Surgical Specialties (United States)

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.

Concerns about opioid-related adverse effects have increased interest in opioid-free anaesthesia, but the benefits compared with opioid-inclusive techniques, especially in the presence of regional anaesthesia, remain uncertain. We undertook a systematic review with a network meta-analysis of randomised controlled trials comparing six strategies in adults: opioid-free anaesthesia and opioid-inclusive anaesthesia using remifentanil alone or other opioids, each with or without regional anaesthesia. Primary outcome was postoperative pain. Secondary outcomes were: postoperative opioid use; post-anaesthesia care unit discharge time; hospital duration of stay; and incidence of complications. We included 885 trials from 59 countries. Techniques incorporating regional anaesthesia consistently ranked highest for postoperative pain. Regional anaesthesia combined with an opioid-free intra-operative strategy achieved some of the highest surface under the cumulative ranking curve values for pain at 2 h, 12 h and 48 h (93%, 85% and 75%, all low certainty). When regional anaesthesia was used, differences between opioid-free and opioid-inclusive techniques were minimal (moderate certainty). For opioid consumption, regional anaesthesia with an opioid-free strategy ranked best at 2 h (moderate certainty), 12 h (low certainty) and 48 h (low certainty), with surface under the cumulative ranking curve values > 98%. Techniques without regional anaesthesia were associated with higher pain scores and greater opioid requirements. Opioid-free approaches, especially when combined with regional techniques, were associated with lower rates of postoperative nausea and vomiting. Regional anaesthesia was the key determinant of improved postoperative pain control, and intra-operative opioids added little additional benefit when regional techniques provided adequate coverage. Without regional anaesthesia, neither opioid-free nor opioid-inclusive strategies showed consistent analgesic superiority. However, opioid-free techniques reduced postoperative nausea and vomiting. These findings support preferential use of regional anaesthesia where feasible and suggest that avoiding intra-operative opioids may facilitate recovery, particularly when regional techniques are employed effectively.

Background The COVID-19 pandemic changed society's habits and customs due to the social restrictions and health measures imposed during the first half of 2020. This study analyzes the composition of the oral microbiota in relation to age, cohabitation, SARS-CoV-2 infection, and COVID-19 severity among children and adults under home confinement in Barcelona, Spain. Methods A prospective study conducted involving children and adults confined during the COVID-19 pandemic in the Barcelona Metropolitan Area between April and June 2020 included several participants living within the same family household. Saliva samples were collected from all participants, and microbiota was characterized through 16S rRNA gene sequencing. Results A total of 142 adults and 265 children living in 121 family households were included in the study. All 142 adults had a prior confirmed SARS-CoV-2 infection, and 20 (14.08%) of them had a history of severe COVID-19. SARS-CoV2 infection was detected in 58/265 (21.89%) of children; all of them were asymptomatic. Oral microbiota composition and diversity did not differ by SARS-CoV-2 infection status in children. In contrast, adults with severe COVID-19 exhibited lower microbiota diversity and distinct microbiota composition compared to those with mild disease. Age-related differences in oral microbiota were minimal between 5-15-year-old children and adults. Additionally, cohabiting individuals shared more Amplicon Sequence Variants than non-cohabitants. Conclusions Age and cohabitation strongly influenced oral microbial composition. Additionally, our study demonstrates that oral microbiota composition in adults varies according to COVID-19 severity, whereas such microbial shifts are not observed in asymptomatic pediatric populations, regardless of infection status.

IntroductionWhile the improved ergonomics, depth of field, and freedom of movement offered by Exoscopes compared to Operative Microscopes are well established, their value in surgical education and training is often mentioned but remains poorly documented.MethodsIn this study, we used a using a slightly modified version of the NOMAT score to compare the microvascular anastomoses on an artificial model made using traditional Operative Microscopes and the Orbeye 4K 3D Exoscope. Each participant performed the task 3 times.ResultsThe results showed that microscope users initially scored higher in several aspects, likely due to greater prior familiarity with the device. However, by the third repetition, the differences were no longer significant, demonstrating that the Exoscope is not inferior to the traditional Microscope in laboratory training. Moreover, the Exoscope group exhibited a faster learning curve for specific skills, highlighting its potential for early adoption by young surgeons.DiscussionThese findings emphasize the educational promise of Exoscopes, particularly in facilitating a smooth transition from traditional microscopes. However, further studies with larger sample sizes and extended training periods are needed to validate these conclusions.

