Lankenau Institute for Medical Research (LIMR) is an independent, nonprofit biomedical research center located in suburban Philadelphia, U.S., on the campus of Lankenau Medical Center. Lankenau Hospital, then known as the German Hospital of the City of Philadelphia, was the site of the city's first bacteriological and chemical research laboratory, founded in 1889.
Lymph node evaluation is a central determinant of oncologic quality in the surgical management of non-small-cell lung cancer (NSCLC). Accurate assessment of hilar and mediastinal lymph nodes underpins pathologic staging, informs postoperative treatment decisions, and remains essential for prognostic stratification and assessment of resection completeness. Although international guidelines provide clear recommendations, real-world data consistently demonstrate substantial variability in lymph node staging practices, with inadequate evaluation frequently observed across institutions and surgical settings. Insufficient nodal assessment, manifested as the omission of mediastinal staging, limited station sampling, or low lymph node yield, is associated with reduced nodal upstaging, inappropriate omission of adjuvant therapy, higher recurrence rates, and inferior long-term survival. Contemporary guidance from major societies, including the National Comprehensive Cancer Network, European Society of Thoracic Surgeons, International Association for the Study of Lung Cancer, and the Commission on Cancer, has increasingly converged on a station-based definition of adequacy, emphasizing systematic evaluation of both N1 and N2 nodal stations rather than reliance on absolute node counts alone. In parallel, preoperative mediastinal staging algorithms have evolved toward routine use of endobronchial and esophageal ultrasound as first-line invasive modalities, reserving surgical mediastinoscopy for selected high-risk or inconclusive cases. Evidence from randomized trials, population-level databases, and meta-analyses indicates that thorough nodal assessment improves staging accuracy and survival, while recent data support the selective use of lobe-specific or tailored lymphadenectomy in carefully staged, low-risk early disease. Finally, emerging quality improvement interventions, including standardized specimen handling, operative checklists, and multidisciplinary feedback mechanisms, have demonstrated measurable improvements in guideline adherence and patient outcomes. This narrative review integrates contemporary evidence and guideline recommendations to outline a practical framework for implementing reliable, high-quality lymph node staging in modern lung cancer surgery.
Transcatheter aortic valve replacement (TAVR) has created a growing population of patients who require redo-TAVR (TAV-in-TAV) for structural valve deterioration. Short-frame balloon-expandable valves implanted within failed short- or tall-frame transcatheter valves ("short-in-short" and "short-in-tall") pose specific challenges, including coronary risk assessment, valve sizing, anchoring, and preservation of coronary access. Under the auspices of the Heart and Valve Collaboratory, an international multidisciplinary panel of experts reviewed bench and clinical data and synthesized contemporary best practices into a pragmatic workflow for redo-TAVR. This document standardizes key anatomic definitions, outlines computed tomography-based strategies for in vivo sizing, and details recommended approaches to predilatation, deployment techniques, and postdilatation. By harmonizing terminology and stepwise planning across imaging, interventional, and surgical teams, this document aims to simplify procedural decision-making and improve safety, coronary preservation, and hemodynamic outcomes in patients undergoing short-in-short and short-in-tall TAV-in-TAV procedures.
INTRODUCTION:Neoadjuvant chemoimmunotherapy (NAT) has become standard of care for select patients with resectable non-small cell lung cancer (NSCLC). Accurate and timely preoperative staging with positron emission tomography and computed tomography (PET-CT) ± invasive mediastinal staging (IMS) is essential to identify patients who may benefit from NAT prior to curative-intent surgery. We sought to evaluate the real-world implementation of guideline-informed staging and treatment decisions in early-stage NSCLC. METHODS:We conducted a retrospective chart review of patients with stage IA-IIIB NSCLC who underwent surgical resection within our medical center between April 1, 2023 and January 1, 2026. We compared clinical stage at diagnosis with pathologic stage at surgery and assessed barriers to NAT utilization. RESULTS:In total, 212 patients met inclusion criteria. Sixteen patients received NAT and most were downstaged. However, based on surgical pathologic staging, there were 39 patients (71% of all NAT-eligible patients) staged as Stage IIA or higher who had not received NAT, 35 of whom did not meet criteria for NAT prior to surgery. Mean time to surgery was 69 days in patients who did not undergo biopsy and 99 days in those who did. CONCLUSION:Nearly 3 quarters of eligible patients were found to have advanced disease at the time of surgery, representing missed opportunities for the consideration of standard-of-care NAT. These findings highlight limitations in the current diagnostic staging and delays between imaging and surgery. Improved accuracy and timeliness of preoperative staging are critical to ensure appropriate multidisciplinary evaluation and optimal delivery of NAT for eligible patients.
BACKGROUND:The aim of this study was to evaluate the feasibility of minimally invasive repair of type A aortic dissection (MIR-TAAD) using mini sternotomy (MS), which improves early outcomes, and to assess its suitability in a highly selected and hemodynamically stable subset of patients. METHODS:All consecutive patients with acute TAAD referred to our department were evaluated for MIR-TAAD if hemodynamically stable and without clinical or CT evidence of coronary ostia involvement. Previous cardiac surgery was an exclusion criterion. RESULTS:Between 2022 and 2024, 12 of 103 dissections (9 men, mean age 67.7±1.3) underwent MIR-TAAD. Pre-operative GERAADA score was 10.5±2.3%. Five patients had severe aortic regurgitation, and one had hemiparesis. All underwent hemiarch replacement, with four also receiving an Ascyrus Medical Dissection Stent. Three had aortic valve replacement, eight had valve resuspension, and one had root replacement. Average CPB, cross-clamp, and circulatory arrest times were 130.8±35.0, 81.1±32.7, and 26.2±10.2 minutes (mean temperature 27.8±2.0). None received intraoperative transfusions; two required re-exploration for bleeding. Average intubation time was 22.75 [16.88, 47.00] hours, ICU stays 3.50 [2.75, 7.00] days, hospital LOS 8.50 [7.50, 11.75] days, and transfusion usage 0.50 [0.00, 1.50] units (6 patients received no transfusions). There was no 30-day or in-hospital mortality. At the median follow-up of 15.5 months [12.25, 35.50], only one patient died due to non-cardiac-related reasons. CONCLUSIONS:MIR-TAAD can be safely performed by MS in highly selected cases without limiting the range of aortic root or arch procedures. This approach achieved satisfactory short-term outcomes that should be interpreted within this low-risk population context.
Poliovirus remains a serious threat to human health. Complete eradication of wild-type poliovirus has not yet succeeded, making the development of successful antivirals critical. Microneutralization assays against all three poliovirus serotypes identified a panel of human monoclonal IgGs, which are either serotype-specific or cross-neutralizing. Here, through cryoEM single particle analysis, we solved high resolution structures of four distinct poliovirus-FAb complexes. These antibodies bind to capsids at the circular depression (canyon) surrounding the icosahedral five-fold symmetry axis, which is also the binding site of the poliovirus receptor (PVR). Analysis of these structures confirms overlap of FAb contacts on the viral capsid with those of PVR. For three of the FAbs, the capsid residues are identified that dictate serotype-specific recognition. Contacts for the cross-neutralizing mAb 10D2 are located deep in the capsid canyon. These structural analyses indicate that antibody competition with the receptor likely leads to neutralization of virus particles and inhibition of poliovirus entry into host cells. Thus, the human IgGs studied here may facilitate development of therapeutics for the ongoing efforts in global eradication of poliovirus.
