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INTRODUCTION:

Axillary sentinel lymph node excision (SLNE) in breast cancer patients with clinically node-negative disease may be carried out using different tracers. The standard tracer is technetium colloid ( 99m Tc). Indocyanine green (ICG) can be used as an alternative. This study aimed to evaluate the clinical usefulness of this fluorescent dye in a standardized setting.

MATERIAL AND METHODS:

A prospective, single-center cohort study carried out at the University Gynecological Hospital of Rostock from September 2023 to May 2024 carried out sentinel lymph node marking using only ICG in patients with breast malignancies. The ICG injection was administered immediately after the induction of anesthesia. Detection of the sentinel lymph node (SLN) was done using a laparoscopy system suitable for ICG. The aim was to determine the detection rate (DR) for SLNs marked exclusively using ICG and to record any complications. The costs of using ICG to mark SLNs were compared with those for 99m Tc marking.

RESULTS:

During the study period, contraindications against marking with ICG were ascertained for five (3.8%) of 132 patients with planned SLNE. A total of 100 SLNEs were carried out after ICG marking in patients who met the inclusion criteria in the context of the study. A median of two SLNs were resected. The detection rate (DR) for SLNs was 98.0%. SLNs were identified in all obese patients. No serious systemic side effects occurred following ICG injection. Transient skin discoloration in the area around the injection site were observed in eight patients. The direct cost of ICG marking was 62.73 Euros, which was 170.36 Euros lower than the cost of 99m Tc marking.

CONCLUSION:

The detection rate of axillary SLNs marked using ICG is high and the method is cost-effective, has few side effects and can also be used in obese patients. Contraindications against the administration of ICG are rare. Marking with ICG is a good alternative to the 99m Tc method and offers advantages in terms of costs, logistics, no exposure to radiation, and patient comfort.

Bone graft substitutes combining the mechanical features of poly-ε-caprolactone (PCL) and the bioactivity of β-tricalcium phosphate (β-TCP) have been widely reported in the literature. Surprisingly, however, very little is known about the incorporation of carbonate at a biomimicking level. The authors studied β-TCP/PCL composites at 20 wt.% and 40 wt.%, either enriched or not with sodium bicarbonate (at 2 wt.% and 4 wt.%), through SEM and EDX analyses; surface free energy estimation; pH measurement after 1, 2, and 3 days of incubation in cell media; nanoindentation; and a protein adsorption test with bovine serum albumin. The early biological response was assessed using adipose mesenchymal stem cells, as an established in vitro model, via cellular adhesion (20 min), spreading (24 h), and viability assays (1, 3, 7 days). By increasing the β-TCP content, the composites' hardnesses and Young's moduli (EiT) were improved, as well as their protein adsorption compared to neat PCL. Sodium bicarbonate increased the polar component of the surface energy, alkalinized the composite with a higher β-TCP content, and attenuated its early negative cell response. Further investigation is needed to deepen the knowledge of the mechanisms underpinning the mechanical features and long-term biological behavior.

Osteoarthritis is a common disease worldwide, most commonly affecting the knee. With the rise of obesity, paired with higher life expectancy, prevalence of osteoarthritis of the knee will rise as well. Therefore, Total Knee Arthroplasty (TKA) rates are expected to increase 85 %, estimating 1.26 million procedures worldwide in 2030. Patients will become older with demographic changes and more elderly people will be eligible for procedure, a patient group is often considered vulnerable, with a higher risk of mortality and complications. This systematic review aimed to compare perioperative outcomes after TKA in Octogenarians with those in a younger cohort. After screening 33,336 publications on total joint arthroplasty in the elderly in the PubMed and Web of Science databases, four studies investigating TKA and matching criteria were included. No notable variations in outcomes were detected among elderly compared to younger patients. Eligibility for a procedure should be based on comorbidities and overall health status rather than age alone.

