The Society of Thoracic Surgeons (STS) 2026 Expert Consensus Pathway on Robotic Cardiac Training outlines principles for the safe initial introduction and subsequent expansion of robotic cardiac programs. The 25-year history of robotic cardiac surgery has established safety and efficacy while providing multiple innovations. There is currently a unique opportunity to coalesce best practices and evidence to inform a recent global surge in interest in incorporating robotic techniques into standard cardiac surgical practice. This consensus is a collaborative effort between the STS Workforce on Evidence Based Surgery, the STS Robotic Cardiac Surgery Taskforce, and multinational leaders in robotic cardiac surgery that aims to standardize initial core principles of preparatory elements, followed by 4 phases of robotic cardiac training to proceed from program commencement to mastery.
Diabetes mellitus (DM) and cardiovascular diseases (CVD) remain leading contributors to global morbidity and mortality, imposing a substantial burden on healthcare systems worldwide. The pathophysiological mechanisms underlying these conditions are complex and closely interconnected, with chronic low-grade inflammation, oxidative stress, endothelial dysfunction, insulin resistance and dysregulated lipid metabolism serving as pivotal shared pathways. Persistent hyperglycaemia and metabolic imbalance in DM accelerate vascular injury and atherosclerotic progression, thereby significantly increasing cardiovascular risk. Consequently, therapeutic strategies that concurrently target both metabolic and cardiovascular dysfunction may offer meaningful clinical advantages and improved long-term outcomes. In recent years, novel antidiabetic agents such as sodium-glucose co-transporter 2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated not only glycaemic control but also substantial cardiovascular protection, including reductions in major adverse cardiovascular events, heart failure hospitalisations and renal disease progression. These pleiotropic effects extend beyond glucose lowering and involve modulation of inflammatory pathways, improvement of endothelial function, attenuation of oxidative stress and favourable haemodynamic changes. Additionally, emerging evidence highlights the role of the gut microbiota as a critical mediator in the bidirectional relationship between DM and CVD. Alterations in microbial composition and diversity, collectively termed dysbiosis, have been associated with systemic inflammation, impaired metabolic homoeostasis, increased intestinal permeability and the production of pro-atherogenic metabolites such as trimethylamine N-oxide. Understanding these microbiome-related mechanisms may open new avenues for preventive and therapeutic interventions targeting the gut-metabolic-cardiovascular axis. This narrative review provides an updated and comprehensive overview of the molecular and cellular mechanisms linking DM and CVD, with particular emphasis on inflammatory signalling, metabolic dysregulation and the emerging influence of the gut microbiome in their shared pathogenesis and therapeutic modulation.
BackgroundAdenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer. Compared with other pancreatic tumors, ASCP has a notably poorer prognosis and shorter survival rates. The optimal therapeutic approaches to ASCP have yet to be defined.MethodsThis retrospective, multicenter European study included all consecutive patients who underwent elective pancreatic surgery for ASCP at participating centers between 2010 and 2024. The inclusion criteria encompassed all patients who underwent scheduled surgery for ASCP during the study period. The exclusion criteria ruled out patients without a confirmed pathologic diagnosis of ASCP, those who did not undergo surgery, and patients with extra-pancreatic disease.ResultsThe study analyzed 194 patients from 29 hospitals in 11 European countries. The overall survival rates were 56.2% at 1 year, 26.3% at 3 years, and 9.8% at 5 years. The disease-free survival rates at the same intervals were 36.6%, 16.5%, and 6.7%, respectively. In the multivariate analysis, significant associations with shorter survival were R2 resections, lymphatic stromal invasion, T4 stage, no adjuvant chemotherapy, and recurrence.ConclusionsPatients who undergo resection for ASCP experience very low 5-year survival rates (10%). It is advisable to avoid resecting T4 tumors in patients with significant comorbidities or R2 resections. Additionally, failure to provide adjuvant chemotherapy, often due to severe postoperative complications, further deteriorates the prognosis.
BACKGROUND:ATP1A3-related disorders are characterized by genetic heterogeneity and phenotypic pleiotropy, posing significant challenges for classification. Although canonical phenotypes have traditionally guided decision-making, increasing evidence highlights their limitations in capturing the clinical complexity. OBJECTIVE:The aims of this study were to characterize movement disorders, paroxysmal features, and genotype-phenotype relationships; to build a curated video archive; and to assess alignment with canonical phenotypes. METHODS:This is an observational study of 88 individuals with pathogenic or likely pathogenic variants in ATP1A3 who were evaluated in specialized movement disorders programs. RESULTS:Age at last clinical follow-up ranged from 0.1 to 63 years; 80.7% were pediatric patients. Chronic movement disorders were present in 68 of 88 individuals (75%); most had two or more coexisting phenomenologies. Dystonia was most common (47/88, 53%), followed by spasticity (28/88, 32%) and ataxia (28/92, 32%). Paroxysmal events occurred in 78 of 88 (88%) patients, including dystonic spells (45/78, 58%), abnormal eye movements (39/78, 50%), and hemiplegic episodes (37/78, 47%). Common comorbidities included epilepsy (21/88, 24%), cognitive impairment (41/88, 47%), and neuropsychiatric disorders. Only 22 of 88 (25%) fulfilled criteria for a single canonical phenotype; 28 of 88 (32%) met canonical criteria plus additional features, 18 of 88 (20%) satisfied criteria for ≥2 canonical phenotypes, and 20 of 88 (23%) fit no canonical category. We identified 43 distinct ATP1A3 variants; recurrent variants (eg, p.Arg756His, p.Asp801Asn, p.Glu818Lys) showed variable expressivity across categories. CONCLUSIONS:The extensive clinical heterogeneity in ATP1A3-related disorders challenges rigid phenotypic classifications. The predominance of patients with overlapping or atypical features supports a shift toward flexible, symptom-based clinical approaches rather than strict reliance on canonical phenotype recognition. © 2026 International Parkinson and Movement Disorder Society.
