University of Szeged

Background/Objectives: Calcified coronary lesions require plaque modification techniques for optimal stent apposition, of which rotational atherectomy (RA) is the most commonly used one. Challenging cases require the use of additional dedicated devices (such as modified balloons, MB); however, data available for evidence-based device selection are limited. The aim of this study is to determine the impact of the balloon-based technology used after successful RA treatment on outcomes. Methods: This study was carried out according to the PRISMA guidelines. MEDLINE, CENTRAL and Embase databases were systematically searched for eligible randomized and non-randomized studies. Results: A total of nine studies and 1024 patients were included in the analysis. Patients were treated with RA followed by either plain balloon angioplasty (RA + BA) or modified balloon (RA + MB) treatment prior to stent implantation. There was no significant difference in MACE (major adverse cardiovascular events; OR: 0.53; 95% CI: 0.21–1.34; p = 0.153), all-cause mortality (OR: 0.68; 95% CI: 0.33–1.42; p = 0.265), and target lesion revascularization (OR: 0.64; 95% CI: 0.27–1.55; p = 0.264) between the two groups. However, a sensitivity analysis demonstrated a significant decrease in MACE for patients with severely calcified lesions (OR: 0.42; 95% CI: 0.25–0.70; p = 0.009) in the RA + MB group. The analyses of the safety outcomes of slow flow/no reflow (OR: 0.59; 95% CI: 0.29–1.22; p = 0.128) and coronary artery perforation (OR: 1.18; 95% CI: 0.70–1.99; p = 0.480) showed no difference between the two groups. Conclusions: Our meta-analysis suggests that the benefit of the more invasive RA + MB treatment is statistically significant for severely calcified lesions, but is not associated with additional procedural complications.

Réka Ehrenberger; Richárd Masszi; Előd-János Zsigmond; Uyen Nguyen Do To; Caner Turan; Anna Walter; Péter Hegyi; Marie Anne Engh; Gábor Zoltán Duray; Zsolt Molnár; Béla Merkely; István Ferenc Édes. Modified Balloon Use After Rotational Atherectomy Reduces Major Adverse Cardiovascular Event Rates in Severely Calcified Coronary Lesions: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine 2024, 13, 6853 .

Réka Ehrenberger, Richárd Masszi, Előd-János Zsigmond, Uyen Nguyen Do To, Caner Turan, Anna Walter, Péter Hegyi, Marie Anne Engh, Gábor Zoltán Duray, Zsolt Molnár, Béla Merkely, István Ferenc Édes. Modified Balloon Use After Rotational Atherectomy Reduces Major Adverse Cardiovascular Event Rates in Severely Calcified Coronary Lesions: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024; 13 (22):6853.

Réka Ehrenberger; Richárd Masszi; Előd-János Zsigmond; Uyen Nguyen Do To; Caner Turan; Anna Walter; Péter Hegyi; Marie Anne Engh; Gábor Zoltán Duray; Zsolt Molnár; Béla Merkely; István Ferenc Édes. 2024. "Modified Balloon Use After Rotational Atherectomy Reduces Major Adverse Cardiovascular Event Rates in Severely Calcified Coronary Lesions: A Systematic Review and Meta-Analysis." Journal of Clinical Medicine 13, no. 22: 6853.

Introduction: Patients (2.7M in EU) with positive cancer prognosis frequently develop metastases (≈1M) in their remaining lifetime. In 30-70% cases, metastases affect the spine, reducing the strength of the affected vertebrae. Fractures occur in ≈30% patients. Clinicians must choose between leaving the patient exposed to a high fracture risk (with dramatic consequences) and operating to stabilise the spine (exposing patients to unnecessary surgeries). Currently, surgeons rely on their sole experience. This often results in to under- or over-treatment. The standard-of-care are scoring systems (e.g. Spine Instability Neoplastic Score) based on medical images, with little consideration of the spine biomechanics, and of the structure of the vertebrae involved. Such scoring systems fail to provide clear indications in ≈60% patients.Method: The HEU-funded METASTRA project is implemented by biomechanicians, modellers, clinicians, experts in verification, validation, uncertainty quantification and certification from 15 partners across Europe. METASTRA aims to improve the stratification of patients with vertebral metastases evaluating their risk of fracture by developing dedicated reliable computational models based on Explainable Artificial Intelligence (AI) and on personalised Physiology-based biomechanical (VPH) models.Result: The METASTRA-AI model is expected to be able to stratify most patients with limited effort end cost, based on parameters extracted semi-automatically from the medical files and images. The cases which are not reliably stratified through the AI model, are examined through a more detailed and personalised biomechanical VPH model. These METASTRA numerical tools are trained through an unprecedentedly large multicentric retrospective study (2000 cases) and validated against biomechanical ex vivo experiments (120 specimens).Conclusion: The METASTRA decision support system is tested in a multicentric prospective observational study (200 patients). The METASTRA approach is expected to cut down the indeterminate diagnoses from the current 60% down to 20% of cases.METASTRA project funded by the European Union, HEU topic HLTH-2022-12-01, grant 101080135