Background: Triple-negative breast cancer is an aggressive breast cancer subtype characterized by the absence of human epidermal growth factor receptor 2, estrogen and progesterone receptors, limiting targeted therapy options. Cisplatin, a chemotherapeutic agent, induces DNA damage and exhibits some efficacy against triple-negative breast cancer, but its effectiveness is often reduced by chemoresistance and systemic toxicity. A very promising strategy to augment cisplatin treatment can be based on combining it with the biologic Cetuximab, an epidermal growth factor receptor inhibitor, which boosts cisplatin efficacy by inducing ferroptosis. Results: To optimize this strategy in a biocompatible and precise manner, we developed a nanoplatform based on red blood cell-derived extracellular vesicles for the combined delivery of Cetuximab and cisplatin, enabling immune evasion, and the possibility of autologous personalization and GMP-compliant production. Owing to their DNA-free lumen and lack of EGFR, RBC-EVs preserve cisplatin activity and prevent interference with cetuximab. This formulation enhances cisplatin's cytotoxicity by up to 50%, as shown in vitro and in patient-derived organoids. It effectively reduces chemoresistance by downregulating hypoxia-related genes and promoting ferroptosis, additionally, it improves cisplatin's cytotoxic effects while reducing hemotoxicity compared to the administration of free cisplatin. Conclusions: These findings highlight the potential of red blood cell-derived extracellular vesicles as a biocompatible delivery system enabling combined therapy and offering a promising strategy to overcome current limitations in TNBC treatment.

Coagulation factor XI (FXI) inhibitors are a promising and novel class of anticoagulants, but a recent animal study found that FXI inhibition exacerbated diastolic dysfunction and heart failure (HF). In the ARIC study (Atherosclerosis Risk in Communities), we investigated whether plasma FXI level was associated with cardiovascular events and cardiac function. ARIC was our primary analytic cohort. We included 4471 participants (median age, 75 years; 57% female; 17% Black) who attended visit 5 (2011-2013) with Somalogic-quantified plasma FXI levels and echocardiographic cardiac function. Prevalent HF and atrial fibrillation (AF) cases were defined as having HF or AF diagnosed at or before each participant's visit 5 exam date. Incident HF and AF events were ascertained through 2021. Associations were assessed using Cox, logistic, and linear regression models. Primary prospective associations were also validated in the CHS (Cardiovascular Health Study) using an orthogonal FXI assay (enzyme-linked immunosorbent assay). At ARIC visit 5, there were 665 and 419 participants with prevalent HF and AF, respectively. During a median follow-up of 9 years, there were 580 and 788 incident HF and AF events, respectively. Lower FXI level was associated prospectively with higher incidence of HF (hazard ratio [HR], 1.36 [for each 1-unit decrement of log2-transformed FXI level] [95% CI, 1.01-1.83]) but not incident AF, and cross-sectionally with increased odds of AF (odds ratio [OR], 1.96 [95% CI, 1.23-3.07]) but not HF. In age-stratified analyses, decreased FXI was associated with higher incidence of HF in participants ≥75 years of age (HR, 1.57 [95% CI, 1.08-2.28]) but not <75 years of age (HR, 1.11 [95% CI, 0.68-1.79]). The inverse FXI-HF association was validated in CHS (HR, 1.18 [95% CI, 1.02-1.36]). At ARIC visit 5, lower FXI level was also associated with higher prevalence of diastolic dysfunction and worse E/A ratio, left atrial (LA) volume index, LA function, and left ventricular mass index, but not left ventricular ejection fraction or global longitudinal strain. Decreased FXI level is associated with greater incidence of HF, especially in older adults. It is also associated with prevalent AF, worse diastolic function, worse LA function, and greater LA size. More research is needed to assess potential unwanted effects of FXI inhibition on the risk of cardiovascular events and cardiac function.

