Search Results (337)

Sustained maternal HIV viral-load (VL) suppression during breastfeeding is essential for eliminating vertical HIV transmission in Sub-Saharan Africa. Although vertical transmission prevention programmes have improved antiretroviral therapy coverage and peripartum outcomes, viral control may deteriorate after delivery. This decline may result from psychosocial stressors, fragmented mother–infant services, and delayed return of results. This review examines post-delivery VL dynamics, breastfeeding-associated transmission risk, and the limitations of binary suppression thresholds. We suggest that post-delivery VL monitoring should be implemented as a rapid-action pathway. In this approach, detectable viraemia during breastfeeding should prompt a timely reassessment of adherence and repeat VL testing. Regimen review and additional measures to reduce the risks for both the mother and infant should be implemented where indicated. We also examine the individual, relational, structural, and health system determinants of post-delivery viraemia and lost to follow-up, including intimate partner violence. Finally, we highlight service delivery innovations that may improve maternal VL suppression and HIV-free infant survival rates. Full article

Background/Objectives: The treatment of multidrug-resistant and hypervirulent Klebsiella pneumoniae is one of today’s biggest healthcare challenges. The depletion of therapeutic options necessities the application of new methods. One promising approach is to use phage-derived enzymes that target the capsule and make the causative more visible to the immune system. As proteins, these enzymes must be optimised by reducing their size and antigenicity to make them suitable for repeated use. Methods: In this study, the recently isolated and cloned K2B1orf61 K2 capsule-specific depolymerase was analysed structurally, and certain amino acid residues were deleted by cloning. The following amino acid residues were removed from the 80th (D2_N80), 115th (D3_N115), and 200th (D4_N200) N-terminal, and 250 (D5_C250) and 20 (D6_C20) from the C-terminal positions of the wild-type molecule (D1_wt). The resulting derivative molecules were compared with in vitro and in vivo tests. Results: In the presence of wild-type depolymerase, human serum was able to eliminate the target bacterium and save the lives of mice challenged with the bacterium in an originally lethal intraperitoneal model. However, the D5_C250 derivative lost all activity, meaning that the bacteria with the K2 capsule in the serum survived and all the mice died. Derivatives D2_N80, D3_N115, and D6_C20 exhibited prolonged activity in the serum killing assay, effectively eliminating bacteria within 5 h. Similar activity differences were revealed in the intraperitoneal experiment: D5_C250 had no rescue effect; however, D1_wt, D2_N80, D3_N115, D4_200, and D6_20 resulted in survival rates of 100%, 60%, 80%, 100%, and 20%, respectively. Conclusions: Our results demonstrate that molecular trimming is a promising procedure for developing ideal therapeutic depolymerases. Full article

Background: Pediatric pulmonary vein stenosis (PVS) is a progressive and recurrent condition associated with high morbidity and mortality. Long-term outcomes of individual pulmonary veins remain poorly described. Methods: All pediatric (<18 years) PVS cases diagnosed between September 2005 and January 2020 with a minimum follow-up of 5 years were included. Vein-specific outcomes were assessed using competing-risk survival analysis adjusted for patient death and vein atresia. Veins with recurrent disease maintaining patency for ≥3 years were analyzed longitudinally to characterize reintervention burden as a surrogate for disease trajectory. Results: A total of 244 affected veins in 107 patients were identified. The cumulative incidence of vein loss progressively increased during the first 3 years, followed by plateauing thereafter. Overall, 147 of 244 veins (60%) were lost within 3 years of diagnosis, including 75 veins lost secondary to patient death. Vein attrition was greatest during the first year following diagnosis. Ninety-seven veins remained patent for ≥3 years, including 73 with recurrent disease. Among these veins, the median reintervention rate decreased significantly from 2 (IQR: 1–4) during the first 3 years to 1 per year (IQR: 1–3) thereafter (p < 0.01) while maintaining continued patency. Conclusions: In pediatric PVS, the first 3 years after diagnosis represent a critical period of active disease with high rates of vein attrition. Veins maintaining patency beyond this period demonstrate a reduced reintervention rate, suggesting stabilization of disease progression. Aggressive surveillance and intervention during this therapeutic window may improve long-term vein and patient outcomes. Full article