L. Cristofolini; B. B. Bròdano; E. Dall’aRa; R. Ferenc; S. J Ferguson; J. M. García-Aznar; A. Lazary; P. Vajkoczy; Jorrit-Jan Verlaan; L. Vidacs. METASTRA: COMPUTER-AIDED EFFECTIVE FRACTURE RISK STRATIFICATION OF PATIENTS WITH VERTEBRAL METASTASES FOR PERSONALIZED TREATMENT THROUGH ROBUST COMPUTATIONAL MODELS VALIDATED IN CLINICAL SETTINGS. Orthopaedic Proceedings 2024, 106-B, 59 -59.

L. Cristofolini, B. B. Bròdano, E. Dall’aRa, R. Ferenc, S. J Ferguson, J. M. García-Aznar, A. Lazary, P. Vajkoczy, Jorrit-Jan Verlaan, L. Vidacs. METASTRA: COMPUTER-AIDED EFFECTIVE FRACTURE RISK STRATIFICATION OF PATIENTS WITH VERTEBRAL METASTASES FOR PERSONALIZED TREATMENT THROUGH ROBUST COMPUTATIONAL MODELS VALIDATED IN CLINICAL SETTINGS. Orthopaedic Proceedings. 2024; 106-B (SUPP_18):59-59.

L. Cristofolini; B. B. Bròdano; E. Dall’aRa; R. Ferenc; S. J Ferguson; J. M. García-Aznar; A. Lazary; P. Vajkoczy; Jorrit-Jan Verlaan; L. Vidacs. 2024. "METASTRA: COMPUTER-AIDED EFFECTIVE FRACTURE RISK STRATIFICATION OF PATIENTS WITH VERTEBRAL METASTASES FOR PERSONALIZED TREATMENT THROUGH ROBUST COMPUTATIONAL MODELS VALIDATED IN CLINICAL SETTINGS." Orthopaedic Proceedings 106-B, no. SUPP_18: 59-59.

Vaccine hesitancy (VH) is an issue for healthcare students, influenced by safety concerns and misinformation. The need for better communication training and understanding sociocultural factors in VH was highlighted in a European University Alliance seminar. Practical exercises like simulation role-playing, interprofessional collaboration, and digital literacy may improve vaccine education.

Sylvain Gautier; Mia-Marie Hammarlin; Edit Paulik; Ilaria Montagni; Judith E. Mueller; Sophie Vaux; Domitille Luyt; Bernice L. Hausman; Arnold Bosman; Aurélien Dinh; Loïc Josseran; Louise Bennet; Elisabeth Delarocque-Astagneau. New pedagogical tools for vaccine education: preparing future healthcare workers for the next pandemic. BMC Medical Education 2024, 24, 1 -6.

Sylvain Gautier, Mia-Marie Hammarlin, Edit Paulik, Ilaria Montagni, Judith E. Mueller, Sophie Vaux, Domitille Luyt, Bernice L. Hausman, Arnold Bosman, Aurélien Dinh, Loïc Josseran, Louise Bennet, Elisabeth Delarocque-Astagneau. New pedagogical tools for vaccine education: preparing future healthcare workers for the next pandemic. BMC Medical Education. 2024; 24 (1):1-6.

Sylvain Gautier; Mia-Marie Hammarlin; Edit Paulik; Ilaria Montagni; Judith E. Mueller; Sophie Vaux; Domitille Luyt; Bernice L. Hausman; Arnold Bosman; Aurélien Dinh; Loïc Josseran; Louise Bennet; Elisabeth Delarocque-Astagneau. 2024. "New pedagogical tools for vaccine education: preparing future healthcare workers for the next pandemic." BMC Medical Education 24, no. 1: 1-6.