Hasan Aziz

Advanced melanoma, a highly lethal skin cancer, causes most skin cancer–related deaths. Oncolytic monotherapy or alongside immune checkpoint inhibitors (ICIs) is emerging as a promising treatment. Evaluating the therapeutic benefit and toxicity profile of different oncolytic viruses is essential to identify the most effective option. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses–based meta-analysis was conducted to assess and contrast the therapeutic effectiveness and tolerability of herpes simplex virus (HSV) and coxsackievirus (CSV) therapies, both alone or alongside ICIs. Searches were performed in PubMed, Scopus, and clinicaltrials.gov. We extracted data on tumor objective response rates (ORRs) and the occurrence of serious (grade 3 or higher) treatment-related adverse events. Risk of bias was assessed using the ROBINS tools. Twenty trials comprising 1509 patients were included. CSV therapy demonstrated an ORR of 35%, falling between HSV monotherapy (31%) and HSV-ICI combination therapy (45%). CSV therapies, even in combination, were associated with fewer incidents of severe adverse events (17%) compared with HSV-ICI treatment (24%). HSV monotherapy also had similar fewer incidents of serious adverse events (16%). Among ICIs pembrolizumab showed the most favorable outcomes. HSV-ICI therapy showed the highest ORR but with more incidences of serious adverse events, while CSV therapy, even in combinations, offered a good safety-efficacy balance. HSV monotherapy or CSV may be favored when minimizing toxicity is a priority, even if it comes at the cost of some reduced response rate. However, combining CSV with ICIs may surpass talimogene laherparepvec monotherapy in efficacy because of the reduced likelihood of tumor resistance. Export

Nonsurgical interventions typically emphasize patients safety, minimum complications, and cost effectiveness compared to surgical procedures. The aim of this study was to conduct a systematic review to evaluate the efficacy of vacuum bell therapy as a nonsurgical option for managing pectus excavatum in pediatric patients. Vacuum bell therapy. A systematic review adhering to PRISMA guidelines was conducted, we searched four electronic databases (PubMed, Scopus, and Web of Science) up to August 15, 2024. The search focused on PE and vacuum therapy. Inclusion criteria targeted pediatric patients, while unsuitable studies were excluded. The JBI Critical Appraisal Checklist, New Castle Ottawa scale assessment and Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2) were utilized to assess risk of bias. Twenty studies met the criteria. Risk of bias was low in two, moderate in thirteen, and high in five studies. VB therapy duration varied from 30 min to several hours daily. Factors influencing outcomes included age, chest wall flexibility, PE severity, VB duration, and symmetry. The most common correction pattern was poor > fair > good > excellent, with good results observed as early as six months. Complications were mild and temporary, not requiring medication. VB therapy shows significant improvement in preteens with mild PE. Efficacy depends on age, chest flexibility, severity, and therapy duration. The lack of randomized controlled trials limits the strength of the evidence. The effectiveness of vacuum bell therapy in failed surgeries or in preventing injuries during procedures like the Nuss, needs further investigation, and if no visible results are seen after 6 to 12 months, surgery should be considered. Graphical Abstract