University Hospital of Basel

Neubauer M.C., Vosshenrich J.

Perrin M., Schweizer T., Oetliker C., Reuthebuch O.T., Babst D., Schaefer D.J.

Summary: Breast augmentation is a popular cosmetic procedure that is generally considered safe. However, the rising trend of nonspecialists performing these procedures has increased the risk of complications, including rare but serious acute bleeding. We present a case of a healthy 22-year-old patient who experienced acute bleeding after bilateral breast augmentation by a nonplastic surgeon, resulting in massive hypovolemic shock that required 27 packed red blood cell (PRBC) transfusions and led to acute cardiopulmonary failure. The patient had 2 cardiac arrests, necessitating resuscitation and extracorporeal membrane oxygenation, which was removed after 6 days. An emergency surgical revision was performed to remove the breast implants for effective hemostasis. This case highlights the significant risks associated with cosmetic breast procedures and emphasizes the importance of early surgical intervention in cases of acute bleeding. Patients should be made aware of these risks, and cosmetic surgery should only be performed by trained specialists.

Kolakowski L., Ebner K.A., Papadopoulou A.

Headache and facial pain syndromes are frequently observed in people with multiple sclerosis (MS), often affecting young adults during pivotal stages of their lives. These conditions can disrupt their ability to work, maintain relationships, and engage in daily activities, leading to significant socio-economic and personal challenges. This narrative review summarizes key epidemiological data and diagnostic insights into headache and facial pain disorders in people with MS. It addresses the complexities of diagnosing these overlapping conditions and highlights specific therapeutic considerations.

Woolen S., Hess C.P., Merkle E.M., Goh C.

Yamamoto H., Matano T.

HIV and simian immunodeficiency virus (SIV) infections are known for impaired neutralizing antibody (NAb) responses. While sequential virus–host B cell interaction appears to be basally required for NAb induction, driver molecular signatures predisposing to NAb induction still remain largely unknown. Here we describe SIV-specific NAb induction following a virus–host interplay decreasing aberrant viral drive of phosphoinositide 3-kinase (PI3K). Screening of seventy difficult-to-neutralize SIVmac239-infected macaques found nine NAb-inducing animals, with seven selecting for a specific CD8+ T-cell escape mutation in viral nef before NAb induction. This Nef-G63E mutation reduced excess Nef interaction-mediated drive of B-cell maturation-limiting PI3K/mammalian target of rapamycin complex 2 (mTORC2). In vivo imaging cytometry depicted preferential Nef perturbation of cognate Envelope-specific B cells, suggestive of polarized contact-dependent Nef transfer and corroborating cognate B-cell maturation post-mutant selection up to NAb induction. Results collectively exemplify a NAb induction pattern extrinsically reciprocal to human PI3K gain-of-function antibody-dysregulating disease and indicate that harnessing the PI3K/mTORC2 axis may facilitate NAb induction against difficult-to-neutralize viruses including HIV/SIV.

Yamamoto H., Matano T.

HIV and simian immunodeficiency virus (SIV) infections are known for impaired neutralizing antibody (NAb) responses. While sequential virus–host B cell interaction appears to be basally required for NAb induction, driver molecular signatures predisposing to NAb induction still remain largely unknown. Here we describe SIV-specific NAb induction following a virus–host interplay decreasing aberrant viral drive of phosphoinositide 3-kinase (PI3K). Screening of seventy difficult-to-neutralize SIVmac239-infected macaques found nine NAb-inducing animals, with seven selecting for a specific CD8+ T-cell escape mutation in viral nef before NAb induction. This Nef-G63E mutation reduced excess Nef interaction-mediated drive of B-cell maturation-limiting PI3K/mammalian target of rapamycin complex 2 (mTORC2). In vivo imaging cytometry depicted preferential Nef perturbation of cognate Envelope-specific B cells, suggestive of polarized contact-dependent Nef transfer and corroborating cognate B-cell maturation post-mutant selection up to NAb induction. Results collectively exemplify a NAb induction pattern extrinsically reciprocal to human PI3K gain-of-function antibody-dysregulating disease and indicate that harnessing the PI3K/mTORC2 axis may facilitate NAb induction against difficult-to-neutralize viruses including HIV/SIV.

Schankin C.J., Popa‐Todirenchi B., Eich A., Branca M., Galimanis A., Scutelnic A., Goeldlin M.B., Beyeler M., Exadaktylos A., Belachew N., Heldner M.R., Kaesmacher J., Meinel T.R., Mattle H.P., Jung S., et. al.