Background/Objectives: Genitourinary Syndrome of Menopause (GSM) negatively affects quality of life in postmenopausal women, causing sexual dysfunction, vaginal atrophy, and pelvic discomfort. Personalized medicine highlights the need for individualized, non-hormonal therapeutic options for women with contraindications to or preferences against hormonal treatment. Non-hormonal therapies, such as laser treatments, have emerged as potential alternatives, but evidence comparing intravaginal and extravaginal K-Laser therapy remains limited. This study aimed to evaluate the efficacy of intravaginal and extravaginal K-Laser therapy on the symptoms of Genitourinary Syndrome of Menopause (GSM) in postmenopausal women. Methods: In this single-center, randomized, single-blind, placebo-controlled trial, 57 postmenopausal women were randomly assigned to receive either intravaginal and extravaginal K-Laser Cube Plus 30 therapy (n = 36) or a simulated control treatment (n = 21). The primary outcome was sexual function, measured by the Female Sexual Function Index (FSFI). Secondary outcomes included vaginal pH and pelvic floor muscle function assessed via the PERFECT protocol. Outcomes were assessed at baseline and after 6 weeks. Results: Sixty-seven women were enrolled, and ten were lost to follow-up. The treatment group showed significant improvements over the control group in FSFI (mean difference = 6.38; p < 0.001), PERFECT protocol scores (mean difference = 0.78; p = 0.004), CPPQ-Mohedo (mean difference = 5.44; p < 0.001), and Menopause Rating Scale (mean difference = 6.50; p = 0.017). Significant reductions were also observed in vaginal dryness, vulvar dystrophy, and atrophy (p < 0.001). Conclusions: Intravaginal and extravaginal K-Laser therapy appears to be a safe and effective non-hormonal treatment for GSM and may support personalized management strategies. However, further well-designed randomized clinical trials with larger samples, longer follow-up of both laser-treated and control groups, and objective outcome measures are needed to provide higher-quality evidence regarding efficacy and identify the patients most likely to benefit. Full article

Background and Objectives: Pediatric-onset metabolic bone diseases, including osteogenesis imperfecta (OI), hypophosphatemic rickets (XLH), hypoparathyroidism, and McCune–Albright syndrome (MAS), require lifelong follow-up because of persistent skeletal fragility, biochemical abnormalities, and functional morbidity extending into adulthood. However, evidence regarding structured transition from pediatric to adult care in these rare disorders remains limited. This study evaluated one-year outcomes of a multidisciplinary transition program for adolescents and young adults with rare metabolic bone diseases. Materials and Methods: This retrospective cohort study included 20 patients aged ≥17 years who underwent evaluation through a structured transition pathway consisting of multidisciplinary team meetings, a joint pediatric–adult transition clinic, and subsequent follow-up in adult endocrinology. Demographic, clinical, treatment, and transition-related data were extracted from medical records. The primary outcome was successful transition, defined as at least one adult endocrinology visit within 12 months. Secondary outcomes included attendance at the transition clinic, follow-up continuity, and treatment modifications. Results: All patients underwent multidisciplinary evaluation, and 85% attended the joint transition clinic. Successful transfer to adult endocrinology was achieved in 90% (18/20), while regular follow-up during the first year was maintained in 75%. Retention was highest in patients with OI, MAS, XLH, vitamin D-dependent rickets, and DiGeorge syndrome (100%). Greater variability was observed in postoperative and primary hypoparathyroidism. Treatment adjustments were required in 40% of patients, including optimization of phosphate/calcitriol replacement and reassessment of bisphosphonate or burosumab therapy. Three patients were lost to follow-up. No acute transition-related complications were observed. Conclusions: In this small exploratory cohort, implementation of a structured multidisciplinary transition pathway was feasible and was accompanied by high transfer and one-year retention rates. Observed differences across diagnostic subgroups should be interpreted cautiously, and larger multicenter comparative studies are needed to evaluate the effectiveness of structured transition frameworks. Full article

