Surgical approach in lung transplantation may significantly impact postoperative respiratory mechanics, yet its effects on ventilation and recovery are not fully defined. This study compares the clamshell incision and thoracotomy in lung transplant recipients, focusing on their effects on postoperative pain, ventilatory support, and opioid requirements. We hypothesize that incision type affects respiratory recovery through differences in postoperative pain, which may impair ventilation and prolong mechanical support. Preliminary data suggest that thoracotomy, which involves intercostal nerve disruption and increased pain, is associated with higher opioid consumption and longer durations of ventilatory support compared to clamshell incision. These patients experience delayed extubation and slower recovery of independent respiration. Adjunct pain management strategies, such as regional anesthesia, may partially mitigate these effects. Primary outcomes include postoperative pain scores and opioid consumption (measured in morphine equivalents). Secondary outcomes include time to extubation, duration of mechanical ventilation, and hospital length of stay. Multivariate regression adjusts for confounders such as age, underlying pulmonary diagnosis, transplant type, and surgeon variability. This study highlights the role of surgical incision in postoperative recovery and suggests that incision choice may impact ventilation and opioid use, offering insights for perioperative care in lung transplant recipients.

Epidural steroid injections (ESIs) are widely used for lumbar radiculopathy, but long-term outcomes in patients needing repeat injections are unclear. This retrospective propensity score–matched cohort study compared single versus multiple ESIs in adults aged 18–80 treated from 2015–2020, excluding spondylolisthesis and lumbar stenosis. Patients received either one ESI or ≥2 injections spaced ≥3 months apart. Primary outcomes were lumbar discectomy and interbody fusion within 5 years; secondary outcomes included opioid use, opioid use disorder, chronic pain, imaging, emergency visits, anxiety, depression, and foot drop. After matching, 16,520 patients were included per group. At 1 year, multiple ESIs were associated with lower discectomy rates (4.5% vs 5.7%, p<0.001), but rates were similar by 5 years (6.8% vs 6.5%, p=0.30). Fusion rates increased over time in the multiple ESI group (5.2% vs 3.4%, p<0.001). Among nonoperative patients (n=14,776 per group), multiple ESIs were linked to higher 5-year rates of opioid use, opioid use disorder, chronic pain, imaging, emergency visits, anxiety, and depression (all p<0.001), with no difference in foot drop. Overall, multiple ESIs were associated with greater fusion use and higher healthcare utilization, likely reflecting differences in disease course rather than a direct causal effect.

Triple-negative breast cancer (TNBC) lacks expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, rendering it largely unresponsive to existing targeted therapies and underscoring the need for delivery platforms that achieve targeted uptake while minimizing systemic toxicity. Affibody-based nanostructures introduce a unique mechanism of action for targeted drug delivery, making them an attractive platform for TNBC and other receptor-defined cancers. We engineered a nanocomplex consisting of high-affinity EGFR-binding affibodies conjugated to a DNA tetrahedron scaffold (4z1-DOX) for targeted delivery of doxorubicin (DOX). The construct was characterized for high drug-loading capacity, receptor-mediated internalization, and cytotoxic activity across EGFR-expressing cancer cell lines. 4Z1-DOX entered cells through an affibody-dependent, receptor-mediated pathway that directed the nanocomplex to lysosomal compartments, enabling controlled intracellular DOX release. This mechanism, while distinct from the passive uptake of free DOX, induced apoptosis and reduced proliferative capacity in cancer cell models. 4Z1-DOX enables receptor-mediated intracellular delivery of doxorubicin through a linker-free nanocomplex design, resulting in effective cytotoxicity. Its high drug-to-carrier ratio and elimination of chemical conjugation constraints highlight key advantages over conventional antibody–drug conjugates, supporting its potential as a more efficient targeted delivery platform.

This abstract has been withheld from publication.

Multiple myeloma is a rare, incurable cancer that affects plasma cells within bone marrow. The disease progresses from a premalignant to overt stage, with a general onset of symptoms including anemia, renal failure, bone lesions, and hypercalcemia. Popular therapeutic approaches to target the disease include manipulating aspects of the tumor microenvironment (TME) to render tumor cells vulnerable under unfavorable conditions. Characteristics of the TME vary with cancer type, host immune status, and therapeutic intervention. A targeted literature review on tumor metabolism, the Warburg effect, and extracellular acidosis was conducted. Established murine models were also evaluated for their ability to replicate hypoxic and acidic bone marrow conditions relevant to testing pH-directed therapies. Past research has specifically emphasized the role of extracellular acidity in the TME. Given what is known about the Warburg effect, it can be recognized that the TME conditions that favor tumor progression include an intracellular alkaline pH, which stimulates cell proliferation, and extracellular matrix acidity, which blocks immunologic attacks against malignant cells and prevents drug entry into the tumor. Therefore, this research proposes a mouse model that supports the development of a treatment focused on reducing the pH of the intracellular TME while maintaining an alkaline extracellular environment to protect bone lesions from corrosion, demineralization, and structural instability.