BACKGROUND: Patients with systemic right ventricle (SRV), either d-transposition of the great arteries following an atrial switch procedure or congenitally corrected transposition of the great arteries, develop severe right ventricular dysfunction, prompting appropriate medical therapy. However, the efficacy of beta-blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in SRV patients is unproven. OBJECTIVES: The objective of this study was to determine the effects of ACEI/ARB and beta-blockers on outcomes in SRV patients after accounting for likely cofounders affecting their use. METHODS: From a retrospective, multicenter study on heart failure-related outcome in individuals with SRV, those who were taking an ACEI/ARB, beta-blocker, or both of these medication were identified. We performed a propensity analysis to match them to those not using these medications at their initial visit. Matching was based on a propensity score, which captured co-morbidities, demographics, and baseline echocardiographic parameters. Primary outcome of death, transplant, or mechanical circulatory support, and secondary outcomes of heart failure hospitalizations/atrial arrhythmias were analyzed respectively. RESULTS: We identified 393 patients taking ACEI/ARB or beta-blocker, or taking both a beta-blocker and ACEI/ARB (62.1% male, median age 31.3 years) and 484 patients (56.4% male, median age of 26.0 years) who were neither on a beta-blocker nor on ACEI/ARB at the time of initial clinic visit. Median follow-up was ∼8 years. After propensity matching, medication use was not associated with decreased mortality, heart failure hospitalizations, or arrhythmias. Hazard ratios remained positive for beta blockers, implying potential harm rather than benefit. CONCLUSIONS: In this large multicenter propensity-matched observational study, patients with SRV taking beta-blockers or ACEI/ARB did not have a benefit in survival or reduced hospitalization. The likelihood of demonstrating favorable effects in larger studies appears remote.

• Publication type
• Journal Article MeSH

BACKGROUND CONTEXT: Spondylodiscitis management presents significant clinical challenges, particularly in critically ill patients, where the risks and benefits of surgical intervention must be carefully balanced. The optimal timing of surgery in this context remains a subject of debate. PURPOSE: This study aims to evaluate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo pyogenic spondylodiscitis. STUDY DESIGN/SETTING: This is an international, multicenter retrospective cohort study involving 24 centers, primarily in Europe. PATIENT SAMPLE: The study included 192 critically ill patients (65.63% male) with a median age of 69 years, all severely affected by pyogenic spondylodiscitis characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. OUTCOME MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included length of ICU stay, length of hospital stay, and relapse rates of spondylodiscitis. METHODS: Patients were divided into three groups: early surgery (within three days of admission), delayed surgery (after three days of admission), and conservative therapy. Propensity score matching and multivariate regression analyses were performed to adjust for baseline differences and assess the impact of treatment modalities on mortality and other clinical outcomes. RESULTS: Delayed surgery was associated with significantly lower 30-day mortality (4.05%) compared to early surgery (27.85%) and conservative therapy (27.78%) (p<.001). Delayed surgery also resulted in shorter hospital stays (42.76 days) compared to conservative therapy (55.53 days) and early surgery (26.33 days) (p<.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days postadmission (p=.02). Risk factors for increased mortality included age (p<.05), multiple organ failure (p<.05), and vertebral body destruction (p<.05), whereas delayed surgery (p<.05) and the presence of an epidural abscess were associated with reduced mortality (p<.05). CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days postadmission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.

• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Length of Stay MeSH
• Discitis * therapy   mortality   surgery   microbiology   MeSH
• Conservative Treatment MeSH
• Critical Illness MeSH
• Middle Aged MeSH
• Humans MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

INTRODUCTION: Left ventricular assist device (LVAD) therapy may lead to an aortic regurgitation, limiting left ventricular unloading and causing adverse events. Whether concomitant aortic valve replacement may improve outcomes in patients with preoperative mild-to-moderate aortic regurgitation remains unclear. METHODS: A retrospective propensity score-matched analysis of adult patients with preoperative mild-to-moderate aortic regurgitation undergoing durable LVAD implantation between 01/01/2011 and 30/11/2021 was performed. Patients undergoing concomitant valve surgery other than biological aortic valve replacement were excluded, resulting in 77 with concomitant biological aortic valve replacement and 385 without. RESULTS: Following 1:1 propensity score matching, two groups of 55 patients with and without biological aortic valve replacement were obtained, (mean age 59 ± 11 years, 92% male, 59.1% HeartWare). Aortic regurgitation was mild in 72.7% and 76.4% and moderate in 27.3% and 23.6% in non-replacement and replacement cohorts respectively. The 30-day survival was 89.1% vs. 85.5% (p = 0.59), 1-year survival 69.1% vs. 56.4% (p = 0.19), and 2-year survival 61.8% vs. 47.3% (p = 0.10) in the non-replacement and replacement groups, respectively. After a mean follow-up of 1.2 years, non-replacement patients had a higher incidence of pump thrombosis (11 [20%] vs. 3 [5.5%], p = 0.022) and fewer major bleedings (2 [3.6%] vs. 11 [20%], p = 0.008). CONCLUSION: Compared with those treated conservatively, patients with mild-to-moderate aortic regurgitation undergoing concomitant aortic valve replacement during LVAD implantation have a similar survival up to 2 years on support. Patients with concomitant valve replacement had a higher risk of bleeding complications but fewer pump thromboses.

• MeSH
• Aortic Valve * surgery   MeSH
• Aortic Valve Insufficiency * surgery   complications   mortality   MeSH
• Heart Valve Prosthesis Implantation * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Heart-Assist Devices * adverse effects   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Heart Failure * complications   mortality   surgery   therapy   MeSH
• Propensity Score MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: To compare the drug survival of etanercept to monoclonal tumour necrosis factor-α inhibitors in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: Patients initiating first line biological therapy with tumour necrosis factor-α were propensity score matched and compared for drug survival with a Kaplan-Meier analysis. RESULTS: We matched 657 to 657 patients in rheumatoid arthritis, the median survival time on etanercept was 44.6 months vs. 36.8 months on monoclonal antibody tumour necrosis factor-α inhibitors, with a hazard ratio of 0.94, p = 0.416 We matched 187 to 356 patients in ankylosing spondylitis, the median survival time on etanercept was 75.1 compared to 68.0 months, hazard ratio of 0.78, p = 0.087 We matched 81 to 160 psoriatic arthritis patients, the median survival time on etanercept was 35.8. compared to 65.7 months, hazard ratio 1.61, p = 0.011. Patients treated with etanercept had significantly worse psoriasis scoring during follow up. CONCLUSIONS: We found comparable survival in rheumatoid arthritis and ankylosing spondylitis. In psoriatic arthritis, we found significantly shorter survival on etanercept, possibly due to worse response of skin and nail manifestations.

• MeSH
• Adalimumab therapeutic use   MeSH
• Spondylitis, Ankylosing * drug therapy   mortality   MeSH
• Antirheumatic Agents * therapeutic use   MeSH
• Adult MeSH
• Etanercept * therapeutic use   MeSH
• Infliximab therapeutic use   MeSH
• Kaplan-Meier Estimate MeSH
• Middle Aged MeSH
• Humans MeSH
• Antibodies, Monoclonal therapeutic use   MeSH
• Arthritis, Psoriatic * drug therapy   mortality   MeSH
• Registries * MeSH
• Arthritis, Rheumatoid * drug therapy   mortality   MeSH
• Aged MeSH
• Propensity Score * MeSH
• Tumor Necrosis Factor-alpha * antagonists & inhibitors   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic MeSH

