Raising the bar: evaluating quality and consistency in clinical guidelines for surgical management of pulmonary carcinoid.

Leading societies have established guidelines that vary significantly regarding recommendations for the surgical management of pulmonary carcinoids (PC). We aimed to assess current guidelines and recommendations for PC surgical management, benchmark their methodological quality, and identify factors that may influence their effectiveness in guiding surgical practice. Literature was sought to identify relevant guidelines for the management of PC.

Antibody-Drug Conjugates in Breast Cancer: The Road Towards Biologically-Informed Selection and Sequencing.

Purpose Of Review: In this review, we discuss evidence supporting the use of antibody-drug conjugates (ADCs) in breast cancer treatment, describe novel ADCs and combination regimens under development, and examine our current understanding of resistance mechanisms and biomarkers to guide ADC selection and sequencing.

Recent Findings: Three ADCs have proven benefit in patients with metastatic breast cancer: trastuzumab emtansine (T-DM1), trastuzumab deruxtecan (T-DXd), and sacituzumab govitecan (SG). There are over two hundred investigational ADCs on the horizon, as pre-clinical studies work to identify novel ADC targets and structures.

Right Ventricle Function: The Role of the Forgotten Chamber in Mitral Valve Surgery.

Background: Referred to as the "forgotten chamber," the right ventricle (RV) is now widely acknowledged as a significant factor, particularly in certain cardiovascular pathologies. Despite historically being undervalued in comparison to the left ventricle, the RV function is deemed crucial in determining patient outcomes following mitral valve (MV) surgery. In the context of MV surgery, it is important to note that the RV is highly susceptible to dysfunction before, during, and after the surgical procedure.

Examining the learning curves in robotic cardiac surgery wet lab simulation training.

Background: Simulation-based training has gained distinction in cardiothoracic surgery, as robotic-assisted cardiac procedures evolve. Despite the increasing use of wet lab simulators, the effectiveness of these training methods and skill acquisition rates remain poorly understood.

Objective: This study aimed to compare learning curves and assess the robotic cardiac surgical skill acquisition rate for cardiac and noncardiac surgeons who had no robotic experience in a wet lab simulation setting.

Desmoplakin Cardiomyopathy: Role of Inflammation and Potential Role of Disease-Modifying Therapies.

Purpose Of Review: To summarize the available data on the use of immunosuppression therapies for the management of hot phases of disease and recurrent myocarditis in patients with desmoplakin cardiomyopathy (DSP-CMP).

Recent Findings: Occurrence of myocarditis episodes has been associated with worsening of outcomes in DSP-CMP. Multiple case reports and small case series have described potential benefit in using anti-inflammatory and immunosuppressive medications for the treatment of those episodes.

Central Sleep Apnea and Cardiovascular Disease State-of-the-Art.

Central sleep apnea (CSA), a rare polysomnographic finding in the general population, is prevalent in certain cardiovascular conditions including systolic and diastolic left ventricular dysfunction, atrial fibrillation, coronary artery disease, carotid artery stenosis, stroke and use of certain cardiac-related medications. Polysomnographic findings of CSA with adverse cardiovascular impacts include nocturnal hypoxemia and arousals, which can lead to increased sympathetic activity both at night and in the daytime. Among cardiovascular diseases, CSA is most prevalent in patients with left ventricular systolic dysfunction; a large study of more than 900 treated patients has shown a dose dependent relationship between nocturnal desaturation and mortality.

Performance of Noninvasive Tests for Metabolic Dysfunction-Associated Steatohepatitis and Liver Fibrosis Resolution after Bariatric Surgery.

Background: Noninvasive tests (NITs) to monitor metabolic dysfunction-associated steatohepatitis (MASH) progression and response to interventions are needed because of the risks of liver biopsy. A monocytes-based diagnostic test using perilipin-2 (PLIN2) and Ras-related protein-14 (RAB14) predict the severity of MASH and fibrosis. Here we compared the performances of PLIN2 and RAB14 with cytokeratin-18 (CK18) assessed by Ella™ or M65 ELISA in predicting MASH and fibrosis resolution following bariatric surgery in a longitudinal and histologically characterized cohort of individuals with obesity.

Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment.

Background And Aims: Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at preventing recurrences. The present study assessed the diagnostic efficacy of a two-step assessment.

Methods: Multicentre prospective, cross-sectional, observational study.

How I Manage Patients with Unexplained Cytopenia.

The term "unexplained cytopenia" is used to describe a condition characterized by peripheral blood (PB) cytopenia that cannot be attributed to identifiable causes using conventional tests or to any concomitant diseases. Unexplained cytopenia requires clinical attention and further investigation to identify individuals at risk of developing a hematologic neoplasm. The available evidence suggests that somatic mutation analysis may effectively complement the diagnostic work-up and clinical management of unexplained cytopenia.

Biomarkers.

Background: This study aims at applying the AT(N) classification to a cohort of patients with Alzheimer's disease (AD) and related disorders, and to investigate how many cases would be eligible for the emerging disease-modifying treatments.

Method: We conducted a retrospective evaluation of 429 patients referred to the Memory Center of IRCCS San Raffaele Hospital in Milan. Patients underwent clinical/neuropsychological assessments, lumbar puncture, structural brain imaging, and positron emission tomography (FDG-PET).

