The gut microbiome and melanoma: A review.

Disturbances in the microbial ecosystem have been implemented in chronic inflammation, immune evasion and carcinogenesis, with certain microbes associated with the development of specific cancers. In recent times, the gut microbiome has been recognised as a potential novel player in the pathogenesis and treatment of malignant melanoma. It has been shown that the composition of gut microbiota in early-stage melanoma changes from in situ to invasive and then to metastatic disease. The gut bacterial and fungal profile has also been found to be significantly different in melanoma patients compared to controls. Multiple studies of immune checkpoint inhibitor (ICI) therapies have shown that the commensal microbiota may have an impact on anti-tumor immunity and therefore ICI response in cancer patients. When it comes to chemotherapy and radiotherapy treatments, studies demonstrate that gut microbiota are invaluable in the repair of radiation and chemotherapy-induced damage and therapeutic manipulation of gut microbiota can be an effective strategy to deal with side effects. Studies demonstrate the oncogenic and tumor-suppressive properties of the gut microbiome, which may play a role in the pathogenesis of melanoma. Despite this, investigations into specific interactions are still in its infancy, but starting to gain momentum as more significant and clinically relevant effects are emerging.

Posterior Percutaneous Screw Fixation to Treat Vertebral Fracture Non-union in Diffuse Idiopathic Skeletal Hyperostosis.

Diffuse idiopathic skeletal hyperostosis (DISH) alters the biomechanical properties of the spine, rendering it highly prone to fracture, following even minor trauma. Risk of delayed diagnosis of vertebral fractures is particularly high in this cohort of patients since radiographs are notoriously difficult to interpret and presentation is late, due to difficulty distinguishing new from pre-existing back pain. Our case describes a gentleman in his late sixties with a six-month delay in presentation to our services with a T12 fracture, secondary to previously undiagnosed DISH, which had progressed to non-union. He underwent T9-L3 thoracolumbar posterior percutaneous stabilisation and fusion. At eighteen months follow-up, there was evidence of union, significant improvement in his pain, no focal neurology signs, and the patient had returned to his activities of daily living (ADLs).