Surgical Specialties (Canada)

This paper is aimed at synthetizing the conceptual basis of compartmental surgery (CS) for tumours of the anterior (floor of mouth and oral tongue) as well as posterior (base of tongue, superior and inferior gingival-buccal sulcus extending into the masticator space and infratemporal fossa) oral cavity, its indications, and outcomes. In spite of numerous bioendoscopic, radiological, and surgical advancements in management of oral cancer, its oncologic surgical control continues to be hampered by a considerable risk of local recurrence rate. Use of a conventional approach based on an empirical 5 mm safe margin surrounding the lesion in its three-dimensional extension, even when associated to accurate frozen sections techniques, seems inadequate to improve the oncologic outcomes of these patients in the near future. In contrast, application of the CS concepts herein detailed seems to open new opportunities for increasing surgical radicality, while maintaining adequate functional outcomes when proper reconstructive techniques are applied. Even though further multicentric prospective studies are needed to confirm the replicability of the oncological results described by pioneers of the CS approach, as well as to quantify the functional outcomes obtained by its large-scale application, this surgical philosophy confirms its vitality, relentless diffusion, and progressive evolution in the head and neck cancer arena.

Transoral laser microsurgery (TOLMS) is an established organ-preserving treatment for early-stage and selected intermediate-stage laryngeal squamous cell carcinoma (SCC). Initially indicated for Tis-T1 lesions, its use has progressively expanded to carefully selected T2 and T3 tumors, providing oncologic outcomes comparable to open surgery and (chemo)radiotherapy [(C)RT] while offering favorable functional results. The CO₂ (carbon dioxide) laser is the preferred device for TOLMS due to its precision and minimal thermal injury, allowing accurate tumor resection with optimal margin control. Successful application of TOLMS relies on strict patient selection and comprehensive pre- and intraoperative assessment. High-definition videolaryngoscopy, angled telescopes, bioendoscopic techniques, advanced imaging modalities, and emerging artificial intelligence tools have significantly improved the evaluation of tumor extent, biological behavior, and laryngeal function. Adequate laryngeal exposure is a critical prerequisite, as difficult exposure is associated with higher rates of positive margins and inferior oncological outcomes. Preoperative imaging, particularly magnetic resonance imaging (MRI) and dual-energy computed tomography (CT), is essential for assessing deep tumor extension, cartilage invasion, and involvement of key anatomical subsites, including the anterior commissure (AC), paraglottic space (PGS), and pre-epiglottic space (PES). AC involvement alone is not an absolute contraindication to TOLMS; however, vertical trans-AC extension and posterior PGS invasion, especially when associated with arytenoid fixation, represent major limitations due to the difficulty in achieving adequate oncologic margins. Surgical margin assessment remains challenging because of specimen shrinkage and variability in pathological evaluation, yet positive margins-particularly deep or multiple-are associated with worse disease-specific survival and laryngeal preservation. In supraglottic SCC, TOLMS is feasible for T1-T2 and selected T3 tumors, although functional outcomes decline with increasing extent of resection and patient age. The role of TOLMS in the salvage setting is limited and requires highly selective indications. In conclusion, TOLMS is an effective treatment for appropriately selected laryngeal cancers, provided that meticulous diagnostic work-up, surgical expertise, and multidisciplinary decision-making are ensured.

To assess whether craniofacial morphology and vertical growth patterns are associated with a preference for hard or soft alimentary boluses in a sample of orthodontic patients. This cross-sectional study included 121 orthodontic patients (69 females, 52 males; mean age = 12.3 ± 3.3 years). Before-treatment, lateral skull x-rays were collected and lateral cephalometric analysis performed, considering variables SpP^GoGn, SN^GoGn, SpP^CoOr, and AN^B. Before undergoing chewing pattern analysis, each patient was asked to chew a standardized soft bolus (chewing gum) and subsequently a standardized hard bolus (wine gum) in a flavor of their choice. Subsequently, each patient was asked to express a preference for one of the two boluses, and the answer was recorded. To assess the association between bolus hardness preference and cephalometric variables, multiple linear regression analyses were performed, controlling for sex and age. Soft bolus was preferred by 64% of subjects (n = 77) and hard bolus by 36% (n = 44). Increased SpP^GoGn angle was significantly associated with soft-bolus preference (P <.05) as well as being female but was independent of age. SN^GoGn increased with age (P <.05) but did not correlate with bolus preference or sex. No significant associations were observed for SpP^CoOr and AN^B. Soft bolus preference was significantly associated with increased intermaxillary divergence but not with cranial divergence, mandibular rotation, or sagittal skeletal relationship. These findings suggest that patients with intermaxillary hyperdivergent patterns may self-select softer boluses, due to a compensatory functional-structural feedback loop.