Some studies indicate the role of TNF-α, IL-6, and IL-8 in the development of endometriosis. However, a comprehensive assessment of plasma, peritoneal, and endometrioma fluids of proinflammatory cytokine concentrations in women with ovarian endometriosis has not yet been performed. Therefore, this study aimed to analyze plasma, peritoneal, and endometrioma fluids for selected proinflammatory cytokine concentrations in women operated on for ovarian endometriosis. A retrospective study was conducted with 56 women who underwent surgery for ovarian endometriosis. Body mass, height, and waist circumference were measured, as well as BMI being calculated. Plasma, peritoneal, and endometrioma fluids' interleukin-6 (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-α) were determined by ELISA. Levels of IL-6 and TNF-α were significantly higher in endometrioma fluid compared to plasma and peritoneal fluid. In addition, levels of IL-6 and TNF-α were significantly higher in peritoneal fluid than found in plasma. Levels of IL-8 did not significantly differ between plasma and both peritoneal and endometrioma fluids, or between peritoneal and endometrioma fluids. There were also positive correlations among IL-6, IL-8, and TNF-α levels in endometrioma and peritoneal fluids (ρ = 0.29; p < 0.05; ρ = 0.51; p < 0.001; ρ = 0.52; p < 0.001, respectively). There were no associations between cytokine levels in plasma, peritoneal, and endometrioma fluids and endometriosis stage. Plasma IL-8 levels can be considered an emerging biomarker of severity of local inflammation related to endometrioma. Further studies are needed for understanding the role of IL-6 and TNF-α as the markers of local inflammation in endometrioma.

STUDY DESIGN:

Narrative review.

OBJECTIVE:

To explore the intersection of osteoporosis, sarcopenia, radiomics, and machine learning in spine surgery, with a focus on clinical applications and opportunities for advancing assessment and predictive modeling methods.

SUMMARY OF BACKGROUND DATA:

Osteoporosis and sarcopenia are significant contributors to negative outcomes in the aging adult spine. Current methodologies for evaluating these disease states remain limited, with significant variability and poor standardization. Advances in computational medicine provide a novel opportunity to improve quantitative assessment of osteosarcopenia, as demonstrated in other areas of medicine. Using radiomic approaches for predictive outcome modeling in spine surgery remains largely untapped.

METHODS:

A comprehensive literature search was performed. Articles were identified using the search terms "osteoporosis," "sarcopenia," "osteosarcopenia," "radiomics," "spine surgery," and "machine learning." Relevant studies were selected based on their focus on the intersection of these topics, emphasizing clinical, imaging, and computational methodologies in spine surgery.

RESULTS:

This review highlights the existing conventional and research methods of assessing both osteoporosis and sarcopenia, particularly regarding their clinical application in spine surgery. Areas of research within the radiomic space for both conditions are also discussed to describe opportunities for growth of future research and areas of focus needed to advance the field of spine surgery alongside the rapid growth of artificial intelligence.

CONCLUSION:

Understanding the relationship between osteoporosis, sarcopenia, and frailty is essential to improving outcomes in spine surgery. Advanced imaging and machine learning approaches offer the potential for more precise assessments and tailored interventions. The Scoliosis Research Society Adult Spinal Deformity Task Force on Senescence has identified this as an area of maximal importance for strategic growth and development of the field.

Glofitamab, a CD20-directed CD3 T-cell engager, was recently FDA-approved after demonstrating a 52% overall response rate (ORR) and a 39% complete response (CR) rate in heavily pretreated diffuse large B-cell lymphoma (DLBCL) patients. However, real-world data on its efficacy and safety remain limited. This study evaluated glofitamab's performance in clinical practice. We conducted a retrospective multicenter study of adults with relapsed/refractory (R/R) DLBCL treated via a national compassionate use program. Patients received at least one dose of glofitamab after failing ≥ 2 prior therapies. Recruitment spanned September 2020-January 2023. Outcomes included ORR, CR (per Lugano criteria), progression-free survival (PFS), and overall survival (OS). Adverse events were classified per ASTCT 2019 criteria, and risk factors for PFS and OS were assessed via logistic regression. Thirty-five patients from six Israeli centers were included (median age: 67 years; 66% male). The median number of prior therapies was 5, with 43% being primary refractory and 91% post-CAR-T therapy. ORR was 34%, with 14% achieving CR. Median PFS and OS were 2 and 4 months, respectively. Treatment was prematurely discontinued in 86%, mainly due to disease progression (46%) and to infections in responding patients (17%). Male sex was a significant risk factor for poor PFS and OS. In this real-world cohort, glofitamab's efficacy was lower than in clinical trials, likely due to a more heavily pretreated population. However, its manageable toxicity supports its potential role in r/r DLBCL treatment.

