Salvage surgery for residual and recurrent head and neck squamous cell carcinoma (RESCUE): An IReC multicentre consecutive cohort study.

Real-world evidence on utilization and clinical outcomes of efgartigimod in patients with generalized myasthenia gravis.

Methylene blue for septic shock in oncologic patients: A propensity score-matched cohort.

The outcomes of salvage surgery for previously irradiated recurrent head and neck squamous cell carcinoma (HNSCC) remain suboptimal. This phase II trial evaluated the effects of preoperative tislelizumab (an anti-programmed cell death protein 1 monoclonal immunoglobulin G4 antibody) plus chemotherapy followed by salvage surgery and adjuvant tislelizumab in this setting. Eligible patients (n = 34) with resectable recurrent HNSCC after radiotherapy received preoperative tislelizumab (200 mg), albumin-bound paclitaxel (260 mg/m2), and cisplatin (60-75 mg/m2) every 3 weeks for 2 cycles, followed by salvage surgery and 6 cycles of adjuvant tislelizumab. The primary endpoint was major pathologic response (MPR). Secondary endpoints included pathologic complete response (pCR), the objective response rate (ORR), 2-year event-free survival (EFS), 2-year overall survival (OS), and safety. The ORR was 35.3% (12/34). Of 26 surgical patients, R0 resection was achieved in 19 (73.1%). The MPR rate was 19.2% (5/26), with a pCR rate of 15.4% (4/26). At a median follow-up of 32 months, 2-year EFS was 39.6% and 2-year OS was 54.8%. All MPR patients remained disease free. Grade 1 to 2 adverse events were common; one grade 3 hyperglycemia occurred. High baseline B-cell receptor (BCR) repertoire diversity and clonal abundance (top 1%/10%) correlated with poor prognosis, with top 1% clonality showing strong prognostic power (AUC = 0.910; P = 0.006). Preoperative chemoimmunotherapy followed by surgery and adjuvant immunotherapy was feasible with encouraging survival in previously irradiated recurrent HNSCC. Baseline BCR repertoire characteristics may serve as a noninvasive prognostic biomarker.

The use of immune checkpoint inhibitors (ICIs) has deeply improved the outcome of relapsed or refractory (R/R) primary mediastinal B-cell lymphoma (PMBCL) patients. However, real-world data are still limited, and several aspects, including the need for consolidation strategies, remain to be fully elucidated. We report the results of the multicenter Italian retrospective observational PRIMICI study on R/R PMBCL patients treated with ICIs in a real-life (off-label) setting. Seventy-four patients, 42 treated with pembrolizumab and 32 with nivolumab-brentuximab vedotin (nivo-BV), were enrolled. The median follow-up was 34 months. The best overall response and complete response (CR) rates were 64% (n = 50) and 50% (n = 37), respectively. Of the 37 patients in CR, 11 received a consolidation treatment and 26 patients continued ICIs; CR were stable, independently from the use of consolidation, with a 4-year disease-free survival of 100%. The estimated 5-year progression-free survival (PFS) and overall survival (OS) were 60.4% (95% confidence interval [C.I.] 48.3%-70.6%) and 77.5% (95% C.I. 65.8%-85.6%), respectively. Nivo-BV was associated with faster and higher response rates and better OS compared to pembrolizumab. OS significantly improved after 2020 due to the use of salvage treatment with CAR T-cells. In conclusion, this study supported the safety and effectiveness of pembrolizumab or nivo-BV as a salvage therapy in R/R PMBCL patients. Importantly, the chance to obtain long-lasting responses, regardless of the use of a consolidation treatment, indicates that ICIs may be used with a curative intent in a significant subset of patients.