To evaluate and compare characteristics and outcomes of dogs with gastrointestinal (GI) and non-gastrointestinal (non-GI) causes of septic peritonitis. Retrospective study from 2009 to 2022. A Midwest veterinary teaching hospital and a West Coast private practice in the United States. A total of 161 dogs diagnosed with septic peritonitis based on intracellular bacteria or a positive culture from peritoneal effusion. None. Of 161 dogs included in the study, 114 (70.8%) survived. Dogs that survived were younger (p=0.011) and, compared with nonsurvivors, had higher total plasma protein (TP) concentrations (p=0.039), higher serum albumin concentrations (p=0.0021), and higher systolic blood pressures (SBP) (p=0.0025) on presentation. Plasma lactate concentration on presentation was not associated with survival (p=0.097). There was no difference in survival between dogs diagnosed with a GI versus non-GI etiology of septic peritonitis. Dogs with GI etiologies weighed more than dogs with non-GI etiologies (p=0.0169). There were no differences in age, temperature, heart rate, SBP, PCV, TP, serum blood glucose concentration, plasma lactate concentration, serum albumin concentration, or Acute Patient Physiologic and Laboratory Evaluation-fast scores upon presentation in dogs with GI etiologies compared with dogs with non-GI etiologies. In a subgroup analysis, dogs with hepatobiliary etiologies were older (p=0.0004) and weighed less (p=0.003) compared with dogs with GI and other non-hepatobiliary etiologies, but there was no difference in survival (p=0.958). This study found no difference in survival to discharge in dogs with GI compared with non-GI etiologies of septic peritonitis. Regardless of the etiology of septic peritonitis, age, TP, serum albumin concentration, and SBP upon presentation were significantly associated with survival.

Conventional flotation circuits struggle to recover valuable ultra-fine coal particles (less than 45μm), leading to significant losses. Conventional technologies typically discard these ultra-fines, sacrificing valuable resources to tailings. Eriez's StackCell® and Flotation Column technologies have demonstrated superior efficiency in the area of ultra-fine coal recovery compared to conventional methods, thanks to their application of wash water over deep froths. When deployed as part of Somerset International's patented Sub325® Fine Coal Recovery System, which captures a very high proportion of ultra-fines to product, total recovery and yield is maximised, thereby also reducing tailings waste. The fine coal recovery system flowsheet offers significant advantages by creating revenue from a waste stream and reducing tailings volumes reporting to tailings storage facilities.

Background: The global burden of cancer necessitates innovative approaches to its management and treatment. Traditional treatments like radiotherapy, immunotherapy, surgery, and chemotherapy, carry significant side effects that impact patient quality of life. Dietary fiber has attracted research interest as a potential mitigator of cancer progression and a supportive agent in cancer treatment. This bibliometric study analyzes trends in research connecting dietary fiber, cancer therapy, and gut health from April 1999 to May 2024. Methods and Results: Web of Science, PubMed, and Scopus databases were used to retrieve peer-reviewed publications from April 1999 to May 2024 on dietary fiber and cancer management. The study identifies a rising scholarly interest in dietary fiber's role in cancer management, focusing significantly on the interactions between dietary fiber and gut microbiota. These interactions are particularly noted for their influence on inflammation and cancer metastasis. The study highlights evolving research themes, the importance of specific fiber types in cancer progression, and highlights persistent foundational themes like glycosylation. Emerging areas include personalized nutrition and innovative therapeutic approaches. The geographical and institutional contributions, mainly from the United States and China, underline the significance of collaborative and interdisciplinary efforts in advancing research. Conclusion: This analysis emphasizes integrating dietary strategies in comprehensive cancer care and aims to address research gaps to develop more effective and patient-centered cancer therapy and prevention strategies.