Search Results (98)

Background/Objectives: Spinal cord stimulation (SCS) is an established therapy for chronic pain, but uncertainties remain regarding long-term real-world outcomes and the role of standardized selection pathways. This study aimed to evaluate real-world, longitudinal outcomes of SCS over 24 months within a structured clinical pathway, focusing on pain intensity, neuropathic symptoms, and health-related quality of life. Methods: A single-center, retrospective observational cohort study was conducted at the Fondazione Istituto G. Giglio (Cefalù, Italy). Data were drawn from the continuing, prospective institutional “SCS Pathway” and included consecutive patients implanted between May 2021 and September 2024. Eligible patients were ≥18 years of age with chronic pain refractory to conventional medical management. Outcomes included pain intensity (VAS, visual analog scale), neuropathic features (DN4, douleur neuropathique 4), and health-related quality of life (EQ-5D, EuroQol 5 Dimensions), assessed at baseline and 3, 6, 12, 18, and 24 months post-implantation. Multilevel models with full information maximum likelihood (FIML) were applied to repeated measures. Results: Seventy-six patients were included (mean age 67.3 ± 10.3 years; 39.5% female). The most frequent diagnoses were post-surgical pain syndrome (42.1%, 32/76) and chronic back and leg pain (40.8%, 31/76). 42.1% (32/76) had previous spine surgery, and 78.9% (60/76) reported neuropathic pain. Across 452 observations, mean VAS scores decreased from 7.9 ± 0.7 at baseline to 3.1 ± 1.1 at 3 months (61% reduction, p < 0.001), with sustained benefit at 24 months (4.5 ± 1.5; 43% reduction, p < 0.001). DN4 scores improved from 7.4 ± 0.8 to 3.2 ± 1.0 at 3 months (56% reduction, p < 0.001), with persistent decreases at 24 months (4.2 ± 1.2; 43% reduction, p < 0.001). EQ-5D improved from 22.8 ± 6.6 at baseline to 70.2 ± 10.6 at 3 months (increase of 208%, p < 0.001), with clinically meaningful gains sustained at 24 months (55.4 ± 13.7, increase of 143%, p < 0.001). Conclusions: In this real-world cohort, SCS therapy results in sustained, clinically significant improvements in pain, neuropathic symptoms, and quality of life. Findings highlight the value of structured selection and follow-up pathways. These data provide a benchmark for multicenter studies linking standardized referral frameworks to long-term, patient-centered outcomes. Full article