BACKGROUND In people with suspected stroke the first assessment occurs under time pressure in the emergency department and is based solely on clinical information. Working hypotheses include mechanism and localization of the clinical deficit on imaging. To assess the performance of neurologists in such situation, we investigated the accuracy with which board‐certified neurologists make the correct diagnosis based solely on clinical information. METHODS In this prospective diagnostic accuracy study done at an emergency department of a university hospital, neurologists had to commit themselves to a diagnosis in people with suspected acute stroke. The main analysis was the accuracy with which they distinguished vascular from nonvascular causes using the discharge diagnosis as a reference. Secondary analyses included the distinction of ischemic from hemorrhagic strokes, and the accuracy with which the lesion location and site of vessel occlusion were identified. The performance of neurologists was also compared to residents and medical students. RESULTS Of 800 people with suspected stroke, 567 (71%) had a vascular (508 ischemic stroke or transient ischemic attack and 59 hemorrhagic stroke) and 233 (29%) had a nonvascular disorder (72 seizures, 33 migraine auras, 12 functional neurological disorders, and 116 other diseases). Vessel occlusion was found in 227 of 410 people with ischemic stroke. Neurologists identified vascular origin with an accuracy of 0.86 (95% CI: 0.83–0.89), a sensitivity of 0.93 (0.90–0.95), and a specificity of 0.66 (0.58–0.73). The accuracy to identify ischemia compared with hemorrhage was 0.91 (0.87–0.93). Neurologists’ accuracy to predict the presence of vessel occlusion was 0.66 (0.61–0.71), of exact lesion location was 42%, and of the affected blood vessel 57%. CONCLUSION In people with acute neurological deficits, the accuracy with which neurologists identify vascular origin is high and depends on neurological education. Experienced physicians should be involved early in the management of people with “code stroke.”

Yaden D.B., Graziosi M., Owen A.M., Agin-Liebes G., Aaronson S.T., Allen K.E., Barrett F.S., Bogenschutz M.P., Carhart-Harris R., Ching T.H., Cosimano M.P., Danforth A., Davis A.K., Garcia-Romeu A., Griffiths R., et. al.

Montagna G., Laws A., Ferrucci M., Mrdutt M.M., Sun S.X., Bademler S., Balbaloglu H., Balint-Lahat N., Banys-Paluchowski M., Barrio A.V., Benson J., Bese N., Boughey J.C., Boyle M.K., Diego E.J., et. al.

PURPOSE The nodal burden of patients with residual isolated tumor cells (ITCs) in the sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) (ypN0i+) is unknown, and axillary management is not standardized. We investigated rates of additional positive lymph nodes (LNs) at axillary lymph node dissection (ALND) and oncologic outcomes in patients with ypN0i+ treated with and without ALND. METHODS The Oncoplastic Breast Consortium-05/ICARO cohort study (ClinicalTrials.gov identifier: NCT06464341 ) retrospectively analyzed data from patients with stage I to III breast cancer with ITCs in SLNs after NAC from 62 centers in 18 countries. The primary end point was the 3-year rate of any axillary recurrence. The rate of any invasive recurrence was the secondary end point. RESULTS In total, 583 patients were included, of whom 182 (31%) had completion ALND and 401 (69%) did not. The median age was 48 years. Most patients (74%) were clinically node-positive at diagnosis and 41% had hormone receptor–positive/human epidermal growth factor receptor 2–negative tumors. The mean number of SLNs with ITCs was 1.2. Patients treated with ALND were more likely to present with cN2/3 disease (17% v 7%, P < .001), have ITCs detected on frozen section (62% v 8%, P < .001), have lymphovascular invasion (38% v 24%, P < .001), and receive adjuvant chest wall (89% v 78%, P = .024) and nodal radiation (82% v 75%, P = .038). Additional positive nodes were found at ALND in 30% of patients, but only 5% had macrometastases. The 3-year rates of any axillary and any invasive recurrence were 2% (95% CI, 0.95 to 3.6) and 11% (95% CI, 8 to 14), respectively, with no statistical difference by type of axillary surgery. CONCLUSION The nodal burden in patients with ypN0(i+) was low, and axillary recurrence after ALND omission was rare in patients selected for this approach. These results do not support routine ALND in all patients with ypN0(i+).

Eden J., Thorne A.M., Bodewes S.B., Patrono D., Roggio D., Breuer E., Lonati C., Dondossola D., Panayotova G., Boteon A.P., Walsh D., Carvalho M.F., Schurink I.J., Ansari F., Kollmann D., et. al.

While it is currently assumed that liver assessment is only possible during normothermic machine perfusion (NMP), there is uncertainty regarding a reliable and quick prediction of graft injury during ex situ hypothermic oxygenated perfusion (HOPE). We therefore intended to test, in an international liver transplant cohort, recently described mitochondrial injury biomarkers measured during HOPE before liver transplantation.

Thiele B., Stein A., Schultheiß C., Paschold L., Jonas H., Goekkurt E., Rüssel J., Schuch G., Wierecky J., Sinn M., Tintelnot J., Petersen C., Rothkamm K., Vettorazzi E., Binder M.

Optimizing functional outcomes and securing long-term remissions are key goals in managing patients with locally advanced rectal cancer. In this proof-of-concept study, we set out to further optimize neoadjuvant therapy by integrating the radiosensitizer trifluridine/tipiracil and explore the potential of cell free tumor DNA (ctDNA) to monitor residual disease.

Katic J., Badertscher P., Zeljkovic I., Ammann P., Reichlin T., Knecht S., Krisai P., Kühne M., Sticherling C.

Marto J.P., Riegler C., Gebert P., Reiff T., Sykora M., Wiącek M., Pakizer D., Araújo A., ter Schiphorst A., Sousa J.A., Reich A., Pina B.F., Mayer-Suess L., Hobeanu C., Zedde M., et. al.

Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O. Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0–2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis. Results: We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7–18) vs 5 (2–13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76–1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84–1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98–15.23]). PSM analysis revealed similar results. Discussion and conclusion: In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.

Chatzimichail E., Steinemann-Inauen A., Gugleta K., Feltgen N., Gatzioufas Z.

Chatzimichail E., Meyer P., Gatzioufas Z., Steinemann-Inauen A.