Biomarkers.

Background: This study investigated microstructural features of the locus coeruleus to entorhinal cortex pathway (LC-EC) in relation to amyloid (A), tau (T), neurodegeneration (N) markers and cognitive impairment in memory clinic patients.

Method: 124 participants were recruited from the Geneva Memory Clinic (n=30 cognitively unimpaired - CU; n=80 MCI and n=14 dementia - CI) and underwent clinical assessment, 3T MRI scan including diffusion weighted imaging, amyloid PET, and tau PET. Diffusivity indices (fractional anisotropy - FA, mean, axial and radial diffusivities - MD, AxD, RD) were assessed in the LC-EC pathway using a probabilistic atlas.

Biomarkers.

Background: The amplitude of resting-state electroencephalographic (rsEEG) rhythms is a promising neurophysiological biomarker to investigate the abnormalities of oscillatory neurophysiological thalamocortical mechanisms related to the general cortical arousal and vigilance in wakefulness in patients with dementia due to neurodegenerative diseases as Alzheimer's disease (ADD), Parkinson's disease (PDD) and Lewy Body disease (DLB). Here, we tested the hypothesis that the reactivity of posterior rsEEG alpha (about 8-12 Hz) rhythms during the transition from eyes-closed to -open condition may be lower in PDD patients than in DLB patients.

Methods: A Eurasian database provided clinical-demographic-rsEEG datasets in 35 ADD patients, 65 PDD patients, 30 DLB patients, and 25 matched cognitively unimpaired (Healthy) persons.

Biomarkers.

Background: Psychotic symptoms may manifest in Alzheimer's disease (AD), especially in advanced disease stages and in patients with higher polygenic risk scores for schizophrenia (SCZ-PRS). Such genetic risk seems also to influence grey matter volume (GMV) alterations in patients with psychosis. Since multiple neurotransmitter systems, namely dopamine (DA) and serotonin (5-HT), have been implicated in psychosis, the aim of this study was to investigate whether a SCZ-PRS may explain variance in the association between GMV and the cerebral distribution of DA and 5-HT.

Biomarkers.

Background: Tau protein tangles have been recently shown to accumulate in multiple brainstem nuclei in pre-cortical Alzheimer's disease (AD) stages. The impact of neurotransmission alterations on brain atrophy and their genetic correlates in AD remain unexplored. Therefore, the aims of this study were: 1) to investigate associations between grey matter (GM) loss across the AD continuum and the distribution of multiple neurotransmitter receptors/transporters; 2) to investigate the impact of polygenic risk scores for AD (PRSs) on such associations.

Biomarkers.

Background: Recent technological advancements have revolutionized our approach to healthcare, enabling us to harness the potential of smartphones and wearables to collect data that can be used to characterize Alzheimer's disease (AD) heterogeneity and to develop digital biomarkers. Our focus is to create comprehensive cross-domain digital datasets and establish an infrastructure that allows for seamless data sharing. Central to accelerating the potential of digital biomarkers for more accurate and early detection is privacy-protecting data access, which when combined with deep molecular phenotyping, will enhance our understanding of the biological mechanisms underlying clinical expression.

Biomarkers.

Background: Dementia with Lewy bodies (DLB) is a an α-synucleinopathy characterized by dementia and a combination of parkinsonism, visual hallucinations, fluctuating cognition or REM sleep behaviour disorder. Specific biomarkers for DLB are lacking. DLB-related pattern (DLBRP) is a metabolic network imaging biomarker which expression can be quantified on a single patient basis.

Upper Lip Single-Point Technique for Lip Reshaping: A Safe, Minimalistic Approach in Over 500 Cases-A Retrospective Study.

Lip augmentation has become one of the most popular esthetic procedures globally, driven by societal standards that equate full lips with youth and sensuality. While young individuals often seek volume enhancement for lip beautification, older adults pursue lip rejuvenation to counter aging effects, such as volume loss, fine lines, and reduced definition. A range of techniques has been developed to meet these esthetic goals, but achieving natural and safe results remains a challenge.

Large, recursive membrane platforms are associated to Trop-1, Trop-2 and protein kinase signaling for cell growth.

The transmembrane glycoproteins Trop-1/EpCAM and Trop-2 independently trigger Ca and kinase signals for cell growth and tumor progression. Our findings indicated that Trop-1 and Trop-2 tightly colocalize at macroscopic, ruffle-like protrusions (RLP), that elevate from the cell perimeter, and locally recur over hundreds of seconds. These previously unrecognized elevated membrane regions ≥20 µm-long, up to 1.

Biomarkers.

Background: Different patterns of atrophy exist in the dementia stage of AD. However, little is known about the heterogeneity of atrophy patterns and the mechanisms that drive subsequent propagation of the disease in the preclinical stages.

Method: From the AMYPAD-PNHS cohort, we included a total of 1323 non-demented individuals, including 1094 amyloid-negative, and 229 amyloid-positive participants (Table 1).

Electrophysiological Signatures of Alpha Coma.

Purpose: Recent research on quantitative EEG in coma has proposed several metrics correlating with consciousness level. However, the heterogeneous nature of coma can challenge the generalizability of these measures. This study investigates alpha-coma, an electroclinical pattern characterized by a widespread, nonreactive alpha rhythm often linked to poor outcomes.