Background and Aims: It has been previously reported that Caucasian population has different kidney transplantation outcomes compared to other racial groups. Data from the Czech Republic are lacking. Methods: In this retrospective cohort study, we analysed 2315 kidney transplant recipients between years 2014-2024 and identified 24 ethnic minority patients (Asians n=20, African Europeans n=4). A control group consisting of Caucasian population was established by propensity score matching in a 3:1 ratio. The primary endpoint was a composite of poor graft function, graft failure, rejection and all-cause mortality at 1- and 5-years post-transplant. Secondary outcomes were individual components of primary endpoint, eGFR at 1- year post-transplant and incidence of delayed graft function. Furthermore, we compared the differences in time on dialysis and on the waiting list prior to transplantation and time from starting dialysis to being wait-listed between the groups. Results: There was no difference in the incidence of primary composite endpoint between the racial minority group (RMG) and the Caucasian control group (CCG) at 1-year (16,7 % vs. 19,4 %, resp.; p=0,84) and 5-years post-transplant (20,8 % vs. 26,4%, resp.; p=0,751). There was also no difference in the incidence of secondary outcomes. However, we found that the RMG spent longer time on dialysis before being wait-listed compared to the CCG (median 1,2 years [IQR 0.9-1.9] vs. 0,8 years [IQR 0.26-1.64], resp.; p=0,030). Furthermore, there was also an evident trend towards longer time on dialysis prior to transplantation in the RMG compared to the CCG (median 2,4 years IQR [1.4-4.3] vs. 1,75 years [IQR 0.74-3.3], resp.; p=0,051) and on the waiting list prior to transplantation (median 1,2 years IQR [0.34-2.7] in RMG vs. median 0,56 years IQR [0.16-1.56] in CCG; p=0,094). Conclusion: In this study, kidney transplant outcomes were similar between the groups. However, racial minority groups are still disadvantaged by longer time on dialysis before reaching transplantation.

• MeSH
• Renal Dialysis MeSH
• Humans MeSH
• Racial Groups MeSH
• Retrospective Studies MeSH
• Kidney Transplantation * MeSH
• Check Tag
• Humans MeSH

BACKGROUND AND AIMS: Anti-tumor necrosis factor-α inhibitors (anti-TNFs) are the established treatment for perianal Crohn's disease (pCD), but relapse and non-response are common. Data on second- and third-line biologics are limited. We present the first direct comparison of second- and third-line biologics in pCD patients with active perianal disease previously treated with first-line anti-TNFs. METHODS: A multicenter retrospective cohort study included adult patients with pCD who failed first-line anti-TNF. The primary outcome was clinical perianal response, with secondary outcomes of radiological response (magnetic resonance imaging or transrectal ultrasound) and healing, and clinical remission. Propensity score matching (PSM) was used to adjust for baseline differences. RESULTS: A total of 486 pCD patients from 23 IBD centers were included, with 333/486 (68.5%) and 216/263 (82.1%) matched by PSM in the second and third-line treatment groups, respectively. In the second-line group, 62/78 (79.5%) of ustekinumab (UST)-treated patients achieved clinical perianal response, compared to 46/78 (58.9%) with vedolizumab (VDZ) (OR 4.47, 95% CI, 1.94-10.28, P < .001) and 38/78 (48.7%) with anti-TNFs (OR 5.29, 95% CI, 2.39-11.71, P < .001). In the third-line group, 38/49 (77.6%) of UST-treated patients achieved clinical perianal response, compared to 29/49 (59.2%) with VDZ (OR 9.96, 95% CI, 2.6-38.4, P < .001) and 27/49 (55.1%) with anti-TNFs (OR 12.03, 95% CI, 2.99-48.47, P < .001). UST-treated patients also had higher radiological response rates than VDZ (OR 3.28, 95% CI, 1.07-10.07, P = .038). CONCLUSION: In pCD patients failing anti-TNFs as first-line treatment, ustekinumab may be more effective than vedolizumab or another anti-TNF as second or third-line therapy.