Background: As survival rates among breast cancer (BC) patients continue to rise, Emotional Functioning (EF)—has become increasingly clinically relevant; however, researchers have yet to fully characterize its long-term, dynamic trajectories following surgery. This systematic review and meta-analysis aimed to (1) characterize the longitudinal trajectories of EF after BC surgery and (2) examine the moderating effects of surgical modality and age. Methods: We conducted this systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. We synthesized data from studies published between 2000 and 2024 that assessed EF using the EORTC QLQ-C30 at multiple post-surgical time points. Using multilevel random-effects meta-analytic models, we examined EF trajectories across 116 effect sizes derived from 40 studies, and evaluated time, surgical modality (breast-conserving surgery (BCS), mastectomy (MA), mastectomy with immediate reconstruction (Mx + IR) and age group as moderators. Results: The overall pooled estimate for EF was 73.44 (95% CI: 70.29–76.58, p < 0.001). Time since surgery significantly influenced EF: scores were lowest during the initial 6 months (66.82, 95% CI: 59.75–73.89), peaked at 7–15 months (77.86, 95% CI: 74.51–81.22) and 31–54 months (77.52, 95% CI: 70.44–84.59), and showed lower values at 16–30 months (72.58, 95% CI: 61.45–83.72) and 55–72 months (69.81, 95% CI: 64.08–75.54). Surgical modality significantly shaped these trajectories (p = 0.013). The overall pooled estimate for EF was 73.44 (95% CI: 70.29–76.58, p < 0.001). Time since surgery significantly influenced EF: scores were lowest during the initial 6 months (66.82, 95% CI: 59.75–73.89), peaked at 7–15 months (77.86, 95% CI: 74.51–81.22) and 31–54 months (77.52, 95% CI: 70.44–84.59), and showed lower values at 16–30 months (72.58, 95% CI: 61.45–83.72) and 55–72 months (69.81, 95% CI: 64.08–75.54). Surgical modality significantly shaped these trajectories (p = 0.013). The BCS group showed a significant inverted-U trajectory in EF scores, with a positive linear slope (β = 1.22, SE = 0.50, p = 0.046) and a small negative quadratic term (β = −0.02, SE = 0.01, p = 0.046), indicating initial improvement followed by decline. A similar pattern was observed for MA, where the linear term (β = 1.19, SE = 0.51, p = 0.054) and quadratic curvature (β = −0.02, SE = 0.01, p = 0.054) suggested an early rise with subsequent decline. In contrast, Mx + IR displayed a high intercept (β = 71.46, SE = 4.46, p < 0.001) but no significant trajectory over time (p = 0.582), indicating stability. The 45–60 year group demonstrated a significant inverted-U trajectory in EF scores, with a positive linear coefficient (β = 0.87, SE = 0.38, p = 0.067) and a negative quadratic coefficient (β = −0.01, SE = 0.01, p = 0.067), suggesting an early rise in emotional functioning followed by a subsequent decline. Participants <45 years also showed a significant inverted-U pattern, starting from a moderately high baseline (β = 67.56, SE = 4.26, p < 0.001) with a positive linear slope (β = 0.82, SE = 0.34, p = 0.051) and a negative quadratic curvature (β = −0.01, SE = 0.01, p = 0.051). In contrast, the >60 year group reported the highest baseline scores (β = 75.60, SE = 5.18, p < 0.001) with no significant trajectory, indicating overall stability. These findings confirm that EF follows a significant inverted-U trajectory (p < 0.001) and is influenced by time, surgical modality, and age. Full article

Background: Surgical site infections (SSIs) following spinal and thoracic procedures are associated with prolonged hospitalization and increased morbidity, with incidence rates of 2–15% in spinal surgery and 3–12% in thoracic procedures. Multiple patient-related and procedure-specific factors contribute to wound complications, including diabetes mellitus, obesity, smoking, extended surgical time, excessive tissue dissection, and hardware implantation. Implementing evidence-based prevention and early intervention strategies is essential in high-risk surgical cohorts. Methods: This narrative review followed searches in PubMed, Scopus, ScienceDirect, Cochrane Library, and Embase for studies published between January 2000 and October 2025. Eligible peer-reviewed articles examined SSI incidence, risk factors, or prevention strategies in adult patients undergoing thoracic or spinal surgery. Data extraction focused on operative parameters, antibiotic prophylaxis regimens, negative-pressure wound therapy (NPWT) use, and patient outcomes. Results: Evidence from found recent studies was synthesized. Key findings demonstrated that operative duration > 4 h increased SSI odds by 41% per additional hour, and blood loss > 500 mL doubled infection risk. Prophylactic NPWT reduced deep SSI rates by 50% in high-risk patients (BMI ≥ 35, diabetes, multilevel instrumentation). Intrawound vancomycin powder reduced deep SSIs by 50–60%, particularly in multilevel fusions. Administering prophylactic antibiotics within 30 min of incision was significantly more effective than at 60 min, with a 23% relative risk reduction. Weight-adjusted antibiotic dosing in obese patients lowered SSI rates from 5.1% to 2.9%. Conclusions: Operative parameters strongly predict SSI risk. An integrated risk- and evidence-based approach to wound management following spinal and thoracic surgeries—combining optimized antibiotic prophylaxis, risk-stratified NPWT application, and operative technique modifications—can significantly reduce SSI incidence. Successful implementation requires institutional commitment, multidisciplinary collaboration, and continuous quality improvement to optimize patient outcomes. Full article