Durable Left Ventricular Assist Device as Salvage Therapy in Fulminant Cardiomyopathy with Severe Mitral Regurgitation

The management of clinically apparent single lesions or oligofocal nephroblastomatosis, a facultative precursor of nephroblastoma, remains debated. We retrospectively analyzed 37 patients with clinically apparent single or oligofocal nephroblastomatosis (two to three lesions per kidney) among 2347 patients registered between 1993 and 2014 in the SIOP93-01/GPOH and SIOP2001/GPOH renal tumor studies. Of the 37 patients, 23 had a single lesion, and 14 had oligofocal disease; 65% had a clinically apparent and/or molecularly diagnosed cancer predisposition syndrome, and 27% bilateral involvement. Preoperative chemotherapy was administered to 62%, primary surgery to 32%, and chemotherapy without surgery to 5%. Nephron-sparing surgery was performed in 71%. In oligofocal cases, preoperative chemotherapy led to significant tumor volume reduction. Prognosis was favorable: 10-year event-free, nephroblastoma-free, and overall survival rates were 77.4%, 80.7%, and 92.0%, respectively. Of 35 patients who underwent definitive surgery, 26 received short postoperative treatment (≤4weeks) or a watch-and-wait approach (W&W). Three patients (11.5%) developed nephroblastoma, two of whom were successfully salvaged. Ten-year nephroblastoma-free survival was 74.1%, 90.0%, and 100% for short, W&W, and long postoperative treatment (>4weeks), respectively. All 12 patients undergoing primary definitive surgery remained nephroblastoma-free. Short postoperative chemotherapy or W&W is a safe option for patients with single or oligofocal nephroblastomatosis in complete remission, provided they undergo close ultrasound monitoring. The modest relapse risk, manageable with salvage therapy, must be weighed against the toxicity of prolonged treatment, especially in infants. Both primary and delayed surgery are viable strategies.

Arteriovenous malformations (AVMs) are rare, high-flow, vascular anomalies that can occur either sporadically or as part of a genetic syndrome. AVMs can progress with serious morbidity and even mortality if left unchecked. Sirolimus is an mTOR inhibitor that is effective in low-flow vascular malformations; however, its role in AVMs is unclear. This scoping review investigates the current evidence base around the use of sirolimus for AVMs. Twenty-one reports encompassing a total of 60 patients with AVMs treated with systemic sirolimus were included. Sirolimus was predominantly used as an adjunct or salvage therapy. Response was variable overall; however, there was a more consistent benefit in patients with PTEN hamartoma syndrome (PHTS)-associated AVMs, where PI3K/AKT/mTOR pathway dysregulation provides a molecular basis for sirolimus efficacy. Standardised outcome reporting, routine molecular profiling, and larger multicentre collaboration are needed to better define the role of sirolimus for AVMs, particularly as part of multimodal care.

Individuals with severe cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels IV and V are at high risk of hip displacement causing pain, reduced sitting tolerance, and hygiene challenges. Salvage procedures such as proximal femoral resection, hip arthrodesis, or total hip arthroplasty are often required. This review evaluated preoperative characteristics, intraoperative variables, and postoperative outcomes of salvage hip surgery in non-ambulatory children and young adults with CP. EMBASE (via Ovid), Medline and PubMed were searched from inception to October 1, 2024, following PRISMA guidelines and a registered PROSPERO protocol. Forward and backward citation chasing was undertaken prior to final submisson. Eligible English-language cohort studies and case series were included. Data were extracted in duplicate and quality was assessed using Methodological Index for Non-Randomized Studies (MINORS). A narrative synthesis was used due to the lack of consistent quantitative outcomes reported. Of 3,004 records screened, 42 studies (793 patients, 1,014 hips) were included. Excision was most common (n = 34 studies), followed by arthroplasty (n = 8) and arthrodesis (n = 4). Most patients were male (56%), and 81.6% were GMFCS level V. Excision procedures had the lowest operative times (mean 2.5 h) and blood loss (mean 232 mL). Preoperative indications included pain (93% of studies) and caretaker concerns including transfer ability, hygiene, and quality of life (83% of studies). Overall, perioperative complication rates were 13.9%. Heterotopic ossification occurred in 69% of studies, proximal femoral migration occurred in 52%, and 80% reported the need for secondary procedures. Salvage surgery provides consistent pain relief and functional benefits in non-ambulatory CP but remains associated with frequent complications and repeat surgery.