• MeSH
• Biological Products * therapeutic use   MeSH
• Crohn Disease * drug therapy   diagnostic imaging   MeSH
• Adult MeSH
• Gastrointestinal Agents * therapeutic use   MeSH
• Antibodies, Monoclonal, Humanized therapeutic use   MeSH
• Remission Induction MeSH
• Tumor Necrosis Factor Inhibitors therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Anus Diseases * drug therapy   MeSH
• Retrospective Studies MeSH
• Propensity Score MeSH
• Ustekinumab * therapeutic use   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

INTRODUCTION: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. AIM: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). METHODS: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in-hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. RESULTS: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non-smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non-smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. CONCLUSION: The occurrence of PPCs in smokers is not different from non-smokers. FUNDING: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands. REGISTRATION: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223). PRIOR PRESENTATION: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.

• MeSH
• Length of Stay statistics & numerical data   MeSH
• Smoking * adverse effects   epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Mortality MeSH
• Lung Diseases * epidemiology   etiology   MeSH
• Postoperative Complications * epidemiology   etiology   MeSH
• Preoperative Period MeSH
• Risk Factors MeSH
• Aged MeSH
• Propensity Score MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

BACKGROUND: Effectiveness of disease-modifying treatment (DMT) in people affected by primary progressive multiple sclerosis (PPMS) is limited. Whether specific subgroups may benefit more from DMT in a real-world setting remains unclear. Our aim was to investigate the potential effect of DMT on disability worsening among patients with PPMS stratified by different disability trajectories. METHODS: Within the framework of the Big MS Data network, we merged data from the Observatoire Français de la Sclérose en Plaques, the Swedish and Italian MS registries, and MSBase. We identified patients with PPMS that started DMT or were never treated during the observed period. Subpopulations with comparable baseline characteristics were selected by propensity score matching. Disability outcomes were analysed in time-to-recurrent event analyses, which were repeated in subclasses with different disability trajectories determined by latent class mixed models. RESULTS: Of the 3243 included patients, we matched 739 treated and 1330 untreated patients with a median follow-up of 3 years after pairwise censoring. No difference in the risk of confirmed disability worsening (CDW) was observed between the groups in the fully matched dataset (HR 1.11, 95% CI 0.97 to 1.23, p=0.127). However, we found a lower risk for CDW among the class of treated patients with an aggressive disability trajectory (n=360, HR 0.68, 95% CI 0.50 to 0.92, p=0.014). CONCLUSIONS: In line with previous studies, our data suggest that DMT does not ameliorate disability worsening in PPMS, in general. However, we observed a beneficial effect of DMT on disability worsening in patients with aggressive predicted disability trajectories.