Objective: To identify facilitating and hindering factors for implementing a care transition strategy for adult patients undergoing elective colorectal cancer surgery, within a primary health care (PHC) context, addressing gaps in the literature on implementation challenges and contextual factors influencing such strategies. Methods: This complex mixed methods study combined a randomized clinical trial (RCT) and a qualitative component within an Implementation Research framework. The RCT enrolled adult patients with colorectal cancer, while the qualitative phase included a multilevel sample of participants. Iterative data integration occurred throughout the planning, implementation, and evaluation phases. The intervention was assessed using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. Statistical analyses were conducted using IBM SPSS Statistics 22.0, applying descriptive and inferential methods. Results: Our findings revealed that the adoption of the intervention was satisfactory; however, Reach, Efficacy, and Implementation were not achieved. Facilitating factors included recognition of the potential of the care transition strategy to improve patient outcomes, and the intervention’s feasibility, replicability, and low cost. The main hindering factors identified included poor communication between care levels, inadequate material resources, and high workload. Integration of qualitative insights helped explain the limited quantitative impact, highlighting contextual challenges during the COVID-19 pandemic. Conclusions: The care transition strategy was well accepted by participants and health care providers, demonstrating potential to strengthen continuity of care between hospital and PHC services. Nonetheless, significant organizational and resource-related barriers hindered its effectiveness. Future studies are required to adapt transitional care models to overcome communication gaps, optimize resource allocation, and enhance implementation in similar settings. Full article

Background: Massive intraoperative blood loss (IBL) is a serious complication in complex spine surgeries such as deformity correction, multilevel fusion, tumor resection, and revision procedures. While no strict definition exists, blood loss exceeding 1500 mL or 20% of estimated blood volume is generally considered clinically significant. Excessive bleeding increases the risk of hemodynamic instability, transfusion-related complications, postoperative infection, and prolonged hospitalization. Methods: This narrative review summarizes the current understanding of the incidence, risk factors, anatomical vulnerabilities, and evidence-based strategies for managing IBL in spine surgery through comprehensive literature analysis of recent studies and clinical guidelines. Results: Key risk factors include patient characteristics (anemia, obesity, advanced age, medication use), surgical variables (multilevel instrumentation, revision status, operative time), and pathological conditions (hypervascular tumors, severe deformity). Perioperative medication management is critical, requiring discontinuation of NSAIDs (5–7 days), antiplatelet agents (5–7 days), and NOACs (48–72 h) preoperatively to minimize bleeding risk. The thoracolumbar junction and hypervascular spinal lesions are especially prone to bleeding due to dense vascular anatomy. Evidence-based management strategies include comprehensive preoperative optimization, intraoperative hemostatic techniques, antifibrinolytic agents, topical hemostatic products, cell salvage technology, and structured transfusion protocols. Conclusions: Effective management of massive IBL requires a multimodal approach combining preoperative risk assessment and medication optimization, intraoperative hemostatic strategies including tranexamic acid administration, advanced monitoring techniques, and coordinated transfusion protocols. Particular attention to perioperative management of anticoagulant and antiplatelet medications is essential for bleeding risk mitigation. Understanding patient-specific risk factors, surgical complexity, and anatomical considerations enables surgeons to implement targeted prevention and management strategies, ultimately improving patient outcomes and reducing complications in high-risk spine surgery procedures. Full article

Background and Objectives: Surgical treatment is central to breast cancer management; however, its long-term impact on QoL varies substantially among patients. This study sought to model the dynamic trajectories of postoperative QoL following breast-conserving surgery (BCS), mastectomy with immediate reconstruction (Mx+IR), and mastectomy alone (MA). It also examined how these trajectories varied across different age groups and over time. Materials and Methods: The review and meta-analysis identified 150 peer-reviewed studies reporting QoL outcomes using validated instruments (EORTC QLQ-C30 or BREAST-Q). A total of 123 observations from 45 studies were included for analysis of global QoL. We standardized QoL scores to a 0–100 scale and harmonized postoperative assessments across six time intervals, extending to more than 73 months. Multilevel random-effects models evaluated linear, quadratic, and logarithmic functions. Subgroup analyses and meta-regressions assessed the moderating effects of surgical type and age. Results: BCS showed the steepest QoL gains, followed by Mx+IR, while MA had the lowest scores and slowest recovery. Compared to BCS, MA showed significantly poorer and delayed recovery, and Mx+IR showed a smaller, borderline decrease. All groups displayed modest long-term QoL plateauing. Conclusions: Global QoL after breast cancer surgery follows distinct, time-dependent patterns shaped by surgical approach and age. These findings emphasize the importance of discussing patients’ quality-of-life expectations with them so that survivorship care can be personalized to their needs. Full article