Waterborne, water-related, and foodborne infectious diseases remain preventable causes of mortality, but long-term evidence on their demographic, spatial, and premature mortality burden is limited in Costa Rica. This ecological population-based study described deaths classified under selected ICD-10 codes during 2000–2023 using official mortality and population data. Crude and age-standardized mortality rates, years of life lost (YLL), and YLL rates were estimated by time, sex, age group, and geographic area. A total of 2450 deaths were identified. Diarrhea and gastroenteritis of presumed infectious origin accounted for 1537 deaths (62.7%), followed by other bacterial intestinal infections (23.8%) and leptospirosis (7.0%). Annual crude mortality rates ranged from 1.28 per 100,000 population in 2021 to 3.03 in 2017. Mortality showed a bimodal age pattern, with the highest rate among persons aged 75 years or older and a relevant early-childhood component. A total of 57,625.5 YLL were estimated, with the largest burden among children aged 0–4 years and the highest provincial YLL rates in Limón, Puntarenas, and Guanacaste. These findings support incorporating premature mortality metrics into environmental health surveillance, although the ecological design does not identify exposure sources or causal determinants. Full article

Background: Traditional orthopaedic casting has remained the cornerstone of non-surgical fracture management for more than a century. Although plaster and fiberglass casts reliably stabilize fractures, they are associated with physical, psychological, emotional, social, and economic burdens that extend beyond bone healing. Children, older adults, and individuals with pre-existing vulnerabilities may be disproportionately affected. Despite increasing recognition of these complications, existing orthopaedic literature has historically prioritized radiographic healing and biomechanical stability, with limited synthesis of the broader multidimensional patient impact of traditional casting. Emerging technologies such as light-cured polymer mesh (LCPM) systems and 3D-printed lattice immobilizers have been developed to address these limitations and better align fracture care with patient-centered principles. Methods: A narrative review was conducted using a structured and transparent literature identification approach informed by PRISMA reporting principles; however, this study was not conducted as a formal systematic review and did not include risk-of-bias assessment or quantitative synthesis. A broad search of PubMed, Scopus, Web of Science, and Google Scholar was performed for studies published between January 2000 and July 2025. Search strategies combined MeSH terms and free-text keywords relating to orthopaedic casting, complications, psychosocial impacts, LCPM, and 3D-printed immobilizers. Following duplicate removal and a structured review process, 87 studies were included in the final narrative synthesis. Eligible studies included randomized controlled trials, observational studies, qualitative research, case series, and systematic reviews. Data were synthesized narratively across five domains: physical, psychological, emotional/social, economic, and technological alternatives. Results: Traditional plaster and fiberglass casts were consistently associated with musculoskeletal deterioration, joint stiffness, dermatological complications, and hygiene challenges. Psychological and emotional consequences included cast-induced anxiety, claustrophobia, depressive symptoms, and diminished autonomy. Social participation was frequently reduced due to mobility restrictions and perceived stigma, while economic impacts included hidden out-of-pocket expenses, caregiver burden, lost wages, and disparities in access to follow-up care. In contrast, emerging alternatives demonstrated promising advantages. LCPM systems improved ventilation, comfort, and hygiene, while reducing saw-related anxiety. Preliminary evidence suggests that both LCPM and 3D-printed systems may support improved patient experience and earlier return to selected activities, although larger comparative studies are needed to confirm effects on complication rates and long-term outcomes. Over time, these benefits may help offset higher upfront material costs. Conclusions: Fracture care should be evaluated not only by radiographic healing but also by patient-centered outcomes such as comfort, independence, and quality of life. Traditional casting imposes significant multidimensional burdens, whereas newer technologies such as LCPM and 3D-printed systems may offer a more holistic approach to immobilization while maintaining acceptable fracture stability in appropriately selected patient populations. While current evidence indicates potential physical, psychological, and economic advantages, large-scale comparative trials remain necessary to confirm long-term clinical, psychosocial, and cost-effectiveness outcomes across diverse populations. Future integration of emerging immobilization technologies into clinical practice may support more patient-centered, function-oriented, and cost-conscious approaches to fracture care. Full article

