antithrombin III (Atenotiv / ATenativ / ATnativ)

Evaluation of perinatal outcomes in patients with recurrent pregnancy losses.

Kalandyk-Osinko Katarzyna K, Baran Joanna K JK, Baran Rafal R, Blajer-Olszewska Beata B et al.

This study aimed to evaluate the incidence of thrombophilia in women with recurrent miscarriage (RM) and assess its impact on pregnancy outcomes. A prospective study was conducted from 2021 to 2023 at the Fryderyk Chopin University Clinical Hospital in Rzeszow, Poland. Forty women with at least two pregnancy losses were enrolled. Laboratory tests assessed genetic and acquired thrombophilias, including Factor V Leiden, prothrombin G20210A, protein C/S, antithrombin III, MTHFR mutations, homocysteine, and antiphospholipid antibodies. Pregnancy outcomes were compared in patients receiving LMWH versus those without anticoagulant therapy. Statistical analysis employed Mann-Whitney U and McNemar chi-square tests, with significance set at p < 0.05. Congenital thrombophilia was found in 17.5% and acquired thrombophilia in 10% of participants, with Factor V Leiden present in 12.5% and antiphospholipid syndrome in 10%. No significant differences were observed in miscarriage or birth rates between women with and without thrombophilia. However, anticoagulation strongly influenced outcomes: 95% of miscarriages occurred without LMWH, while 52.5% of women receiving LMWH achieved live births (χ² = 14.09; p < 0.001). The combined use of LMWH and low-dose aspirin (ASA) showed the highest success rate, with 47.2% of treated pregnancies resulting in full-term deliveries. Thrombophilia alone did not significantly increase miscarriage risk, but LMWH therapy markedly improved perinatal outcomes in women with RM, regardless of thrombophilia status. These findings support the potential role of anticoagulant therapy in selected patients to enhance live birth rates.

Antibody Responses in Pediatric Dengue Indicate Emergence and Co-Circulation of DENV-3 Genotypes I and III in Myanmar and Orthoflavivirus Cross-Reactivity.

Balingit Jean Claude JC, Nwe Khine Mya KM, Lin Htin H, Aung Wah Wah WW et al.

Dengue virus (DENV) remains a major public health concern in Southeast Asia, disproportionately affecting children. In Myanmar, DENV-3 Genotype III predominated before 2017, with Genotype I emerging thereafter. To assess the impact of this emergence on antibody responses, we analyzed paired acute and convalescent serum samples from 38 pediatric dengue patients collected between 2017 and 2019 alongside archived 2004 samples. Neutralization and in vitro antibody-dependent enhancement (ADE) were assessed against DENV-3 Genotypes I and III and other serotypes, with cross-reactivity analysis to Zika and Japanese encephalitis viruses. Samples from 2004 showed reduced neutralization and higher ADE for Genotype I, consistent with its absence at the time. In contrast, 2017-2019 samples exhibited comparable neutralization for both genotypes, with genotype- and year-dependent ADE differences, indicating that Genotype I emergence was associated with evolving functional antibody profiles. Hence, providing immunological evidence for continued co-circulation of DENV-3 Genotypes I and III in Myanmar. Future prospective pediatric cohort studies with continuous surveillance of circulating orthoflaviviruses and their genotypes, are essential to elucidate how pre-existing dengue immunity shapes genotype emergence and cross-orthoflavivirus immunity in endemic regions.

PACIFIC-5 Trial: Refining Patient Selection for Consolidation Durvalumab in Unresectable Stage III NSCLC.

Zhou Shiqiong S, Ke Qinghua Q

The Contemporary Role of Intracoronary Physiological Assessment: Fractional Flow Reserve, Non-Hyperemic Pressure Ratios, Wireless Technologies, and Microcirculation.

Triantafyllis Andreas S AS, Kotoulas Sotirios C SC, Xenogiannis Iosif I, Poulimenos Leonidas E LE et al.

Background/Objectives: Angiographic stenosis severity and functional significance are discordant in up to 65% of intermediate coronary lesions. Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has shown better clinical outcomes than standard angiography-guided PCI, therefore functional significance defines revascularization. This review evaluates the contemporary evidence for intracoronary physiology assessment tools, such as FFR, non-hyperemic pressure ratios (NHPRs), angiography-derived wire-free indices, and microvascular function testing, and proposes a framework for their implementation into clinical practice. Methods: We conducted a narrative review, synthesizing data from landmark randomized controlled trials (DEFER, FAME I-III, DANAMI-3-PRIMULTI, COMPARE-ACUTE, DEFINE-FLAIR, iFR-SWEDEHEART, iMODERN, FAVOR III China and Europe, FAST III, ALL-RISE, CorMicA), along with pooled analyses, meta-analyses, position papers, and relevant guidelines. Results: FFR-guided revascularization resulted in a 28% reduction in cardiac death or myocardial infarction in pooled analyses (HR 0.72, 95% CI 0.54-0.96). leading to a Class I, Level A indication. NHPRs, including iFR, achieved non-inferiority to the FFR at 1 year; however, a 5-year pooled meta-analysis raised concerns of increased all-cause mortality with iFR guidance compared to the FFR (HR 1.34, 95% CI 1.08-1.67). Approximately 20% of lesions show FFR-iFR discordance, driven by vessel-specific physiology and microvascular factors. Wire-free technologies yielded conflicting results: the FAVOR III China trial favored the QFR over angiography, yet FAVOR III Europe failed non-inferiority versus the FFR, while the recent FAST III and ALL-RISE trials demonstrated the non-inferiority of angiography-derived physiology at 1 year. Up to 40% of patients with angina have non-obstructed coronary arteries, and coronary vasomotor function testing can identify treatable microvascular endotypes improving symptoms and quality of life. Conclusions: Functional invasive coronary angiography is advocated to decipher vessel hemodynamics and to guide treatment. The FFR remains the gold standard for invasive physiological assessments, while NHPRs and wire-free technologies are valuable adjuncts with specific indications and limitations. A thorough microvascular evaluation is essential for differentiating between various INOCA endotypes and is gradually being adopted by the interventional community. While NHPRs and virtual technologies struggle to dethrone the king FFR, a comprehensive intracoronary physiology assessment is essential to guide treatment.