Odeh, Nour B.

BACKGROUND: Pectus deformities are common chest wall abnormalities, with surgical correction recommended for severe cases. Female patients undergoing repair may have a history of breast implants or seek concurrent augmentation. This retrospective study examines clinical implications of pectus repair in patients with breast implants and provides recommendations. STUDY DESIGN: A retrospective review of female patients undergoing pectus repair at Mayo Clinic Arizona (January 1, 2010 to February 1, 2025) was conducted. Outcomes and complications were analyzed in patients with and without breast implants. RESULTS: In total, 456 female patients were included (447 excavatum, 7 arcuatum, and 2 carinatum; median age 32.7). Most patients (78.5%) underwent primary minimally invasive repairs (MIRPE); 6.6% underwent primary hybrid MIRPE, 5.5% underwent redo MIRPE, and 9.4% underwent primary redo open and complex reconstructions. In total, 104 patients (22.8%) had a history of breast implants, with 68 patients having breast implant-related procedures at the time of pectus surgery. At 12 months, the cumulative incidence of infection was significantly higher in patients with implants present at the time of pectus repair than in those without (8.8% vs 1.8%; log rank, p = 0.0015). A 4.9-fold increase in overall infection was seen in patients with indwelling or placed implants during pectus surgery. Deep infections were significantly more common in patients with implants (4.4%) than without (1.0%; p = 0.035). Similarly, superficial infections were more frequent in patients with implants (4.4%) than without (0.8%; p = 0.016). At 30 days, patients with implants had higher rates of infection (p = 0.032), pneumothorax (p = 0.008), and hematoma (p = 0.027), with no significant differences in other complications. CONCLUSIONS: Breast implants at the time of pectus repair were associated with increased risk of postoperative infection, pneumothorax, and hematoma. Removal of implants before pectus repair is recommended with delayed replacement, if desired.

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease marked by cholestasis and progressive fibrosis. While ursodeoxycholic acid (UDCA) remains the first-line therapy, approximately 30–40% of patients have an inadequate biochemical response, increasing the risk of disease progression. Obeticholic acid (OCA), a potent farnesoid X receptor (FXR) agonist, was the first second-line agent approved by the only Food and Drug Administration (FDA) and has demonstrated moderate biochemical efficacy but limited tolerability due to dose-dependent pruritus and safety concerns in cirrhosis. Fenofibrate, a peroxisome proliferator-activated receptor alpha (PPAR-α) agonist, showed substantial alkaline phosphatase (ALP) reductions when added to UDCA, although its long-term benefit remains unconfirmed in large-scale trials and its use remains off-label in the United States, unlike FDA-approved agents. Seladelpar, a selective peroxisome proliferator-activated receptor delta (PPAR-δ) agonist, and elafibranor, a dual PPAR-α/δ agonist, have both recently received FDA accelerated approval after demonstrating significant improvements in ALP, biochemical response rates, and pruritus relief in phase 3 trials. This review summarizes these second-line therapies’ mechanisms, efficacy, safety, and limitations emphasizing the need for individualized treatment decisions and ongoing research into long-term clinical outcomes.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), are among the most prevalent causes of chronic liver disease worldwide, closely linked to the global rise in overweight and obesity, type 2 diabetes, and metabolic syndrome. Until recently, treatment options were limited to lifestyle interventions, with no approved pharmacologic therapies. Resmetirom, a liver-directed, selective thyroid hormone receptor beta (THR-β) agonist, is a promising disease-modifying agent that targets hepatic lipid metabolism, inflammation, and fibrosis. Clinical trials, including the pivotal phase 3 MAESTRO-NASH and MAESTRO-NAFLD-1 trials, have demonstrated significant improvements in liver fat reduction, lipid profiles, histological endpoints, and health-related quality of life, with a favorable safety profile. In March 2024, the FDA granted accelerated approval of resmetirom for adults with MASH and moderate-to-advanced fibrosis, marking a significant milestone in MASLD treatment. This review discusses the mechanistic rationale, preclinical data, and pivotal clinical trial outcomes supporting resmetirom’s role in MASLD/MASH management, while outlining ongoing research needs, including long-term safety, pediatric evaluation, and biomarker development for optimized patient selection.

Importance Pectus arcuatum is a rare anterior chest wall deformity that is often confused with excavatum, carinatum, or a mixed deformity. A complete understanding of its clinical and physiological basis will improve diagnostic accuracy and allow for standardized management. Objectives To gain a comprehensive understanding of pectus arcuatum, focusing on its nomenclatures, epidemiology, classification, pathophysiology, preoperative presentation and assessments, management options, and surgical outcomes. Evidence Review PubMed, Google Scholar, and subsequent reference searches were used to extract original studies addressing pectus arcuatum fully or partially. The searches were performed on February 2, 2025. Two independent reviewers screened articles based on preestablished inclusion and exclusion criteria. Quality assessment was performed, but given the rarity of arcuatum and the limited, heterogeneous nature of available literature, none of the studies were excluded based on the level of evidence or quality assessments. Using a standardized data extraction form, results were synthesized and presented as a review with recommendations to guide clinical decision-making. Findings A total of 65 studies were included in the final review. Of those, 37 (56.9%) were cohort studies, 18 (27.7%) were case reports, 8 (12.3%) were case series, and 2 (3.1%) were technical reports. A total of 455 cases of pectus arcuatum were represented. Heterogeneity was found in nomenclature, epidemiology, associated conditions, assessments, management, and outcomes. An open surgical approach and, more recently, hybrid open and minimally invasive technique are reported for surgical repair. Postoperative outcomes were good in most surgical series, with no significant difference when compared with the repair of other pectus deformities. Conclusions and Relevance Results of this systematic review reveal that pectus arcuatum is a rare variant of pectus deformities that is distinct from carinatum and excavatum. Unified terminology and standardized diagnostic criteria are important to facilitate proper management. Minimally invasive hybrid approaches continue to refine outcomes, balancing invasiveness with efficacy.

Aortic stenosis is a progressive condition with substantial implications for morbidity and mortality. In recent years, attention has shifted toward risk stratification and the development of individualized management plans to optimize treatment outcomes. The management of asymptomatic patients has become a topic of significant controversy, as emerging studies challenge traditional watchful waiting guidelines and propose the potential benefits of early intervention. While early intervention may reduce overall morbidity and mortality in this patient population, the associated procedural risks remain a critical consideration. This review seeks to analyze the existing literature, offering an updated perspective on patient risk stratification and evidence evaluating both management approaches.