Patient information leaflets (PILs) for medicines are legally required across the European Union to support safe medicine use, informed decision-making, and treatment adherence. However, they are often criticised for complexity, poor readability, and anxiety-inducing descriptions of side effects. Health literacy (HL), the ability to access, understand, appraise, and apply health information, may affect how patients engage with PILs. Italy has a high prevalence of limited HL, yet population-based evidence on its influence remains scarce. This study examined patterns of PIL use, comprehension, and related behaviours in the Italian adult population, accounting for HL differences. A cross-sectional survey was conducted between October 2024 and April 2025 among 1,977 adults (mean age 46.5 years; 63% women). Recruitment combined social media dissemination with general practitioner collaboration to reach older and less digitally active individuals. The questionnaire collected sociodemographic data, HL (using the six-item HLS-EU-Q6 and a single-item functional HL screener), and indicators of PIL engagement, including reading frequency, reasons for non-consultation, comprehension of extracts, anxiety, therapy discontinuation, risk interpretation, and perceptions of commercial influence. Data were analysed using descriptive and inferential statistics. 66% of respondents reported always reading PILs for prescription medicines, and 71% did so for over-the-counter products. Overall, 17.2% had inadequate HL, 52.4% problematic, and 30.4% sufficient. Among sociodemographic variables, only education differed by HL level (2.09 vs. 2.02; p = 0.04). Higher HL was associated with more frequent PIL reading, greater confidence in medicine use (mean 2.22 vs. 1.94; p < 0.001), and lower anxiety (2.21 vs. 1.97; p < 0.001). In contrast, respondents with lower HL more often discontinued therapies after reading PILs (37% vs. 28%; p = 0.02) and overestimated vaccine risks compared with analgesics (25% vs. 9%). Perceiving PILs as commercially influenced was also more common among those with limited HL (p < 0.001). HL significantly shapes how Italian adults use and interpret PILs, influencing engagement, confidence, anxiety, and therapy behaviours. Current formats may inadvertently widen inequalities by overburdening readers with limited HL. Public health efforts should prioritise simplification, plain language, balanced risk communication, and perceptions of neutrality to promote equitable and safe medicine use.

The therapeutic landscape of non–small cell lung cancer (NSCLC) has been profoundly transformed by the widespread adoption of molecular profiling and the development of targeted therapies, like tyrosine kinase inhibitors (TKIs), antibody–drug conjugates (ADCs), and bispecific antibodies (BsAbs). These agents have significantly improved survival and quality of life in molecularly selected subgroups, potentially converting NSCLC into a chronic disease requiring prolonged treatment exposure. However, extended survival has led to increasing recognition of cancer treatment–related cardiovascular (CV) disease as a clinically relevant and sometimes dose-limiting complication. Unlike conventional chemotherapy, CV toxicities associated with targeted therapies frequently arise from on-target or off-target interference with signaling pathways that are essential for myocardial survival, endothelial function, vascular regulation, and the cardiac conduction system. From common pathophysiological mechanisms, a broad spectrum of clinical manifestations arises, ranging from asymptomatic electrocardiographic changes to arterial hypertension, dyslipidemia, venous thromboembolism, arrhythmias, and heart failure. This review provides a comprehensive overview of CV toxicities associated with targeted therapies in NSCLC, integrating mechanistic insights with clinical evidence. We summarize class-specific CV risk profiles across EGFR, ALK/ROS1, RET, MET, NTRK, BRAF, and KRAS-G12C inhibitors, as well as ADCs and BsAbs, highlighting both shared and distinct patterns of cardiotoxicity. As targeted therapies continue to expand across disease stages and treatment lines, CV toxicity is expected to play an increasingly important role in therapeutic decision-making. Integrating CV considerations into oncologic care is therefore essential to preserve treatment continuity, optimize long-term outcomes, and maximize the benefits of modern targeted therapies in NSCLC.

ABSTRACT Autosomal dominant polycystic kidney disease (ADPKD) is a complex, multisystemic disorder exhibiting notable sex-related differences in clinical presentation, progression and complications. While the disease affects both sexes, disease expression and complications differ significantly between men and women. This review explores the biological, hormonal and psychosocial sex differences in ADPKD across multiple clinical domains. Men tend to experience faster kidney growth, earlier onset of hypertension and slightly younger age at kidney replacement therapy. Women, in contrast, are more susceptible to polycystic liver disease (PLD), often exacerbated by oestrogen exposure, especially during pregnancy or hormonal treatments. Although urinary tract infections are more prevalent among women, cyst infections show no major sex-based difference in incidence, although men may respond less favourably to antibiotic therapy. Cardiovascular complications, intracranial aneurysms and reproductive health risks also show sex-related patterns. Fertility and reproductive counselling must be individualized, as reproductive challenges and risks differ markedly between men and women. Pregnancy in women with ADPKD, especially those with reduced renal function or PLD, carries increased risks and requires specialized care. Fertility in men with ADPKD is usually preserved, although sometimes it may be impaired due to seminal vesicle cysts and sperm morphological abnormalities. However, assisted reproductive techniques generally achieve outcomes comparable to those of unaffected individuals. Psychosocial aspects such as pain, emotional burden and quality of life are also influenced by sex and require integrated management strategies. While tolvaptan slows disease progression in both sexes, pharmacodynamic responses may differ slightly. Incorporating sex-specific insights into ADPKD care, including hormonal and reproductive considerations, is critical to advancing personalized medicine. Understanding these differences will optimize management and improve quality of life for individuals living with ADPKD.