Background: Brolucizumab has demonstrated efficacy for diabetic macular edema (DME) in pivotal clinical trials; however, comparative real-world data directly contrasting treatment-naive and anti-VEGF-switched eyes over a prolonged follow-up period remain limited. This case series evaluated 48-week functional, anatomical, and safety outcomes of intravitreal brolucizumab (IVBr) in treatment-naive and switched DME eyes in routine clinical practice. Methods: This retrospective, two-center case series included 21 eyes with center-involving DME treated with IVBr between May 2022 and April 2024. Eyes were classified into a treatment-naive group (n = 10), which included only eyes with no prior anti-VEGF treatment for DME, and a switched group (n = 11), which included eyes previously treated with other anti-VEGF agents but not achieving dry macula. Dry macula was defined as the absence of fovea-involving fluid on OCT. BCVA (logMAR), central retinal thickness (CRT), dry macula rate, the proportion of eyes gaining ≥2 lines of BCVA, number of injections, mean injection interval, and intraocular inflammation (IOI) were assessed at baseline and at 6, 12, 24, and 48 weeks. Results: At baseline, BCVA was 0.44 ± 0.27 in the treatment-naive group and 0.46 ± 0.28 in the switched group (p = 0.943), and CRT was 435.8 ± 150.1 μm and 461.8 ± 139.8 μm, respectively (p = 0.751). In the treatment-naive group, BCVA improved from 0.44 ± 0.27 to 0.24 ± 0.19 at week 48 (p = 0.023), and 5 eyes (50.0%) gained ≥2 lines. In the switched group, BCVA did not improve significantly (0.46 ± 0.28 to 0.41 ± 0.40; p = 0.461); 3 eyes (27.3%) gained ≥2 lines, and 1 eye (9.1%) lost ≥2 lines. CRT decreased significantly in treatment-naive eyes (435.8 ± 150.1 to 312.6 ± 106.2 μm, p = 0.020) and showed a non-significant reduction in switched eyes (461.8 ± 139.8 to 363.6 ± 127.4 μm, p = 0.067). Dry macula rates at week 48 were 40.0% and 27.3%, respectively (p = 0.659). Six switched eyes had prior intravitreal corticosteroid treatment for DME. One treatment-naive eye developed IOI, which resolved without permanent visual impairment. Conclusions: In this retrospective case series, IVBr was associated with anatomical improvement over 48 weeks, with clearer functional and anatomical responses in treatment-naive eyes than in switched eyes. However, the switched group was older and had a more heterogeneous treatment history, including prior intravitreal corticosteroid treatment. The findings should therefore be interpreted as exploratory. Full article

This study examined the effects of functional training on musculoskeletal (MSK) injuries, days lost from training, and attrition rate among police recruits in Abu Dhabi. A total of 441 Abu Dhabi Police recruits were randomly allocated into experimental (n = 220) and control (n = 221) groups. The experimental group underwent six weeks of preconditioning functional training, while the control group followed the standard Abu Dhabi Police recruitment procedure. Subsequently, both groups entered 16 weeks of basic military training (BMT). The outcome measures (injury rate, days lost from training, and attrition rate) were collected at the end of BMT. The proportion of injuries reported by the experimental group was significantly lower than that reported by the control group (15.3% versus 52.3%, respectively [χ² = 66.8, p < 0.001]). There were significant differences in the median (minimum, maximum) number of injuries and number of days lost to training between the experimental and control groups [1 (1, 5) versus 2 (1, 9), p = 0.002 (r = 0.30); and 2.5 (1, 26) versus 5.0 (1, 37), p < 0.001 (r = 0.34), respectively]. The number of dropouts due to MSK injuries during BMT was 1 in the experimental group and 5 in the control group (p = 0.06). Tactical athletes who did not undergo preconditioning training demonstrated a greater risk of non-contact lower-limb injury than those who received structured conditioning training. Therefore, preconditioning training might be a beneficial tool to minimize injuries among tactical athlete trainees. Trial Registration: ISRCTN registry (ISRCTN41786994), retrospectively registered on 13 April 2026. Full article

