Gene therapy represents a paradigm shift in haemophilia management, offering the potential for sustained factor expression and freedom from prophylactic infusions. Two adeno-associated virus (AAV)-based gene therapies are now approved. Long-term follow-up data demonstrate remarkable durability, with 13-year results showing sustained reductions in annualized bleeding rates in patients with haemophilia B. Outcomes differ between haemophilia A and B: factor VIII levels in haemophilia A decline after peaking, whereas factor IX expression in haemophilia B remains more stable. Recent analyses confirm significant reductions in bleeding rates and treatment requirements, along with well-characterized safety profiles. Liver toxicity remains the primary safety concern, with transaminase elevations typically responding to corticosteroids. Rare adverse events include one reported case of inhibitor development and very few thrombotic events. Reported malignancies to date have not been associated with gene therapy. Current limitations include eligibility restrictions due to preexisting neutralizing antibodies, immune responses to AAV capsids, and variable patient outcomes. These challenges may contribute to slower adoption despite regulatory approval. Emerging approaches such as CRISPR-Cas9 gene editing, high-active factor variants, and novel delivery systems are under investigation. Key implementation issues include outcome-based reimbursement, hub-and-spoke treatment models, and ensuring equitable global access.
Purpose of reviewHospital-acquired anemia (HAA) is a common complication associated with adverse outcomes, including increased transfusion requirements and prolonged hospital length of stay. The precise etiology of HAA remains elusive, and preventive or therapeutic strategies are inconsistently applied or lacking altogether. This review summarizes current evidence on the incidence, underlying mechanism, clinical consequences, and available interventions for HAA.Recent findingsThe causes of HAA are multifactorial involving procedural or diagnostic blood loss, impaired erythropoiesis, coagulation abnormalities, nutritional deficiencies, and hemolysis. Measures such as small volume tubes and closed blood collection devices have proven safe and effective for reducing the volume of drawn blood. Recent studies suggest that the incidence of HAA can be diminished by implementing systematic, patient-centered approaches.SummaryHAA remains prevalent despite long-standing recognition of its clinical consequences. Although awareness has continuously increased, treatment and prevention strategies are still not widely established.
The American Society of Plastic Surgeons guidelines emphasize the need for additional evidence regarding perioperative glycemic control in patients with diabetes undergoing breast reduction surgery. This study evaluates the association between preoperative hemoglobin A1c (HbA1c) levels and postoperative complications in patients with diabetes undergoing reduction mammaplasty. A retrospective cohort study of the National Surgical Quality Improvement Program (NSQIP) database was performed, identifying patients diagnosed with diabetes who underwent breast reduction surgery from 2021 to 2023. Patients were stratified by preoperative HbA1c levels: well-controlled (HbA1c < 6.5
Neoadjuvant chemoimmunotherapy (chemo-IO) has fundamentally reshaped the treatment paradigm for resectable non-small cell lung cancer (NSCLC), challenging long-held surgical boundaries and redefining what constitutes “resectable” disease. Trials such as CheckMate-816, KEYNOTE-671, and AEGEAN have demonstrated that integrating immune checkpoint blockade with chemotherapy yields unprecedented rates of pathological response and event-free survival, positioning chemo-IO as the new global standard for stage IB–IIIA NSCLC. Yet these advances bring new complexities; how do we define resectability in an era of immunotherapeutic downstaging, and how should multidisciplinary teams adapt to evolving biology? Traditional radiological and anatomic criteria now sit alongside immune-mediated regression and circulating tumor DNA (ctDNA) kinetics as measures of treatment success. ctDNA clearance and pathological response serve as powerful surrogates for long-term survival, with ongoing studies such as MERMAID-1/2 exploring their potential to guide adjuvant therapy and spare overtreatment. The modern challenge lies in integrating these biomarkers into surgical decision-making and developing standardized, biology-informed resectability frameworks. Future progress will depend on close collaboration between surgeons, oncologists, and translational scientists to expand surgical candidacy safely and define the next generation of curative strategies in lung cancer.