Background: Cerebral palsy (CP) is a static, non-progressive brain pathology that affects mobility and musculoskeletal health. Objective: This review aims to describe the pediatric orthopedic management strategy at one specialty center with focus on optimal lifelong mobility function for ambulatory CP. Methods: Beginning in the 1990s, a protocol was developed to proactively monitor children with surgical or conservative interventions. After three decades, we undertook a prospective institutional review, board-approved 25–45-year-old adults callback study. Inclusion criteria were all children treated through childhood who could be located and were willing to return for a full evaluation. Results: Pediatric orthopedic interventions focused on regular surveillance with proactive treatment of progressive deformities. When function was impacted, we utilized multi-level orthopedic surgery guided by instrumented gait analysis. Childhood outcomes of this approach were evaluated through retrospective studies. Results show high correction rates were achieved for planovalgus foot deformity, knee flexion contracture, torsional malalignments, and stiff-knee gait. Our prospective adult callback study evaluated 136 adults with CP, gross motor function classification system levels I (21%), II (51%), III (22%), and IV (7%), with average ages of 16 ± 3 years (adolescent visit) compared with 29 ± 3 years (adult visit). Adults in the study had an average of 2.5 multi-level orthopedic surgery events and 10.4 surgical procedures. Compared with adults without disability, daily walking ability was lower in adults with CP. Adults with CP had limitations in physical function but no increased depression. A higher frequency of chronic pain compared with normal adults was present, but pain interference in daily life was not different. Adults demonstrated similar levels of education but higher rates of unemployment, caregiver needs, and utilization of Social Security disability insurance. Conclusions: The experience from our center suggests that consistent, proactive musculoskeletal management at regular intervals during childhood and adolescence may help maintain in gait and mobility function from adolescence to young adulthood in individuals with CP. Full article

Objectives: The goal of this longitudinal study was to explore how gastrointestinal-symptom distress and benefit finding together influence health-related quality of life (HRQOL) over time in colorectal cancer (CRC) survivors. Colorectal cancer (CRC) survivorship may differ from other cancer types due to the persistent burden of gastrointestinal symptoms. The highly visible and socially sensitive nature of these sequelae may influence the trajectory of benefit finding compared with other cancers. Specifically, we explored whether increases in symptom distress predicted declines in physical and mental HRQOL whether benefit finding was directly related to or buffered the negative impact of symptom distress on HRQOL. Methods: Participants were 73 Taiwanese women and men who underwent surgery for CRC. Using a three-time-point, multilevel framework, participants were assessed at 1, 3, and 6 months after surgery. Hierarchical linear modeling was used to investigate whether gastrointestinal-symptom distress and benefit finding covary over time with HRQOL. Results: The results indicated that increases in gastrointestinal-symptom distress were linked to declines in both physical and mental HRQOL. Benefit finding had no direct association with HRQOL but significantly moderated the symptom-HRQOL relationship, weakening the negative impact of symptom distress among those with higher benefit finding. Conclusions: Rises in a CRC survivor’s gastrointestinal-symptom distress went hand-in-hand with drops in both physical and mental HRQOL. This study adds to the literature in that benefit finding has a favorable effect on cancer adjustment when patients face higher symptom distress after the surgery and treatment. Further implications on possible mechanisms were discussed. Full article