Background: Effective root canal disinfection is essential for successful nonsurgical root canal treatment (RCT). Although sodium hypochlorite (NaOCl) remains the standard irrigant, it carries a risk of chemical tissue injury if extruded beyond the root canal system and may have limited penetration into anatomically complex regions. Underwater discharge plasma (UDP) generates reactive oxygen and nitrogen species (RONS) through high-frequency, high-voltage electrical discharge in aqueous media, and preclinical and in vitro studies have reported broad-spectrum antimicrobial activity. This study evaluated the clinical and radiographic outcomes of nonsurgical RCT performed using physiological saline-based UDP irrigation without NaOCl in a heterogeneous real-world clinical cohort. Methods: This single-center retrospective cohort study included 186 teeth from 134 patients treated with the PLAZEN RCT^® UDP device and physiological saline irrigation, without NaOCl. The median follow-up period was 16 months. Radiographic outcomes were assessed using the Periapical Index (PAI) system, and treatment success was evaluated according to prespecified Strict and Loose criteria incorporating both radiographic and clinical findings. Stratified analysis was performed according to preoperative PAI score: Group A (PAI 1–2) and Group B (PAI 3–5). UDP-related adverse events, defined as thermal tissue injury caused by discharge heat, were ascertained through retrospective review of clinical records, operative notes, and serial periapical radiographs. Results: Among the 186 treated teeth, radiographic outcomes were classified as Healed (85.5%), Healing (3.8%), and Unhealed (10.8%). Overall Strict and Loose success rates were 79.6% and 82.3%, respectively. Initial treatment showed numerically higher success rates than retreatment. In the stratified analysis, Group A showed an 84.1% success rate with 100% tooth survival, whereas Group B demonstrated Strict and Loose success rates of 68.5% and 83.3%, respectively. Exploratory multivariable analysis showed that periodontal pocket depth > 3 mm was the most consistent factor associated with lower odds of treatment success, whereas associations involving canal obliteration and higher preoperative PAI score were less stable across sensitivity analyses and should be interpreted with caution. No UDP-related adverse events were recorded during follow-up. Attrition sensitivity analyses were performed, and the outcome estimates should be interpreted with caution, given the retrospective design and substantial loss to follow-up. Conclusions: In this preliminary observational cohort, physiological saline-based UDP irrigation without NaOCl was associated with favorable observed periapical healing outcomes and no recorded UDP-related adverse events over a median follow-up of 16 months. However, loss to follow-up was substantial; when all 116 teeth lost to follow-up were classified as treatment failures, the worst-case Strict success rate decreased to 49.0%. Therefore, these findings should be interpreted as preliminary descriptive evidence of clinical feasibility rather than as evidence of comparative efficacy or definitive clinical safety. Adequately powered randomized controlled trials with concurrent NaOCl control arms and long-term follow-up are warranted to evaluate the comparative effectiveness, safety, and reproducibility of physiological saline-based UDP irrigation protocols. Full article

