Chordomas are rare sarcomas arising from notochordal tissue and occur most commonly in the spine. The standard of care for chordomas without evidence of metastatic disease generally consists of en bloc resection followed by adjuvant radiotherapy. However, long-term (20-year) survival rates are approximately 30%. Chordomas are generally considered as chemo resistant. Therefore, systemic therapies have rarely been employed. Novel immunotherapies, including antibody therapy and tumor vaccines, have shown promise in early trials, leading to extended progression-free survival and symptom relief. However, the outcomes of larger trials using these vectors are heterogeneous. The aim of this review is to summarize novel chordoma treatments in immune-targeted therapies. The current merits, trial outcomes, and toxicities of these novel immune and targeted therapies, including those targeting vascular endothelial growth factor receptor (VEGFR) targets and the epidermal growth factor receptor (EGFR), will be discussed.

The SARS-CoV-2 public health challenges have highlighted the urgent need for coronavirus-targeting life-saving therapeutics. Given the emergence of drug-resistant strains, the development of antivirals against viral proteins beyond the commonly targeted main protease or RNA-dependent RNA polymerase is critical. The SARS-CoV-2 nonstructural protein 13 (nsp13) is a highly conserved RNA helicase and an essential component of the viral replication–transcription complex (RTC). It unwinds double-stranded RNA to facilitate viral transcription and replication, making it a strong target for drug development. To identify nsp13 inhibitors, we used an ultra-high-throughput nucleic acid unwinding assay to screen a library of FDA-approved drugs and bioactive compounds. We identified forty inhibitors with IC₅₀ values ranging from 1.4 to 10 μM. Ten were further selected for biochemical and biophysical characterization. Four of these are bound to nsp13 without interacting with the nucleic acid substrate and without inhibiting the ATPase activity of nsp13. Hydrogen–deuterium exchange coupled with Mass Spectrometry (HDX-MS) studies show compound binding causes differential exchange in two regions of nsp13. Furthermore, these compounds have antiviral activity against infectious SARS-CoV-2 in multiple cell lines, with cytotoxicity affecting, in some cases, the apparent antiviral effect. Future optimization efforts could help develop therapeutics against SARS-CoV-2 and other potential coronavirus threats.

Background: Cancellation of elective shoulder arthroscopy negatively affects the surgical scheduling process and results in significant financial loss for a health care institution. Despite this, the patient-related and surgical-related risk factors of cancellation remain undefined. Methods: A retrospective review at a single inner-city urban tertiary-care medical center was undertaken, including consecutive non-instability shoulder arthroscopy procedures from January 2016 through March 2024. Patient demographics and surgical data, including age at booking, marital status, diagnosed depression and/or anxiety, insurance type, distance from home to clinic, socioeconomic status, and history of ipsilateral and contralateral shoulder surgery, were tabulated. Cases were categorized as noncancelled, cancelled rescheduled, and cancelled not rescheduled. The time between booking and cancellation, in addition to the specific reason for cancellation, was documented. Results: A total of 756 consecutive cases were reviewed, of which 210 (27.8%) were cancelled before the planned surgical date. The cohort consisted of 399 women (52.8%) with a median age at booking of 56 years (IQR 51, 62). Of the cancellations, 90 (42.8%) rescheduled and underwent arthroscopy after a median of 111 days (IQR 23, 134). A history of ipsilateral cancellation (odds ratio [OR] 14.80, 95% confidence interval [CI] 4.88–44.89, P < .001), missing an outpatient visit before surgery (OR 1.57, 95% CI 1.10–2.24, P = .013), and having an ED visit within 12 months before the planned surgery (OR 1.50, 95% CI 1.05–2.14, P = .025) were significantly associated with cancellation. An ED visit within 12 months before planned surgery (OR 2.42, 95% CI 1.27–4.63, P = .008) was associated with a higher risk of not rescheduling after cancellation, whereas Workers' Compensation status trended toward a lower risk of not rescheduling (OR 0.28, 95% CI 0.08–1.06, P = .06). Discussion: Identification of the independent factors associated with cancellation of shoulder arthroscopy may help direct finite health care resources toward intervening among those patients with a high likelihood of rescheduling. Level of Evidence: Level III (Prognostic)

Study Design: Systematic review. Objective: To evaluate perioperative and clinical outcomes after open versus endoscopic lumbar decompression in patients with obesity. Summary of Background Data: Obesity is associated with increased technical difficulty and perioperative morbidity in lumbar spine surgery. Endoscopic spine surgery (ESS) may reduce soft tissue disruption and wound morbidity, but comparative data in obese patients remain limited. Materials and Methods: A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Web of Science were searched from inception through January 21, 2026. Studies were included if they enrolled adult patients with obesity undergoing lumbar decompression without fusion for degenerative pathology and reported at least one operative or perioperative outcome. Pediatric patients, nonlumbar or nondegenerative procedures, fusion-only cohorts, and nonprimary literature were excluded. Demographics, operative outcomes, complications, reoperation, and patient-reported outcomes were extracted and synthesized qualitatively. Results: Fourteen studies were included after screening 667 titles/abstracts and 93 full texts; 11 primary clinical studies informed the results synthesis. Two studies directly compared endoscopic and open decompression in obese patients. Ma and colleagues reported lower estimated blood loss after unilateral biportal endoscopic decompression compared with open surgery and shorter hospitalization. Castel and colleagues reported shorter hospitalization after full endoscopic lumbar discectomy compared with open surgery, although operative time was longer in the endoscopic cohort. Complications included surgical site infection, durotomy, nerve root injury, and recurrent disc herniation, with low event rates. BMI-stratified studies showed comparable pain and disability improvement between obese and nonobese patients. Conclusion: Based on limited comparative evidence from two studies, endoscopic decompression in obese patients was associated with similar clinical improvement and potential perioperative advantages compared with open surgery, including lower reported blood loss and shorter length of stay. Limitations include retrospective designs, heterogeneous techniques, only two comparative studies, and inconsistent reporting. These findings should be considered preliminary, and prospective comparative studies are needed. Level of Evidence: Level III.