Background/Objectives: To assess the incidence and factors associated with urethral stricture following monopolar transurethral resection of the prostate (mTURP) and open simple prostatectomy (OSP) over a 21-year period. Methods: We conducted a retrospective cohort study of adult male patients insured by Clalit Health Services in Israel, who underwent either mTURP or OSP at multiple centers. Key baseline characteristics, including age, body mass index (BMI), socioeconomic status, Charlson comorbidity index score, and the incidence of urethral stricture, were collected. Postoperative urethral strictures were identified using the ICD-10 code N35.9 (urethral stricture, unspecified). Results: Between January 2000 and December 2021, 54,872 patients underwent simple prostatectomy across 29 hospitals, with 43,525 (79%) undergoing mTURP and 11,347 (21%) undergoing OSP. The median age of patients undergoing mTURP was 73.6 years, while those undergoing OSP had a median age of 72.1 years (p < 0.0001). The incidence of urethral strictures was 1.15% (500) following mTURP and 0.538% (61) following OSP, with an incidence rate ratio (IRR) of 2.139 (p < 0.0001). On multivariable analysis, factors associated with the development of urethral stricture included the type of procedure (HR = 2.349, 95% CI.: 2.081-2.653, p < 0.0001), older age at surgery (HR = 1.012, 95% CI.: 1.007-1.018, p < 0.0001), higher Charlson Index score (HR = 1.128, 95% CI.: 1.109-1.148, p < 0.0001), and lower BMI (HR = 0.990, 95% CI.: 0.982-0.999, p = 0.027). Conclusions: Our study highlights a higher incidence of urethral stricture following mTURP compared to OSP. Additionally, older age and a higher Charlson comorbidity index were associated with increased risk of stricture development postsurgery.

INTRODUCTION:

Treatment targets can be considered the threshold where treatments generate optimal health outcomes while causing minimal complications. Treatment targets often uses a surrogate measure for the disease process, but are linked with an important outcome of disease management. Unlike chronic diseases such as type 1 diabetes, type 2 diabetes, hypertension, and dyslipidemia, which have clear treatment targets, obesity management lacks defined therapeutic targets. Insights from other chronic diseases may improve patient outcomes. They guide care, assess therapy response, and reduce complications.

AREAS COVERED:

This article explores how treatment targets for diabetes, hypertension, and dyslipidemia were developed, drawing on a narrative review of literature from 1950 to 2025 using PubMed and Embase. It examines how similar principles could inform obesity treatment, proposing early hypotheses like BMI ≤ 27 kg/m2 and WHtR < 0.53 that warrant future validation.

EXPERT OPINION:

Targets in chronic disease care reduce complications. While not yet validated, BMI ≤ 27 kg/m2 and WHtR < 0.53 May serve as early anchors for structured obesity treatment strategies.

Background/Objectives: Colorectal cancer is a significant health problem worldwide. Surgery is the primary curative treatment for most colorectal cancers. Cardiopulmonary exercise testing is now performed widely before surgery, and it is the most objective and precise means of evaluating pre-surgical physical fitness. Also, we can use the 6 min walk test to measure cardiorespiratory fitness before surgery. Methods: We included colorectal patients who were awaiting open abdominal or laparoscopic surgery. After admission to the hospital, patients who signed informed consent forms fulfilled a short questionnaire about health and physical status, preoperative physical activities, and quality of life questionnaire (EORTC QLQ-C30). Patients performed a 6 min walk test (6MWT) 2 days before surgery and 7 days after surgery. 6MWT is a tool for measuring the functional status of fitness. Also, they fulfilled the quality of recovery questionnaire (QoR 15) 7 days after surgery. Results: In a final analysis, we included 72 patients with a mean age of 62.48. We compared the number of steps, walk distance, average and maximal walk speed, and average and maximal heart rate before and after surgery, overall, and by group. Our findings show a statistically significant difference between men and women in the walk distance (F = 4.99, p = 0.02) The number of steps showed a statistically significant difference according to patients' ages (F = 2.90, p = 0.02). Also, we detected differences in the average and maximum heart rate during walking when comparing body mass index (average heart rate F = 5.72, p = 0.00, maximum heart rate F = 2.52, p = 0.04). Conclusions: Our study provides evidence that average and maximal heart rate during the 6 min walk test was higher in the postoperative period, especially in overweight and obese participants.