Background/Objectives: Contemporary minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia carry retreatment rates up to 32%, with holmium laser enucleation of the prostate (HoLEP) increasingly used as salvage therapy. Prior reviews focused on salvage HoLEP (sHoLEP) following transurethral resection; however, technical challenges specific to the post-MIST field remain uncharacterised. We aimed to characterise technical barriers during sHoLEP following contemporary MISTs, with secondary evaluation of efficacy, safety and feasibility. Methods: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines (PROSPERO: CRD420261321711), five databases were searched from inception to February 2026. Studies reporting sHoLEP outcomes in adults with prior MIST were included. Qualitative findings were synthesised thematically; quantitative outcomes reported by three or more studies underwent random-effects meta-analysis. Risk of bias was assessed using methodological index for non-randomized studies methodological index for non-randomized studies (MINORS) and certainty of evidence using grading of recommendations, assessment, development, and evaluation (GRADE). Results: Ten studies (354 sHoLEP, 3618 primary HoLEP (pHoLEP) patients) were included. Technical difficulty was MIST-type dependent: thermoablative procedures and prostatic artery embolisation preserved the enucleation plane, while prostatic urethral lift (PUL) introduced morcellation-specific challenges including blade jamming and staged procedures. Meta-analysis revealed no difference in operative time or tissue weight, but reduced enucleation efficiency (weighted mean difference; WMD −0.11 g/min, p = 0.027) and peak urinary flow improvement (WMD −3.0 mL/s, p < 0.001). Both findings were sensitive to analysis, losing significance on restriction to predominantly MIST cohorts, and the enucleation efficiency result additionally lost significance on removal of the most heavily weighted study (p = 0.94). Complication rates were equivalent (odds ratio (OR) 0.92, p = 0.787). Conclusions: sHoLEP is safe and efficacious following contemporary MIST. Surgeons should anticipate MIST-specific challenges, particularly morcellation difficulties after PUL requiring tailored instrumentation. Prospective MIST-specific studies are needed. Full article

Background: Diabetic patients face increased severity in viral respiratory infections, yet during the longitudinal progression of lung recovery, the radiological clearance is poorly quantified. Methods: This prospective study at an infectious diseases hospital analyzed 430 patients with confirmed viral pneumonia. Radiological severity (Rx) and pleural effusion were scored (0–3) at admission (day 1) and follow-up (day 6). Results: Diabetics presented with significantly higher baseline severity (Median 2.0 vs. 1.0, p < 0.0001). While both groups improved at identical rates (Median Δ = −1.0), a significant radiological lag persisted in diabetics at day 6 (Median 1.0 vs. 0.0, p < 0.0001). Attrition analysis (N = 75) revealed a divergent lethal split: attrition in the non-diabetic cohort was almost exclusively driven by low-severity early departures against medical advice (94.2%), whereas diabetic attrition was primarily characterized by early mortality (60.9%; p < 0.0001). Although the diabetic state was associated with a pronounced radiographic resolution delay in unadjusted comparisons, this disadvantage was substantially attenuated and lost statistical significance after adjustment for admission radiological severity (adjusted OR 2.04, 95% CI 0.88–4.76) and chronic comorbidity burden (adjusted OR 1.37, 95% CI 0.56–3.39), indicating that the diabetic lag is largely explained by a higher presenting severity and comorbidity burden rather than by an independent acute effect of diabetes itself. Sensitivity analyses suggest that the observed lag in survivors likely underestimates the true disease burden, given the concentration of early mortality among high-risk diabetic cases. Full article

Background: There are ongoing challenges in revascularizing patients with severe left ventricular (LV) dysfunction, with high rates of short- and long-term complications. Cardiac magnetic resonance (CMR) imaging is widely used for these patients; however, the prognostic value of the sum scar score and microvascular obstruction (MVO) remains unclear. Method: A retrospective study of data from King Abdullah Medical City (KAMC) between 2023 and 2025 was conducted to evaluate revascularization decisions made based on CMR studies. Patients who had normal LV function, no angiogram report, or incomplete CMR imaging were excluded. The primary outcome was hospitalization or death in patients with or without revascularization. Results: The cohort included 145 patients. The patients had a mean age of 56.7 ± 9.7 years and were predominantly male 131 (90.3%), with a high prevalence of cardiovascular risk factors: diabetes 102 (70.8%), hypertension 84 (58.7%), known dyslipidemia 46 (32%), and smoking 65 (45.5%). Most patients underwent a viability study within 7 days of a myocardial infarction (MI), 58 (40%), and a further 42 (28.9%) did so within 7–15 days. The CMR LVEF was 29.5 ± 8, and the sum scar score was 38.8 ± 21.9; MVO was observed in 34 patients (23.4%). The number of patients who underwent revascularization at the index admission was 66 (45.5%), of whom 48 (33%) received percutaneous intervention (PCI) and 18 (12.4%) underwent coronary artery bypass surgery (CABG). The patients lost to follow-up numbered 51 (35%). There were no significant differences between the two groups for the primary endpoints, including hospitalization (p-value: 0.61) and mortality (p-value: 0.31). Conclusion: In this retrospective study, CMR did not have an independent effect on hospitalization or mortality in patients who had revascularization compared to medical therapy groups. MVO and the LGE scar score were not significantly associated with cardiovascular outcomes. Our cohort was underpowered, with a high proportion of patients lost to follow-up, limiting the generalizability of the data. Full article