• MeSH
• Multiple Sclerosis, Chronic Progressive * drug therapy   physiopathology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Disability Evaluation MeSH
• Disease Progression MeSH
• Registries MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: In our previous study on erythropoiesis-stimulating agent (ESA) treatment in lower risk myelodysplastic syndromes from the European MDS (EUMDS) Registry, we showed that patients treated with ESAs had longer survival compared with patients who receive red blood cell transfusion (RBCT). In this study, with a longer follow up time and more patients included, we aimed to assess long-term effects on survival and health-related quality of life (HRQoL) of exposure to ESAs with or without RBCT in patients with lower risk myelodysplastic syndromes. METHODS: The EUMDS Registry is a non-interventional, longitudinal, real-world registry prospectively enrolling newly diagnosed patients older than 18 years with lower risk (International Prognostic Scoring System low or intermediate-1) myelodysplastic syndromes from 16 European countries and Israel. The analysis was restricted to patients with haemoglobin concentrations less than 100 g/L enrolled between Jan 1, 2008, and July 1, 2019, with last censoring of data on Dec 31, 2021. Patient management was recorded every 6 months, including treatment, transfusions, and HRQoL. ESA treatment followed local guidelines. The patients were separated into four groups at each study visit: no ESA or RBCT, ESA only, ESA plus RBCT, and RBCT only. The data were analysed longitudinally over time according to ESA and RBCT status during each 6-month interval, using propensity score matching. The main outcomes were median overall survival and leukaemia-free survival, and HRQoL. This study is registered with ClinicalTrials.gov, NCT00600860, as is ongoing. FINDINGS: 2448 patients (the ESA-unexposed group [n=1265] and ESA-exposed group [n=1183]) were diagnosed before July 1, 2019; 1520 (62·1%) were male and 928 (37·9%) were female. Median follow-up time was 3·9 years (IQR 1·6-6·5). After applying eligibility criteria and propensity matching, there were 426 patients in the ESA-unexposed group and 744 patients in the ESA-exposed group. Median overall survival in the ESA exposed group was 44·9 months (95% CI 40·2-50·5) compared with 34·8 months (28·6-39·2) in the ESA unexposed group; the absolute difference was 10·1 months (95% CI 2·2-18·0; hazard ratio [HR] 0·70 [95% CI 0·59-0·83]; p<0·0001). Patients without RBCT in the presence or absence of ESA exposure maintained significantly better HRQoL than those with RBCT, irrespective of ESA exposure (linear mixed effect model of EQ-5d-3L index score, RBCT coefficient -0·04 [95% CI -0·06 to 0·03], p<0·0001; linear mixed effect model of VAS, -4·57 [-6·02 to -3·13], p<0·0001). INTERPRETATION: ESA treatment in patients with lower risk myelodysplastic syndromes significantly improves overall survival when started before or early after the onset of regular transfusion therapy. Avoiding RBCT is associated with significantly better HRQoL. FUNDING: H2020 European Research Council, Novartis Pharmacy B V Oncology Europe, Amgen, BMS/Celgene International, Janssen Pharmaceutica, Takeda Pharmaceuticals International, and Gilead Sciences.

• MeSH
• Hematinics * therapeutic use   MeSH
• Cohort Studies MeSH
• Quality of Life * MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Myelodysplastic Syndromes * drug therapy   mortality   therapy   complications   MeSH
• Registries MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Erythrocyte Transfusion adverse effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

BACKGROUND: The optimal number of septal branches to target during initial alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) remains a subject of debate. It is unclear whether to proceed with ASA of additional septal branches if a satisfactory hemodynamic effect has not been achieved following ablation of the first branch. METHODS: Using propensity score matching analysis, we compared patients who achieved satisfactory outcomes after ASA of a single septal branch with those in whom additional branches were ablated. RESULTS: A total of 457 patients were included in the study, with a median follow-up of 5.61 years (interquartile range 2.08-10.91 years). Propensity score matching identified 92 pairs (184 patients), divided into the single-ablated-branch and more-ablated-branches groups. No significant differences were found in the incidence of major cardiovascular adverse events within the first 30 days between the two groups. Similarly, there were no differences in long-term outcomes between the matched single-ablated-branch and multiple-ablated-branches groups regarding all-cause mortality (3.77 vs.2.90 deaths per 100 patient-years, log-rank p = 0.649), re-intervention rates (12 % vs. 8 %; log-rank p = 0.345), left ventricular outflow gradient (14 ± 13 mmHg vs. 16 ± 15 mmHg; p = 0.209), or NYHA functional class (1.7 ± 0.6 vs. 1.6 ± 0.7; p = 0.629). CONCLUSIONS: In both short- and long-term follow-ups, ASA targeting single or multiple septal branches showed comparable efficacy and safety in patients with hypertrophic obstructive cardiomyopathy.

• MeSH
• Ablation Techniques * methods   MeSH
• Ethanol * administration & dosage   MeSH
• Cardiomyopathy, Hypertrophic * surgery   diagnostic imaging   diagnosis   physiopathology   mortality   MeSH
• Catheter Ablation * methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Heart Septum * surgery   diagnostic imaging   MeSH
• Propensity Score MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH