWE and PW than with single wire, and highest in ADR procedures, leading to more complex procedures with higher contrast and radiation usage. Complications increased with ADR, while they were similar with PW and AWE. Through the observation period PW adoption increased steadily from 6.7% to 10.7%, as the DLC use facilitating PW increased from 8.3% to 17.0% over the observation period. In this largest database of contemporary CTO PCI from Europe, PW adoption increased over time but remained low at about 10%. While there was a wide individual variety among the operators, it was a safe and successful technique.

Diabetic patients with coronary artery disease may benefit from elective coronary artery bypass graft (CABG) surgery. It is unknown whether this merit is transferable to patients with acute myocardial infarction (AMI) undergoing surgery. A total of 1,427 patients underwent CABG within 48 hours of being diagnosed with AMI at the current institution between 2001 and 2019. Of these patients, 206 (14.4%) had insulin-dependent diabetes mellitus (IDDM) and 148 (10.4%) had non-insulin dependent diabetes mellitus (NIDDM). Retrospective data analysis was performed. Patients with NIDDM showed the highest perioperative risk profile, with a EuroScore II of 11.6 (±10.3) compared with 7.8 (±8.0) in non-diabetic patients and 8.4 (±7.8) in patients with IDDM (p<0.001). Sub-analysis demonstrated a higher proportion of non-ST-elevation myocardial infarction patients in the NIDDM cohort compared with the IDDM cohort (70.9% vs 56.8%; p=0.005). Postoperatively, NIDDM patients had more sepsis (p<0.01) and longer ventilation times (p<0.001) compared with non-DM and IDDM patients (p<0.01). Wound healing complications were rare, but almost twice as high in NIDDM patients compared with non-DM and IDDM patients (4.7% vs 0.9% vs 2.4%, respectively). The 30-day mortality was highest in the NIDDM cohort (18.3% vs 11.3% vs 7.8%; p=0.012). Analysis of survival for up to 15 years revealed a significantly reduced survival of diabetic patients compared with non-diabetic patients, with lowest survival rates in NIDDM patients (p<0.001). Non-insulin dependent diabetes mellitus patients undergoing CABG within 48 hours of being diagnosed with AMI are at increased risk of short-term and long-term complications. Therefore, this particular group should undergo a careful evaluation concerning the expected risks and benefits of CABG in this setting.