Purpose: We aim to review our experience in treating children with ependymoma, the third most common malignant central nervous system tumor in children, at Ankara Bilkent City Hospital. Methods: We reviewed medical records of children <18 years old at diagnosis with ependymoma followed up between 2006 and 2024. Clinical, pathological, radiological, treatment, and outcome data were evaluated. Results: Thirty-two patients (56% males) were included. Median age at diagnosis was 6.8 years (range: 0.6–17 years). Sixteen tumors (50%) were Grade 2 histology. Resection extent was gross total resection (GTR, n = 16), subtotal resection (STR, n = 15), or biopsy (n = 1). Radiotherapy was given to 10 patients; chemotherapy to 3; and both to 11. Eight patients underwent surgery only. In univariate analysis, resection extent significantly impacted both event-free survival (EFS) (3-year EFS 79.0% in GTR vs. 38.9% in STR, p = 0.009) and overall survival (3-year OS 100% in GTR vs. 79.4% in STR, p = 0.035). Four patients (12.5%) died. Six patients remained alive with active disease; three were lost to follow-up. Conclusions: The best outcomes occurred in patients who underwent GTR. The EFS/OS rates were comparable to those in the literature. Our findings suggest that chemotherapy and radiotherapy in relapsed ependymoma may prolong survival. Full article

Objective: To evaluate the feasibility and early outcomes of a curvature-guided strategy that guides dual-branch revascularization during Zone 1 Thoracic Endovascular Aortic Repair (TEVAR) based on whether the aortic pathology is predominantly located on the greater or lesser curvature of the arch. Methods: In this retrospective, descriptive study (February 2023–June 2024), 43 consecutive patients were included under a predefined anatomical protocol. Of these, 3 patients (7.0%) were lost to follow-up and were included in the analysis of baseline characteristics and perioperative outcomes. The remaining 40 patients constituted the per-protocol follow-up cohort. Pathologies predominantly on the aortic arch’s greater curvature (n = 21) were managed with a Castor single-branched stent-graft for the left subclavian artery (LSA) and a left common carotid artery (LCCA) chimney stent. Those on the lesser curvature (n = 22) received a physician-modified endograft (PMEG). The primary outcome was technical success; secondary outcomes included safety, branch patency, and reintervention. Results: The overall technical success rate was 97.7% (100% in the Castor-chimney cohort [21/21] vs. 95.5% in the PMEG cohort [21/22]). No perioperative stroke, spinal cord ischemia, or retrograde type A dissection occurred in either cohort. Two type II endoleaks were observed: one intraoperative in the Castor-chimney cohort and one during follow-up in the PMEG cohort. Among the 40 patients (20 per cohort) who completed a median follow-up of 22.5 months, freedom from aortic-related reintervention was 95% (38/40), with one reintervention occurring in each cohort. Branch patency was 100% (20/20) in the PMEG cohort, whereas it was 95% (one asymptomatic LSA occlusion) in the Castor-chimney cohort. Conclusions: The implementation of a curvature-guided protocol, which rationally matches endograft techniques to arch anatomy, suggests acceptable early safety and efficacy for complex Zone 1 TEVAR. This anatomy-driven framework offers a potential personalized approach to dual-branch revascularization and warrants prospective validation. Full article