This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Surgery is a critical function of the healthcare system, key to addressing a substantial portion of the global disease burden. The integration of advanced artificial intelligence (AI) and robotics ecosystems into the operating room (OR) promises to radically transform surgery, with profound implications. This article analyzes the current state of surgical AI and robotic systems; presents a vision for their future, highlighting technological and research challenges and their associated impact on surgical teams; and discusses the ethical and regulatory implications. AI systems will use complex, multimodal data streams collected from patients, surgical teams, robots, and the OR environment to become increasingly capable of situational awareness, workflow recognition, performance benchmarking, causal inference, outcome prediction, and intraoperative decision-making to optimize surgical actions. Robotics will move from passive instrument-handling tools to autonomous systems with human-in-the-loop control, with embodied AI and enhanced sensor-based perception providing comprehensive spatial–temporal understanding, anticipatory behaviors, and adaptive learning. The surgeon’s role will shift toward supervision, coordination, and high-level decision-making, while nurses, assistants, and anesthesiologists will have additional competencies complemented by clinical data scientists and AI and robotic integration engineers. Ethical challenges will include liability and the implications of diluted authority chains, the potential for AI bias to exacerbate health inequalities, and the concentration of research and industry in resource-rich nations. New regulatory and compliance frameworks, trial methods, reporting standards, and training approaches will be needed to ensure the safety and effectiveness of these systems. Ultimately, AI and robotics should sustain, rather than disrupt, surgical practices by refining the skills of care providers to achieve true personalized surgery and propel procedural and technological advancements.
Teclistamab is the first approved anti-B-cell maturation antigen (BCMA) bispecific antibody for patients with triple-class exposed relapsed/refractory multiple myeloma (RRMM), based on the results of the MajesTEC-1 clinical trial. Here, we first report the findings from REALiTEC, a retrospective observational study of patients who received teclistamab outside of clinical trials in Europe and Israel. The study included 113 patients from 23 sites in eight countries, with most (88.5%) accessing the medication through pre-approval access programs. The median age was 66 years, and patients had a median of 6 prior lines of therapy. Notably, 78.8% were triple-class refractory, 44.2% penta-class refractory, and 35.4% had previous anti-BCMA treatment. Overall response rate (ORR) was 60.2%, with 52.2% of patients achieving a very good partial response or better (≥VGPR). After a median follow-up of 20.7 months, median duration of response (DOR) was 20.3 months, median progression-free survival (PFS) was 9.7 months, and median overall survival (OS) was 26.3 months. Patients attaining ≥VGPR experienced longer DOR (median 26.1 months), with 12-month PFS and OS rates of 71.2% and 83.1%, respectively. Subgroup analyses demonstrated consistent outcomes across different patient groups, even in those with historically poorer outcomes. Most common adverse events were infections (all grades 70.8%), cytokine release syndrome (55.8%), neutropenia (35.4%), and anemia (25.7%), with no new safety signals identified. Infection rates decreased over time, and immunoglobulin replacement therapy was used in up to 60% of patients. REALiTEC corroborates the efficacy observed in the MajesTEC-1 study, supporting teclistamab as an effective treatment option in heavily pre-treated RRMM patients.
Background: Numerous studies have shown robotic-assisted thoracoscopic surgery (RATS) to be a safe alternative to video-assisted thoracoscopic surgery, and its use has been widely adopted and continues to increase. However, there are a number of potential serious complications that necessitate conversion to thoracotomy. We reviewed our experience with the management and outcomes of such complications in a high-volume robotic center. Methods: We performed a retrospective review of all major robotic resections (single surgeon, single center) performed between May 2018 and June 2025. Serious complications were defined as any major vascular or bronchial injury, erroneous transection, and any other event resulting in an extra procedure beyond the planned operation. Results: Between May 2018 and June 2025, a total of 1480 major RATS cases were performed. We identified 25 serious complications (17 intraoperative and 8 postoperative). Intraoperative complications included 13 major vascular injuries (including 1 transection of the main pulmonary artery requiring an arterial sleeve), 1 cardiac injury, and 3 bronchial injuries (1 occurring during intubation). Interestingly, these resulted in only 10 (59%) conversions to open surgery, with the rest managed robotically. There were no intraoperative deaths and 2 in-hospital deaths among patients with serious complications. Conclusions: RATS is safe and the risk of serious complications is low, and these complications do not always necessitate conversion. However, vigilance, understanding, and preparation for potential complications are key for surgeons as well as the entire robotic theater team. This ensures that complications can be dealt with efficiently and decisively, enhancing patient safety and optimizing surgical outcomes.
Summary Our study confirms an association between basophil histamine content and features of type IIb CSU. However, this biomarker is not suitable for predicting omalizumab treatment response or treatment course.
