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- Enhancing Recurrence-Free Survival Prediction in Hepatocellular Carcinoma: A Time-Updated Model Incorporating Tumor Burden and AFP Dynamics.Publication . Akabane, Miho; Kawashima, Jun; Altaf, Abdullah; Woldesenbet, Selamawit; Cauchy, François; Aucejo, Federico; Popescu, Irinel; Kitago, Minoru; Martel, Guillaume; Ratti, Francesca; Aldrighetti, Luca; Poultsides, George A; Imaoka, Yuki; Ruzzenente, Andrea; Endo, Itaru; Gleisner, Ana; Pinto Marques, Hugo; Oliveira, Sara; Balaia, Jorge; Lam, Vincent; Hugh, Tom; Bhimani, Nazim; Shen, Feng; Pawlik, Timothy MBackground: Existing models to predict recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on static preoperative factors such as alpha-fetoprotein (AFP) and tumor burden score (TBS). These models overlook dynamic postoperative AFP changes, which may reflect evolving recurrence risk. We sought to develop a dynamic, real-time model integrating time-updated AFP values with TBS for improved recurrence prediction. Patients and methods: Patients undergoing curative-intent hepatectomy for HCC (2000-2023) were identified from an international, multi-institutional database with RFS as the primary outcome. AFP trajectory was monitored from preoperative to 6- and 12-month postoperative values, using time-varying Cox regression with AFP as a time-dependent covariate. The predictive accuracy of this time-updated model was compared with a static preoperative Cox model excluding postoperative AFP. Results: Among 1911 patients, AFP trajectories differed between recurrent and nonrecurrent cases. While preoperative AFP values were similar, recurrent cases exhibited higher AFP at 6 and 12 months. Multivariable analysis identified TBS (hazard ratio (HR):1.043 [95% confidence interval (CI): 1.002-1.086]; p = 0.039) and postoperative log AFP dynamics (HR:1.216 [CI 1.132-1.305]; p < 0.001) as predictors. Contour plots depicted TBS's influence decreasing over time, while postoperative AFP became more predictive. The time-varying Cox model was created to update RFS predictions continuously on the basis of the latest AFP values. The preoperative Cox model, developed with age, AFP, TBS, and albumin-bilirubin score, had a baseline C-index of 0.61 [0.59-0.63]. At 6 months, the time-varying model's C-index was 0.70 [0.67-0.73] versus 0.59 [0.56-0.61] for the static model; at 12 months, it was 0.70 [0.66-0.73] versus 0.56 [0.53-0.59]. The model was made available online ( https://nm49jf-miho-akabane.shinyapps.io/AFPHCC/ ). Conclusions: Incorporating postoperative AFP dynamics into RFS prediction after HCC resection enhanced prediction accuracy over time, as TBS's influence decreased. This adaptive, time-varying model provides refined RFS predictions throughout follow-up.
- Balloon Atrioseptostomy for Transposition of the Great Arteries in Europe: Characteristics and Outcomes.Publication . Lucron, Hugues; Malekzadeh-Milani, Sophie-Guiti; de Montclos, Thomas Perouse; Baruteau, Alban-Elouen; Mendoza Soto, Alberto; Butera, Gianfranco; Michel-Behnke, Ina; Ovaert, Caroline; Bautista-Rodriguez, Carles; Bentham, James; Jalal, Zakaria; Betrian Blasco, Pedro; Bouvaist, Hélène; Vincenti, Marie; Ferreira Matins, José Diego; Jellimann, Jean-Marc; Callegari, Alessia; Bonnemains, Laurent; Bonnefoy, Ronan; Castaldi, Biagio; Charbonneau, Anne; Dauphin, Claire; Lefort, Bruno; Schubert, Stephan; Brard, Mélanie; Domanski, Olivia; Denis, Charlotte; Wacker, Julie; Maragnes, Pascale; Karsenty, Clément; Loureiro, Petra; Jakob, André; Hascoët, Sébastien; Bonnet, DamienIntroduction and objectives: Balloon atrial septostomy (BAS) improves oxygenation in neonates with transposition of the great arteries (TGA) and restrictive foramen ovale. Currently, there is a global shortage of dedicated BAS catheters, while new unmarked catheters have recently become available at some European centers. This study aimed to characterize BAS outcomes using the currently available BAS catheters in Europe. Methods: A 2-year multicenter observational registry was conducted, including all neonates undergoing BAS for TGA. We report preliminary results (September 2022-February 2024) focusing on BAS characteristics and outcomes. Results: A total of 250 BAS procedures were performed in 29 centers. The median neonatal weight was 3.16kg, and 88% of neonates had a prenatal diagnosis. Most procedures were performed often on the first day of life during working hours (72.8%), mainly in catheterization laboratories (59.2%). Guidance primarily involved ultrasound with or without fluoroscopy. A guidewire was used in 41.2% of procedures. A total of 290 catheters (286 Z-5 or Z-6) were used, achieving an overall BAS success rate of 96%. Complete procedural failure was associated with the use of the umbilical venous route (OR, 3.62; P=.001) and lower-volume catheters (OR, 7.01; P<.001). The occurrence of significant complications (8%; OR, 9.33; P<.001) was associated with complete procedural failure. For complex procedures, significant risk factors were the absence of fluoroscopy (OR, 3.32; P=.001), use of the umbilical venous route (OR, 2.28; P=.005), and lower-volume catheters (OR, 2.43; P=.03). Conclusions: In the current era, BAS can be challenging, and significant complications and complete failures are not uncommon. The use of the umbilical venous route, low-volume BAS catheters, absence of fluoroscopy guidance, and the occurrence of complications negatively impact procedural outcomes.
