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Obesity can initiate, promote, and maintain systemic inflammation via metabolic reprogramming of macrophages that encircle adipocytes, termed crown-like structures (CLS). In breast cancer the presence of CLS has been correlated to high body mass index (BMI), larger mammary adipocyte size and postmenopausal status. However, the prognostic significance of CLS in HER2 + breast cancer is still unknown. We investigated the prognostic significance of CLS in a cohort of 69 trastuzumab-naïve and 117 adjuvant trastuzumab-treated patients with primary HER2 + breast cancer. Immunohistochemistry of tumour blocks was performed for CLS and correlated to clinical outcomes. CLS were more commonly found at the adipose-tumour border (B-CLS) (64.8% of patients). The presence of multiple B-CLS was associated with reduced time to metastatic disease (TMD) in trastuzumab treated patients with BMI ≥ 25 kg/m 2 but not those with BMI < 25 kg/m 2 . Phenotypic analysis showed the presence of CD32B + B-CLS was strongly correlated to BMI ≥ 25 kg/m 2 and reduced TMD in trastuzumab treated patients. Multivariable analysis suggested that CD32B + B-CLS positive tumours are associated with shorter TMD in trastuzumab-treated patients (HR 4.2 [95%CI, (1.01–17.4). This study indicates adipose-tumour border crown-like structures that are CD32B + potentially represent a biomarker for improved personalisation of treatment in HER2-overexpressed breast cancer patients.

Melanoma poses significant challenges due to its resistance to conventional therapies and increasing incidence rates. Stage III melanoma, characterised by regional lymph node involvement, has a high risk of recurrence despite surgical resection. Adjuvant immunotherapy, particularly using the PD-1 inhibitors pembrolizumab and nivolumab, has shown promising results in improving recurrence-free survival (RFS) and overall survival (OS) in Stage III melanoma patients. This retrospective analysis examined the effects of adjuvant pembrolizumab or nivolumab on patients with Stage III melanoma treated in a tertiary oncology centre. Of the 110 patients, 95 received pembrolizumab and 15 received nivolumab. The pembrolizumab completion rate was 62.1%, with 31.2% discontinuing due to disease progression or adverse effects. The nivolumab completion rate was lower at 40%, with 60% discontinuing due to toxicity or disease progression. Grade 3 or higher toxicities were observed in 17% of pembrolizumab and 53.3% of nivolumab patients. Disease progression occurred in 27.4% of pembrolizumab and 26.7% of nivolumab patients. Pembrolizumab showed a 12-month RFS of 78.9% and 24-month RFS of 77.6%, with an OS of 97.9% at 12 months. Nivolumab exhibited a 12-month RFS of 86.7% and 24-month RFS of 80%. RFS rates varied by disease stage and mutation status. Adjuvant pembrolizumab and nivolumab both demonstrate efficacy in improving RFS and OS in Stage III melanoma patients. Pembrolizumab has higher completion rates and fewer toxicities compared to nivolumab. Further studies are warranted to explore long-term outcomes and optimise treatment strategies.

We describe the case of an 86-year-old man with a background of severe left ventricular dysfunction and ischaemic cardiomyopathy who, having been optimised for heart failure therapy in hospital, unexpectedly deteriorated again with hypotension and progressive renal failure over the course of 2 days. Common causes of decompensation were ruled out and a bedside echocardiogram unexpectedly diagnosed new pericardial effusion with tamponade physiology. The patient underwent urgent pericardiocentesis and 890 mL of haemorrhagic fluid was drained. Common causes for haemopericardium were ruled out, and the spontaneous haemopericardium was thought to be related to introduction of rivaroxaban anticoagulation. The patient made a full recovery and was well 2 months following discharge. This case highlights the challenges of diagnosing cardiac tamponade in the presence of more common disorders that share similar non-specific clinical features. In addition, this case adds to growing evidence that therapy with direct oral anticoagulants can be complicated by spontaneous haemopericardium, especially when coadministered with other agents that affect clotting, renal dysfunction and cytochrome P3A5 inhibitors.