Prognostic factors and survival after recurrence in major salivary gland carcinomas: a multicenter study.

The exact cause of ulcerative colitis (UC) remains unclear but likely involves an immune response to an unidentified component of gut microbiota. The use of antibiotics in treating acute severe UC (ASUC) remains controversial. This study aimed to assess the benefits of adding antibiotics to corticosteroids for managing ASUC. This retrospective study included patients with ASUC who met the Truelove and Witts diagnostic criteria at admission and received intravenous (IV) corticosteroids, with or without adjunctive antibiotics. Key outcomes included the need for medical and surgical rescue therapy during hospitalization and UC-related re-hospitalization rates at 1 week, 3 months, and 1 year. Propensity score matching (PSM) was employed to minimize selection bias in evaluating the impact of adjunctive antibiotics on clinical outcomes. Of the 386 screened patients, 222 met the inclusion criteria: 75 (33.8%) received IV corticosteroids alone, while 147 (66.2%) received IV corticosteroids combined with antibiotics. After PSM (60 patients per group), the addition of antibiotics showed no significant effect on the need for medical rescue therapy during hospitalization, re-hospitalization, or clinical response based on the partial Mayo score after 1 week of hospitalization (68.3% vs. 60.0%; P= 0.341). Similarly, no significant differences were observed in the need for medical rescue therapy, re-hospitalization, or UC-related surgery rates at 3 months or 1 year (P> 0.05). In patients with ASUC, treatment outcomes did not significantly differ between those receiving IV corticosteroids alone and those receiving a combination of IV corticosteroids and antibiotics, suggesting that adjunctive antibiotic use may offer no added clinical benefits.

Extracorporeal Cardiopulmonary Resuscitation in Cardiac Arrest.

Chronic graft-versus-host disease (cGVHD) remains a leading cause of late morbidity after allogeneic hematopoietic cell transplantation (HCT), but its phenotype under modern prophylaxis with post-transplant cyclophosphamide (PTCy) is not well characterized. We conducted a prospective, single-center study of 600 consecutive adults undergoing HCT with PTCy- based prophylaxis to assess incidence, clinical manifestations, treatment response, prognostic factors, and outcomes. Donors included matched siblings (36%), matched unrelated (34%), haploidentical (24%), and mismatched unrelated (6%). The 1-year cumulative incidence of moderate-to-severe cGVHD was 22% (95% confidence interval [CI]: 19-26%). The mouth was the most frequently involved organ (64%), with lichen planus-like changes as the predominant diagnostic feature, whereas sclerotic forms were uncommon. Notably, 27% of moderate-to-severe cases were managed successfully without systemic corticosteroids. The cumulative incidence of systemic therapy requirement was 15% at 1 year, with risk significantly higher in donors ≥30 years and in female-to-male transplants. Among 105 patients requiring systemic steroids, 64% achieved complete response, 32% discontinued immunosuppression, yet 18% developed cGVHD-related sequelae. Mouth ulcers and erythema, as well as a lung score ≥2 at steroid initiation independently predicted shorter failure-free survival. At 2 years, overall survival, cGVHD-free relapse-free survival, and GVHD-free relapse-free survival were 76% (95% CI: 72-79), 63% (95% CI: 60-68), and 57% (95% CI: 53-62), respectively. In conclusion, after HCT with PTCy-based prophylaxis, systemic therapy was required in only a minority of patients, with risk influenced by donor age and sex mismatch rather than donor type. While corticosteroids were generally effective, a substantial subset required salvage therapy, underscoring the burden of refractory cGVHD and the need for steroid-sparing approaches and novel interventions.