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

Objectives: Several conditions associated with type A aortic dissection may require preoperative invasive mechanical ventilation (IMV). The current literature lacks data on this subset of patients’ prevalence and postoperative outcomes. This study aims to investigate this unexplored issue in a multicenter European registry. Methods: Data from 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD) were the subject of this analysis. Bootstrapped Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was performed for variable selection to identify key predictors of hospital death. In the second step, a multilevel multivariable logistic regression (MMLR) was carried out, given the clustered structure of the data. Results: A total of 346 (9.3%) out of 3735 patients required preoperative IMV. Compared to the non-IMV patients, patients requiring IMV had a significantly higher rate of organ malperfusion (52% vs. 35%, p < 0.001) and a higher proportion of tears in the aortic root (p = 0.048). The in-hospital mortality rate among IMV patients was 38% vs. 15% in non-IMV patients (p < 0.001), without a difference in post-discharge survival (p = 0.84). At the MMLR, patients who required IMV had 135% higher odds of in-hospital death compared to the remaining patients. IMV yielded the second highest odds in the prediction model for in-hospital mortality (OR 2.13, CI 1.60 to 2.85, p < 0.001). Among IMV patients, the extension of surgery to the aortic arch was significantly associated with increased in-hospital mortality (p < 0.001, OR 2.98). In multivariable analysis, preoperative IMV was independently associated with increased odds of in-hospital mortality. Conclusions: The need for invasive mechanical ventilation before surgical repair for type A aortic dissection is not infrequent. In this subpopulation, the in-hospital mortality rate was twofold compared to patients who did not require IMV. The awareness of the preoperative risk profile and outcomes of this subset of patients should urge surgeons to tailor the surgical strategy more appropriately to improve the immediate postoperative results. Full article

This study explores the change in inflammatory markers over the course of neoadjuvant chemoradiation and adjuvant chemotherapy for LARC and assesses the association with clinicopathological factors at pre-specified time-points. We examined the trends of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), carcinoembryonic antigen (CEA), fibrinogen, and albumin through multilevel modelling of 29 prospective LARC patients across six time-points: before neoadjuvant chemoradiation (T1), week 3 of chemoradiation (T2), post-chemoradiation (T3), post-surgery (T4), midpoint of adjuvant chemotherapy (T5), and chemotherapy completion (T6). Variables collected included ethnic background, body mass index (BMI), smoking status, and pathological responses graded by Ryan tumour regression grade and pathological tumour and nodal status. NLR and PLR demonstrated an increasing trend during chemoradiation. Median CEA was highest at baseline and lowest at T4. The highest median values for NLR, PLR, CRP, and fibrinogen were at T4. Smokers demonstrated a trend towards a higher NLR compared to non-smokers. NLR was significantly higher in Caucasians compared to Asians at T2. Patients with pathological node-negative status had a higher NLR at T5 and T6 and a higher PLR at T1, T3, T5 and T6. Overall, inflammatory indices change dynamically throughout treatment and vary with clinicopathological factors. Full article

In modern surgery, the internal fixation plates fabricated from hydroxyapatite/poly(L-lactide) (HA/PLLA) composites encounter clinical limitations in fracture treatment due to their inadequate mechanical properties. In this work, pressure-induced flow (PIF) technique is employed to address this limitation. Under optimal processing conditions (140 °C and 250 MPa), the HA/PLLA composites exhibit an impressive flexural strength of 199.2 MPa, which is comparable to that of human cortical bone, the strongest bone tissue in the body. The tensile strength and the notched Izod impact strength are close to 84.2 MPa and 16.7 kJ/m², respectively. Meanwhile, the HA/PLLA composites develop multi-level stacked crystal layers during PIF processing, accompanied by increases in crystallinity (53.1%), crystal orientation (81.6%) and glass transition temperature (78.8 °C). After 2 months of in vitro degradation, the HA/PLLA composites processed by the PIF technique still maintain considerable flexural strength (135.3 MPa). The excellent mechanical properties of HA/PLLA composites processed by PIF technique expand their potential as an internal fixation plate. Full article

Background: Surgical residents are a high-risk population for burnout, yet no studies have assessed its prevalence among thoracic surgery residents in Europe or Italy. Methods: A nationwide cross-sectional survey was conducted among Italian thoracic surgery residents to assess burnout and quality of life. The Maslach Burnout Inventory measured burnout risk, while tailored questions evaluated quality of life. Univariate and multivariable analyses identified burnout risk factors, and χ² tests explored relevant associations between variables. Results: Of 193 eligible residents, 98 (50.8%) completed the survey. High burnout risk was identified in 60.2% of respondents. Independent risk factor associations between burnout risk and low perceived inclusion and aggregation, low colleague quality, low residency program rating, low personal life satisfaction, perceived lack of valorization, and exposure to sexual harassment were not significant in multivariable models. No differences in burnout risk were found across gender, geographic location, or training year. Conclusions: Burnout among Italian thoracic surgery residents underscores systemic challenges such as excessive administrative demands, insufficient mentorship, limitations to self-care, and gaps in theoretical training. Addressing these issues requires comprehensive reforms, including curriculum enhancement, strengthened mentorship, improved administrative support, and accessible mental health resources. A multi-level intervention strategy is essential to enhance resident well-being and training quality. Full article