- Lymphocyte-C-Reactive Protein Ratio: Impact on Prognosis of Patients Following Resection of Primary Liver Cancer.Publication . Altaf, Abdullah; Baldo, Andrea; Khalil, Mujtaba; Rashid, Zayed; Akabane, Miho; Zindani, Shahzaib; Sarfraz, Azza; Ruzzenente, Andrea; Aldrighetti, Luca; Bauer, Todd W; Pinto Marques, Hugo; Martel, Guillaume; Popescu, Irinel; Weiss, Mathew J; Kitago, Minoru; Poultsides, George; Maithel, Shishir K; Lam, Vincent; Hugh, Tom; Gleisner, Ana; Shen, Feng; Cauchy, François; Koerkamp, Bas G; Endo, Itaru; Pawlik, Timothy MObjective: We sought to characterize the prognostic value of lymphocyte-C-reactive protein ratio (LCR) among patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent curative-intent LR for HCC and ICC between 2000 and 2023 were identified from a multiinstitutional database. The prognostic value of nine different inflammatory markers were evaluated relative to short- (i.e., postoperative morbidity) and long-term (recurrence-free survival [RFS] and overall survival [OS]) outcomes. Results: Among 715 patients, 499 (69.8%) and 216 (30.2%) individuals were included in the derivation and validation cohorts, respectively. Patients with advanced disease and poor tumor biology had lower median levels of LCR. An optimal LCR cutoff threshold of 6100 was identified in the derivation cohort. LCR demonstrated the highest accuracy to predict RFS and OS, with areas under the ROC curve of 0.724 and 0.716, respectively. After adjusting for relevant clinicodemographic factors, lower LCR remained associated with higher odds of postoperative complications (OR: 1.98 [95% CI: 1.27-3.10] and p = 0.003) and particularly, infectious complications (OR: 2.80 [95% CI: 1.57-5.01] and p < 0.001). A lower LCR was independently associated with worse RFS (HR: 2.43 [95% CI: 1.41-3.83] and p = 0.002) and OS (HR: 2.95 [95% CI: 2.10-4.16] and p < 0.001). The prognostic ability of LCR for short- and long-term outcomes performed well in an independent validation cohort. Conclusion: LCR was strongly associated with risk of postoperative morbidity as well as worse RFS and OS among patients undergoing LR for HCC and ICC. Preoperative LCR assessment can aid surgeons in the preoperative risk-stratification of patients undergoing surgery for primary liver cancer.
- Multiple Sclerosis Relapse Incomplete Recovery and Associated Factors - a Systematic Review and Meta-Analysis.Publication . Ladeira, Filipa; Soares, Mafalda; Faustino, Patrícia; Leal Rato, Miguel; Gomes, Inês; Caetano, André; Taipa, Ricardo; Sá, Maria JoséObjectives: We conducted a meta-analysis to assess the frequency of incomplete recovery from multiple sclerosis (MS) relapses and a systematic review to evaluate the influence of six factors on incomplete recovery: relapse severity, age, sex, disease duration, disease-modifying treatment use, and the presence of contrast-enhancing lesions at relapse. Methods: We searched Scientific databases to identify suitable publications. Our outcome was MS relapse incomplete recovery, defined as a post-relapse EDSS measured at least 6 months after the event higher than the pre-relapse EDSS. We synthesized the rate of incomplete recovery using meta-analysis (random effect model). and summarized the effect estimates (or HR) for demographic and clinical factors. Results: We included 13 studies (with a total of 19,920 patients and 27672 relapses having at least six month of follow up) . The pooled rate of incomplete recovery was 0.42 (95 % confidence interval 0.31 to 0.54). The subgroup systematic review identified that relapse severity was the most consistent and strongest predictor of incomplete recovery, with odds ratios ranging from 2.4 to 17.2. Other factors were less consistently associated with relapse recovery. Conclusion: This systematic review indicates that relapse recovery is often incomplete, with relapse severity being the strongest and most consistent predictor of incomplete recovery.