To evaluate the efficacy and safety of venetoclax combined with intensive chemotherapy regimens in patients with relapsed or refractory acute myeloid leukemia (R/R AML) through a systematic review and single-arm meta-analysis. A systematic search of PubMed, Embase, and Cochrane CENTRAL was conducted from inception to January 2025. Non-randomized studies enrolling R/R AML patients treated with venetoclax plus intensive chemotherapy were included. Pooled rates of complete remission (CR), composite complete remission (CRc), overall response rate (ORR), and adverse events were estimated using random-effects models. Heterogeneity was assessed with I2 statistics, and sensitivity and subgroup analyses were performed according to chemotherapy regimen. Six retrospective studies comprising 235 patients were included. The pooled CR rate was 27.0% (95% CI, 9.18-57.50; I2 = 84.6%), CRc rate was 51.45% (95% CI, 36.15-66.76; I2 = 83.5%), and ORR was 63.79% (95% CI, 49.67-77.92; I2 = 82.0%). Febrile neutropenia occurred in 71.38% and pneumonia in 23.6% of patients. Venetoclax combined with intensive chemotherapy demonstrates meaningful antileukemic activity in R/R AML, with an expected toxicity profile. Prospective trials are warranted to define its role relative to standard salvage therapies.

Benralizumab as Rescue Therapy for Eosinophilic EVALI in a Lung Transplant Recipient

Extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a comparative cohort study from the first ECPR program in Brazil.

Our retrospective observational cohort study investigated the effect of the timing of escalation to dual salvage therapy utilizing ceftaroline with vancomycin or daptomycin for the treatment of persistent methicillin-resistant Staphylococcus aureus bacteremia on patient outcomes. Eligibility criteria included age ≥18 years old, at least one positive blood culture for methicillin-resistant Staphylococcus aureus, and receipt of salvage therapy consisting of ceftaroline in combination with either vancomycin or daptomycin for any duration during their bloodstream infection within our health system over a 10-year period. This resulted in the inclusion of 189 adult patients. Patients were stratified by the timing of ceftaroline initiation: ≤5 days (early initiation) versus >5 days (late initiation) from index positive culture. The study populations were similar, although there was a higher prevalence of persons who inject drugs started on early salvage therapy (36.0% versus 18.0%, P = 0.005) and fewer patients with type II diabetes (25.8% versus 41.0%, P = 0.028). Analysis revealed no statistically significant differences between 90-day all-cause mortality or readmission rates in either group; however, there was less 90-day microbiologic recurrence in the early initiation group (3.4% versus 11.0%, P = 0.046). Patients started on early salvage therapy also had fewer total days of bacteremia (7.0 versus 10.5 days, P < 0.001), fewer metastatic foci of infection (61.8% versus 82.0%, P = 0.002), and a shorter duration of treatment (46.0 versus 50.0 days, P = 0.013).IMPORTANCETreatment of methicillin-resistant Staphylococcus aureus bacteremia remains a challenge due to its high morbidity and mortality. Ceftaroline has been studied for off-label utilization in dual salvage therapy with daptomycin or vancomycin in these patients, although current data regarding the optimal timing for its addition are limited. We sought to address this knowledge gap with our retrospective review of patient outcomes at our hospital system who received ceftaroline for this indication. Overall, earlier initiation of ceftaroline-based dual therapy was beneficial, as evidenced by reduced microbiologic recurrence, shorter duration of bacteremia, reduced metastatic disease, and subsequent shorter duration of therapy if patients were escalated to dual salvage therapy with ceftaroline within 5 days of the index culture.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency. While systemic corticosteroids are first-line therapy, intratympanic corticosteroid (ITC) injection has emerged as an important modality. The optimal timing of ITC-as primary therapy, combined initial treatment, or salvage therapy-remains controversial. To critically synthesize current evidence regarding ITC efficacy at different treatment timings and provide evidence-based clinical recommendations. A structured search of PubMed, Embase, and the Cochrane Library was conducted from database inception to December 2025 using terms sudden sensorineural hearing loss, ISSNHL, sudden deafness, intratympanic injection, ITC, intratympanic dexamethasone, and intratympanic methylprednisolone. The search identified 321 records, and additional articles were found in the reference lists of key reviews, meta-analyses, and guidelines. Studies were selected using predefined criteria, prioritizing randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and relevant observational studies in adults with ISSNHL. Eligible studies evaluated ITC as primary monotherapy, combined initial therapy, or salvage therapy, and reported quantitative audiometric outcomes. Exclusion criteria included non-idiopathic sudden hearing loss, pediatric populations, non-corticosteroid intratympanic therapies, animal or laboratory-only studies, case reports, conference abstracts without full text, duplicate publications, and studies without clinically interpretable hearing outcomes. After screening, 25 studies were included. Salvage ITC provides significant benefit (OR: 6.04; 95% CI: 3.26-11.2; NNT≈3) with Grade A evidence. Combined initial therapy is superior to systemic steroids alone (OR: 2.50; 95% CI: 1.95-3.21), particularly for severe hearing loss. ITC monotherapy is non-inferior to systemic steroids (PTA difference: 2.0 dB). A stratified approach based on treatment timing is recommended. Salvage ITC should be offered to all patients with incomplete recovery. Combined therapy should be considered for patients with severe hearing loss. ITC monotherapy is appropriate when systemic steroids are contraindicated.