Background: Lung cancer is the leading cause of cancer-related mortality in the United States, which disproportionately affect racial and ethnic minorities. Disparities in lung cancer screening, diagnosis, treatment, and survival outcomes are due to a complex interplay of socioeconomic factors, structural racism, and limited access to high-quality care. This review aims to examine the underlying causes of these disparities and explore potential mitigation strategies to improve lung cancer care equity. Methods: A review of the literature was conducted, evaluating racial and ethnic disparities in lung cancer care. Disparities in lung cancer screening, genomic testing, surgical and systemic treatment, and survival were explored. Additionally, interventional strategies such as risk-based screening, patient navigation programs, and policy reforms were examined. Results: Racial and ethnic minority patients are diagnosed at younger ages with fewer pack-years yet are less likely to qualify for screening under current guidelines. They receive lower rates of guideline-concordant treatment, including surgery, radiation, chemotherapy, and biomarker testing, and have reduced access to specialty care. Socioeconomic barriers, medical mistrust, and geographic disparities further contribute to these inequities. Targeted interventions, including mobile screening programs, financial assistance initiatives, and culturally competent care, have shown promise in improving lung cancer outcomes. Conclusion: A multi-level approach, incorporating healthcare policy changes, improved screening criteria, and an enhanced community engagement strategy, is essential for achieving equitable lung cancer care, ultimately improving outcomes for racial minority populations. Full article

Introduction: Advanced magnetic resonance imaging (MRI) techniques in neuroplasticity evaluations provide important information on stroke disease and the underlying mechanisms of neuronal recovery. It has been observed that gray matter density or volume in brain regions closely related to motor function can be a valuable indicator of the response to treatment. Objective: To compare structural MRI-evaluated gray matter volume changes in patients with post-stroke upper limb spasticity for >1 year between those undergoing surgery and those treated with botulinum toxin A (BoNT-A) and to relate these findings to upper limb function and quality of life outcomes. Materials and Methods: Design. A two-arm controlled and randomized clinical trial in patients with post-stroke upper limb spasticity. Participants. Thirty post-stroke patients with spastic upper limbs. Intervention. Participants were randomly assigned (1:1 allocation ratio) for surgery (experimental group) or treatment with BoNT-A (control group). Main outcome measures. The functional parameters were analyzed with Fugl-Meyer, Zancolli, Keenan, House, Ashworth, pain visual analogue, and hospital anxiety and depression scales. Quality of life was evaluated using SF-36 and Newcastle stroke-specific quality of life scales. The carer burden questionnaire was also applied. Clinical examinations and MRI scans were performed at baseline and at six months post-intervention. Correlations between brain volume/thickness and predictors of interest were examined across evaluations and groups. Results: Five patients were excluded due to the presence of intracranial implants. Eleven patients were excluded from analyses since they were late dropouts. Changes were observed in the experimental group but not in the control group. Between baseline and six months, gray matter volume was augmented at the hippocampus and gyrus rectus and cortical thickness was increased at the frontal pole, occipital gyrus, and insular cortex, indicating anatomical changes in key areas related to motor and behavioral adaptation These changes were significantly related to subjective pain, Ashworth spasticity scale, and Newcastle quality of life scores, and marginally related to the carer burden score. Conclusions: The structural analysis of gray matter by MRI revealed differences in patients with post-stroke sequelae undergoing different therapies. Gray matter volume and cortical thickness measurements showed significant improvements in the surgery group but not in the BoNT-A group. Volume was increased in areas associated with motor and sensory functions, suggesting a neuroprotective or regenerative effect of upper limb surgery. Full article