ABSTRACT
The world is facing a significant demographic transition, with a substantial increase in the proportion of older persons, as well as long-lived persons (especially nonagenarians and centenarians). One of the popular beliefs is that old age is synonymous with disease and disability. However, the successful aging hypothesis suggests that those older persons with advanced chronological age who maintain their functional capacity derive from it a delay in biological aging, enhancing the quality of organic aging and regulation. Therefore, regardless of chronological age, even in cases of extreme longevity, those older adults with a successful aging phenotype and favorable functional capacity would be expected to have satisfactory post-surgical recovery with a low risk of morbidity and mortality. Currently, there is a significant gap between the availability of high-certainty surgical evidence that allows for evidence-based interventions applicable to the long-lived population-taking into account the actual conditioning factors of the health phenotype in older persons-and, above all, predictors of satisfactory post-surgical evolution. The application of meta-research to geriatric surgery emerges as a fundamental tool to address this knowledge gap and reveals opportunities and limitations that need to be resolved in the near future to establish evidence-based surgical care for older persons. The aim of this manuscript was to present a real and globally relevant scenario related to surgical care, addressing the longevity, the availability, and the quality of surgical evidence applicable to this population, and also to present variables to consider in analysis and future perspectives in research and meta-research in geriatric surgery.
ABSTRACT
Non-small-cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, often diagnosed at advanced stages, which diminishes the effective treatment options and survival rates. This systematic review assesses the utility of emerging biomarkers-circulating tumor DNA (ctDNA), microRNAs (miRNAs), and the blood tumor mutational burden (bTMB)-enhanced by next-generation sequencing (NGS) to improve the diagnostic accuracy, prognostic evaluation, and treatment strategies in NSCLC. Analyzing data from 37 studies involving 10,332 patients from 2020 to 2024, the review highlights how biomarkers like ctDNA and PD-L1 expression critically inform the selection of personalized therapies, particularly beneficial in the advanced stages of NSCLC. These biomarkers are critical for prognostic assessments and in dynamically adapting treatment plans, where high PD-L1 expression and specific genetic mutations (e.g., ALK fusions, EGFR mutations) significantly guide the use of targeted therapies and immunotherapies. The findings recommend integrating these biomarkers into standardized clinical pathways to maximize their potential in enhancing the treatment precision, ultimately fostering significant advancements in oncology and improving patient outcomes and quality of life. This review substantiates the prognostic and predictive value of these biomarkers and emphasizes the need for ongoing innovation in biomarker research.
ABSTRACT
Cutaneous leishmaniasis (CL) is a zoonotic disease caused by protozoa of the Leishmania genus, transmitted by vectors from the Phlebotominae subfamily. The interaction between the vector, reservoir, and parasite is susceptible to climate change. This study explores how temperature and rainfall influenced the incidence of CL in 15 Colombian municipalities between 2017 and 2019. Epidemiological data were obtained from Colombia's Instituto Nacional de Salud, while climatological data came from the Instituto de Hidrología, Meteorología y Estudios Ambientales. Using Spearman's rank correlation coefficient, we examined the relationships between monthly climatic variables and the cumulative incidence of CL, considering various lag times. The data were further analyzed using Locally Weighted Scatterplot Smoothing (LOWESS). Our findings reveal both significant positive and negative correlations, depending on locality and climate variables. LOWESS analysis indicates that while rainfall-related incidence remains stable, temperature impacts incidence in a parabolic trend. This study underscores the significant yet complex influence of climatic factors on CL incidence. The insights gained could aid public health efforts by improving predictive models and crafting targeted interventions to mitigate the disease's impact, particularly in regions vulnerable to climate variability.