The optimal endovascular treatment strategy for medium and distal vessel occlusions remains undefined given the anatomical challenges of distal vessels. Stent retriever-assisted intra-arterial lysis (SAIL) is a pharmacomechanical technique designed to facilitate clot dissolution while minimizing mechanical stress on fragile distal vessels. We performed a retrospective single-center analysis of consecutive patients with acute ischemic stroke due to distal vessel occlusions treated with SAIL between November 2022 and January 2026. Distal occlusions included M2-M3, A2-A3, and P1-P2 segments, and were classified as primary or secondary. SAIL consisted of temporary stent retriever deployment across the thrombus to restore flow, followed by intra-arterial tirofiban infusion through a distal access catheter and subsequent device resheathing. Primary outcomes were feasibility and safety; secondary outcomes included angiographic reperfusion and clinical outcomes. 24 patients were included (mean age 74±14.6 years; median baseline National Institutes of Health Stroke Scale (NIHSS) 16). Most occlusions involved the middle cerebral artery territory (79.2%). SAIL was predominantly used after unsuccessful mechanical thrombectomy (70.8%), with a median of two prior device passes. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) was achieved in 87.5% of patients, including near-complete or complete reperfusion (mTICI 2c-3) in 62.5%. Any intracranial hemorrhage occurred in 25.0% of patients and symptomatic intracranial hemorrhage in 4.2%. At 90 days, functional independence (modified Rankin Scale 0-2) was observed in 6 of 12 patients (50%) with available follow-up. SAIL was feasible and achieved high reperfusion rates with a low rate of symptomatic intracranial hemorrhage despite frequent use as rescue therapy after failed thrombectomy. These findings support further evaluation of pharmacomechanical strategies for distal vessel occlusions.

Like a roll of dice, unraveling the antimicrobial resistance to ESKAPE pathogens against various drugs is a perilous challenge in coeval healthcare due to their swift acquisition of resistant genes and drastic spreading of antimicrobial resistance. These pathogens manifest both innate and adopted resistance machineries against manifold antibiotic categories, consisting of -lactams, glycopeptides, fluoroquinolones, aminoglycosides, tetracyclines, macrolides, and salvage therapy agents - linezolid and colistin. The machineries underlying resistance include enzymatic drug alteration, as seen with -lactamases, aminoglycoside-altering or methylating enzymes, carbapenemase, chloramphenicol acetyltransferase; biofilm formation, target site mutations, resistance determinants lateral gene transfer, and overexpression of efflux pumping. The frequency of incidence of multidrug-resistant strains as well as extensively drugresistant, and also pan-drug-resistant strains appreciably intricates infection management, and furthermore pitches into amplified morbidity, mortality, and ultimately affects global healthcare expenditures. This overview provides an ample review of the antimicrobial resistance contours, elementary molecular mechanisms, and clinical consequences of ESKAPE pathogens, accentuating emerging waves and potential approaches to counter these menacible nosocomial pathogens.