- Pulmonary Endarterectomy's Blind Spot: Is Echocardiography the Answer?Publication . Timóteo, Ana Teresa; Galrinho, Ana
- Marantic Endocarditis in Malignancy: A Case Report of a Challenging Diagnosis.Publication . Ferreira, Inês; Fiúza M Rua, Inês; Ramos, Diogo; Cabaço, Sérgio; Valente, AndréMarantic endocarditis is a condition characterized by sterile vegetations in the heart valves, and is much rarer than infectious endocarditis. It's typically associated with conditions such as cancer or autoimmune diseases. We report the case of a patient with stage four lung cancer, presenting with fever after chemotherapy, and diagnosed with marantic endocarditis, after extensive testing to exclude an infectious agent. The patient's imaging techniques suggested infectious embolization to the liver and spleen, which supported the diagnostic hypothesis of infectious endocarditis, but the liver biopsy was positive for metastasis. Oncology was consulted for follow-up, and the patient was discharged on anticoagulation therapy, the standard treatment for marantic endocarditis. This case underscores the difficulty of diagnosing marantic endocarditis and the extensive testing required, considering its poor prognosis and the importance of treatment.
- Global Inequities in Diabetes Technology and Insulin Access and Glycemic Outcomes.Publication . Santova, Alzbeta; de Bock, Martin; Lanzinger, Stefanie; Goldbloom, Ellen B; Bratina, Natasa; Barcala, Consuelo; Alhomaidah, Doha; Pande, Arunkumar R; Guness, Pravesh Kumar; Dzivite-Krisane, Iveta; Limbert, Catarina; Sumnik, ZdenekImportance: Advanced diabetes technologies such as continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (insulin pumps [CSII]), and glucometers alongside insulin access represent the criterion standard for managing type 1 diabetes (T1D) in children. Global disparities in their access and reimbursement may be associated with glycemic outcomes. Objective: To describe how accessibility and reimbursement of advanced diabetes technologies and insulin are associated with glycated hemoglobin (HbA1c) levels in centers participating in the SWEET initiative, an international pediatric diabetes registry. Design, setting, and participants: This global multicenter cross-sectional study collected data from 81 centers in 56 countries. Web-based questionnaires were distributed to representatives of all 121 pediatric diabetes centers participating in the SWEET initiative from March 1 to May 31, 2024, and used to map accessibility of and reimbursement for CGM, CSII, glucometers, and insulin. Reimbursement data were compared with HbA1c levels using the SWEET Study dataset. Participants included 42 349 children with T1D. Exposures: Responses were categorized into 4 groups based on the extent of reimbursement for diabetes technologies and insulin. Main outcomes and measures: Mean HbA1c levels across centers calculated from measurements current as of December 31, 2023, analyzed by categories of accessibility of and reimbursement for diabetes technologies and insulin. Results: Data collected from 81 of 121 SWEET centers (67%) across 56 countries included HbA1c levels from 42 349 children with T1D (22 021 male [52%]; mean [SD] age, 14.3 [4.4] years; mean [SD] diabetes duration, 6.0 [4.2] years). Universal access with complete reimbursement for all technologies and insulin was reported by 32 centers from 19 countries, while 8 countries reported no reimbursement for any technologies or insulin. Centers with full reimbursement for CSII, CGM, glucometers, and insulin showed mean HbA1c levels of 7.62% (95% CI, 7.59%-7.64%) to 7.75% (95% CI, 7.73%-7.77%) compared with 9.65% (95% CI, 9.55%-9.71%) to 10.49% (95% CI, 10.40%-10.58%) in centers with no reimbursement and/or no availability (P < .001 for all items). Conclusions and relevance: This cross-sectional study found that HbA1c levels were associated with the accessibility of modern diabetes technologies and insulin. Efforts to ensure universal accessibility are required to reduce global inequities and glycemic outcomes for children with T1D..
- Unveiling the Dark Side of Negative Behaviors Among Nurses and Their Implications in Workforce Well-Being and Patient Care: A Scoping Review.Publication . Santos, Nuno; Barahona, Rita; Cruchinho, Paulo; Nunes, ElisabeteIntroduction: Negative behaviors in nursing undermine well-being, erode team cohesion, and jeopardize patient safety. Rooted in systemic stressors-workload, emotional strain, and power imbalances-they have far-reaching effects on job satisfaction and care quality. Objective: To systematically map the scientific evidence on negative behaviors among nurses in healthcare organizations. Methods: A scoping review was conducted using five databases: CINAHL, MEDLINE, Scopus, Psychology & Behavioral Sciences Collection, and RCAAP (for grey literature). The review followed the Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines. Two independent reviewers conducted data extraction and synthesis. Results: Eighteen studies published between 2017 and 2024 met inclusion criteria from an initial pool of 88 references. Eleven thematic domains emerged: (1) the cycle of violence; (2) victims profile; (3) perpetrator profile; (4) negative behaviors spectrum; (5) negative behaviors prevalence; (6) risk predictors; (7) protective predictors; (8) impact of negative behaviors on nurses; (9) impact of negative behaviors on patients; (10) impact of negative behaviors on healthcare organizations; (11) organizational strategies and the role of the nurse managers. Conclusions: The findings highlight the multidimensional nature of negative behaviors and the variability in how they are defined and assessed. This review highlights the need for conceptual clarity and standardized tools to address negative behaviors in nursing. Nurse managers, as key organizational agents, play a critical role in fostering psychological safety, promoting ethical leadership, and ensuring accountability. System-level strategies that align leadership with organizational values are essential to protect workforce well-being and safeguard patient care.