Staying #Up2Date 🚨

1. Periop aspirin (ASA) 

In the ASSURE DES trial, 926 patients s/p drug-eluting stent (DES) placement >1 year prior were randomized to continue/switch to ASA periop vs. stop all antiplatelet agents 5d before low-to-intermediate risk elective, noncardiac surgeries. The primary outcome (composite of death, MI, stent thrombosis, stroke) did not differ between groups (0.6% for ASA group vs. 0.9%), though minor bleeding (but not major) was higher in the ASA group (14.9% vs. 10.1%). 

2. MRI-guided prostate biopsy (bx)

This Swedish trial had an MRI-targeted group, where patients with elevated PSA (3–10 ng/mL) underwent MRI, and only those with suspicious lesions received bx. In the systematic group, patients with elevated PSA also had an MRI, but all patients underwent standard systematic biopsies (10–12 cores), plus additional bx if MRI showed suspicious lesions. Only 4% of men in the MRI-targeted group underwent bx vs. 9% in the systematic group, with fewer prostate cancer diagnoses overall (2.8% vs. 4.5%), mostly due to fewer clinically insignificant cancers (1.0% vs. 2.4%).  Rates of potentially incurable cancers were also similar (23 vs. 15 cases), suggesting MRI can reduce unnecessary biopsies and overdiagnosis of prostate cancer.

3. False-negatives in mammography screening

This US observational study found that women with false positive mammography results were less likely to return for screening, especially Asian and Hispanic/Latinx women. The decrease in adherence was minor if women required additional imaging (2% less likely) but much larger if women required short-term follow-up (16% less likely) or biopsy (10% less likely). Multiple consecutive false positives further reduced adherence.

Pancake Bones

How 3D-printers can change the way bones heal

What happened: The University Of Waterloo is developing 3D-printed bones that can improve outcomes for cancer patients. 

Why it’s interesting: Associate Professor Thomas Willet developed the idea while working with orthopedic surgeons at Mount Sinai Hospital, where he observed bone defects that couldn’t heal on their own. While simple fractures can heal naturally, bone cancer and trauma patients often require new bone grafts.

Willet developed a specialized material that can be 3D-printed to fit each patient’s unique needs. What sets it apart is the absence of cellular material, which reduces the risk of rejection. The synthetic bone has a texture similar to pancake batter and is made from biopolymers such as soybean oil and hydroxyapatite—an essential mineral found in natural bones.

Once placed in the body, the 3D-printed bone eventually dissolves as the body grows natural bone to replace it. Although the design is still in its early stages, researchers believe it could enhance quality of life and lower healthcare costs.

What’s next? Right now, researchers are printing small-scale bones and skulls to better understand the material. It’ll take years and substantial funding before this tech is ready for the public. In the meantime, the team is preparing for clinical trials and plans to continue development.

Bottom line: 3D-printed bones, made from innovative biopolymers, could revolutionize the way complex bone defects are treated for bone cancer and trauma patients. Still, it’ll be a few years before the technology is ready for hospital use.

Hot Off The Press

1: 🦠 According to the CBC, superbugs could kill 39 million people by 2050. Doctors and world leaders are calling antibiotic resistance a “global health emergency” and pushing for smarter antibiotic use and better prevention to stop these infections from getting deadlier.

2: 🏥 A Minnesota woman made history as the first Stage 4 colorectal cancer patient in the US to receive a double lung transplant. On her 42nd birthday, she celebrated being officially cancer-free. After fighting the disease since 2017 and running out of treatment options, she turned to Northwestern Medicine’s DREAM program as a last hope. Now, doctors believe this breakthrough could open new doors for using lung transplants to treat advanced cancers that have spread.

3: 💔 The tragic death of Alice Webb—the first known UK fatality from a liquid Brazilian butt lift (BBL)—has people calling for stricter regulations. Experts say both surgical and non-surgical BBLs come with serious risks, such as embolisms and unlicensed practitioners doing dangerous procedures. The bottom line? BBLs shouldn’t be banned, but they should definitely be done only by qualified pros under tighter rules.

4: 💊 Pharma is targeting Gen Z with a new male birth control pill. With abortion restrictions tightening, researchers are looking into new, non-hormonal options that could help make shared responsibility the norm. California-based YourChoice Therapeutics just kicked off a human trial for a once-a-day pill that blocks sperm production — but it could be a while before it gets full FDA approval.

Notable Numbers 🔢

5x: the number of whooping cough cases this year compared to 2023, bringing infections back to pre-pandemic levels. There have been over 15,600 cases in the US, and public health officials say it's mostly due to lower vaccination rates and fading immunity. Teens with dropping immunity are driving the outbreaks, and experts are looking into better vaccine options to tackle the resurgence.

94%: the percentage of Canadians who believe breast cancer screening should start at age 40. But even with strong support for early detection, a lot of people still aren’t getting screened. This highlights major gaps in awareness and access. The message is clear: it’s time to update the guidelines and make breast cancer care fair for everyone.

89: the age of Dame Maggie Smith, who passed away peacefully. King Charles called her a "national treasure," and her Harry Potter co-star Daniel Radcliffe remembered her as a "fierce intellect" with a "gloriously sharp tongue." Whether she was the unforgettable Dowager Countess in Downton Abbey or Professor McGonagall in Harry Potter, her incredible talent earned her the title of "the best of the best," according to Miriam Margolyes.

💬 In Our Community

A forward-thinking physician wondered how they can best pass on wealth and support their children in the future. Their only concern: the majority of their assets are trapped in their corporations (approx. $10-12 million by time they retire) and will incur heavy taxation. Here’s what their fellow physicians had to say:

• A very popular comment was, “there’s only two things guaranteed in life, death and taxes.” Some recommended a permanent life insurance policy. However, they noted that the benefits would only be available to the children after the policyholder's passing, meaning they won’t be around to witness their children use that money to achieve their goals and dreams.

• Some recommended hiring the children early in their adulthood within the corporation and paying them a salary while they are still in a lower tax bracket. This approach would help them build savings and investments from a young age.

• Others suggested withdrawing money from the corporation and investing it in the children’s TFSA accounts over several years. This strategy could help avoid corporation bloat (i.e., having a large sum in the corporation, which is more heavily taxed) and ensure that the TFSA accumulates interest.

Postcall Picks

😭 Laugh: at anesthesia’s patients who always need a little (lot) more…

🎧 Listen: to the newest CMAJ podcast to learn how AI is helping spot high-risk patients before they deteriorate and its future implications on clinical practice.

👀 Watch: this video explaining Alzheimer's and the challenges in its treatment. Then read the latest controversy surrounding the recently approved FDA breakthrough drug Donanemab.

🇺🇸 Debate: Last night, CBS News hosted the first (and likely only) vice presidential debate ahead of the US election, between Tim Walz and JD Vance.

🤑 Save: on treats and toys for your furry friends with 20% off your next three orders at Chewy, a beloved online pet shop!

Relax

First Question: What do you call gallstones in the gallbladder?

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