Abstract Introduction Heart failure (HF) significantly contributes to global morbidity and mortality, yet the provision of palliative care (PC) remains suboptimal in this population. Despite its anticipated benefits in symptom management and quality of life, the patterns of PC engagement across diverse HF subgroups are not well-defined. This study aims to identify HF subtypes and evaluate their PC trajectories to inform targeted strategies for improving PC access and delivery. Methods Using linked electronic health records from the Clinical Practice Research Datalink (CPRD) in England, we identified individuals aged ≥18 years with incident HF who died during follow-up. A previously developed machine learning-informed analytical framework was applied to define distinct HF subgroups based on demographic characteristics, biomarkers, hospitalizations, and comorbidities. Kaplan-Meier (KM) estimates were used to assess survival and PC trajectories across these subgroups. Results Among 51,332 individuals with incident HF, 15,376 (30%) received PC. Five distinct HF subgroups were identified: Cancer-Associated (9.3%), Cardiometabolic (12.7%), Metabolic (42.9%), AF-Associated (5.9%), and Late-Onset (29.2%). The median time to PC initiation (in those receiving it) following the diagnosis of HF was 4.3 years (IQR: 1.8–8.5). The Cancer-Associated subtype received PC earliest (median 2.6 years post-HF), while the Late-Onset subtype had the latest initiation (2.9 years) and the shortest median PC duration before death (0.35 years). Approximately 30% of patients had limited PC access. KM analysis demonstrated significant differences in PC receipt across these subtypes (p &amp;lt; 0.0001). Interpretation: Despite the high symptom burden and end-of-life needs in HF, receipt of PC remains limited, particularly among ‘late-onset’ HF patients. These findings underscore the inequity of PC provision even for high-risk groups in whom the early integration of wholistic care might benefit quality of life.Heart failure/palliative care subtypes Percentage of subtypes of HF/PC

Several urinary markers reflect disease severity and have the potential to support the management of heart failure (HF). Collecting urine samples is easy and inexpensive, and urine sample composition can be altered not only by underlying kidney impairments (i.e. filtration barrier damage and tubular injury) but also via neurohormonal and inflammatory activation, ageing, comorbidities, other medical conditions and pharmacological interventions. For instance, urinary sodium may help to predict the response to loop diuretic therapy in acute HF, while albuminuria is used as a risk marker and therapeutic target for the progression of cardiovascular and kidney diseases in chronic HF, especially when accompanied by kidney disease. However, these markers remain underutilized in clinical practice. This review paper underscores the role of urinary markers in HF, with a specific focus on: (i) the pathophysiologic mechanisms underlying urinary marker excretion, (ii) the prognostic values of urinary markers across diverse HF phenotypes and non‐cardiovascular comorbidities (i.e. chronic kidney disease and diabetes), (iii) the impact of medical therapies on urinary markers, and (iv) existing knowledge gaps that challenge their implementation in clinical practice. The recommendations are aligned with current guidelines, evidence, and expert consensus.

Heart failure (HF) is characterized by increasing prevalence, high morbidity and mortality, poor quality of life, and substantial healthcare costs. Despite advancements in pharmacologic and device-based therapies, translating evidence from randomized controlled trials into clinical practice remains suboptimal. The Global Registries and Surveys Programme-Heart Failure (GRASP-HF) is a pan-European, snapshot, observational study, aiming at assessing the real-world implementation of evidence-based HF management. GRASP-HF captures both acute and chronic HF presentations to assess the adherence to the 2021 and 2023 European Society of Cardiology (ESC) HF Guidelines. It also serves as a platform for the accreditation of HF centres for the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme. This manuscript outlines the rationale, methodology, and design of GRASP-HF. Unlike previous registries, GRASP-HF ensures that all patients are consecutively enrolled over a pre-defined 2-month period, minimizing selection bias. GRASP-HF offers a real-time perspective on diagnostic strategies, use of guideline-recommended medical therapy and implementation of quality-of-care indicators. In addition, GRASP-HF addresses less explored domains by other registries, such as frailty, rare aetiologies (e.g. amyloidosis, genetic cardiomyopathies, Takotsubo syndrome), as well as non-fatal events during hospitalization and follow-up. GRASP-HF is also designed to inform ESC educational strategies and to benchmark progresses in HF care across European and non-European centres. In conjunction with ICARe-HF, annual repetition of GRASP-HF aims to facilitate continuous feedback between evidence, practice, and quality improvement. GRASP-HF will assist National Cardiac Societies in shaping national and institutional policies and will contribute with data-driven insights to future guideline development.