Computational predictions of magnetic resonance acoustic radiation force imaging for breast cancer focused ultrasound therapy

PURPOSE

In magnetic resonance-guided focused ultrasound (MRgFUS) breast therapies, the focal location must be characterized to guide successful treatment. Focal characterization is difficult because heterogeneous breast tissues introduce phase aberrations that blur and shift the focus and traditional guidance methods do not work in adipose tissues. The purpose of this work is to evaluate numerical simulations of MRgFUS that predict the focal location. Those simulations are compared to clinical magnetic resonance acoustic radiation force imaging (MR-ARFI) data collected during in vivo treatment of breast tumors.

METHODS

The focal location was evaluated before MRgFUS treatment with MR-ARFI in five patients. The hybrid angular spectrum method (HAS) was applied to simulate pressure fields which were converted to forces, then convolved with a 3D Green's function (with time-of-arrival weighting) to produce a simulation of the MR-ARFI tissue displacement.

RESULTS

The focal locations found by the simulations and the MR-ARFI measurements were on average separated by 3.7 mm (SD: 0.9 mm). Characterization of the focal zone spatial distributions had a normalized root mean squared difference of 8.1% (SD: 2.5%). The displacement magnitudes of the simulations underestimated the MR-ARFI measurements by 82% (SD: 5.6%).

CONCLUSIONS

The agreement between MR-ARFI measurements and simulations demonstrates that HAS can predict the in vivo focal location in heterogeneous tissues, though accurate patient-specific properties are needed to improve predictions of tissue displacement magnitude. Tools developed in this study could be used to streamline MRgFUS treatment planning and optimization, for biomechanical property estimation, and in developing phase aberration correction techniques.

The clinical value of Delphian and pre-tracheal lymph nodes in predicting lateral lymph nodes metastasis of papillary thyroid carcinoma

BACKGROUND

Occult lymph node metastasis of papillary thyroid carcinoma is common. However, whether undergoing prophylactic lateral lymph node dissections is still controversial. This cross-sectional study with large cohort of patients aims to investigate the clinical value of Delphian and pre-tracheal lymph node in predicting lateral lymph node metastasis of papillary thyroid carcinoma.

MATERIALS AND METHODS

A retrospective analysis was conducted on 865 papillary thyroid carcinoma patients with Delphian and pre-tracheal lymph node data who underwent thyroidectomy plus central and lateral lymph node dissection. Data on clinicopathological characteristics were collected. Subsequently, a predictive model was established based on the results of the univariate and multivariate analyses.

RESULTS

The rates of Delphian and pre-tracheal lymph node metastasis and lateral lymph node metastasis were 54.7% and 39.1%, respectively. Having ≥ 3 or 1-2 Delphian and pre-tracheal lymph node metastasis dramatically increased the risk of lateral lymph node metastasis (OR = 8.5, 95% CI 5.3-13.4 and OR = 3.9, 95% CI 2.7-5.7, respectively). The upper tumour had a 3.7 times higher risk of lateral lymph node metastasis than other locations. Patients ≤ 42 years or tumour size >8 mm had a higher risk of lateral lymph node metastasis.

CONCLUSIONS

Delphian and pre-tracheal lymph node metastasis was associated positively with the risk of lateral lymph node metastasis. For patients without clinical lateral lymph node metastasis, the Delphian and pre-tracheal lymph node could be considered to harvest as the first step in a thyroidectomy to facilitate further conduct of the operation.

Correlation between ultrasonography and elastography parameters and molecular subtypes of breast cancer in young women

OBJECTIVE

To explore the differences of conventional ultrasound characteristics, elastic imaging parameters and clinicopathological characteristics of distinct molecular subtypes of breast cancer in young women, and to identify imaging parameters that exhibited significant associations with each molecular subtype.

METHODS

We performed a retrospective analysis encompassing 310 young women with breast cancer. Observations were made regarding the ultrasonography and elastography characteristics of the identified breast lesions. Subsequently, based on immunohistochemistry results patients were classified into five distinct molecular subtypes: luminal A, luminal B (HER2-), luminal B (HER2+), HER2+, and triple-negative breast cancer (TNBC). Clinical, pathological, and ultrasound imaging features were compared among these subtypes using binary logistic regression analysis.

RESULTS

Statistically significant differences were observed in various parameters across the five molecular subtypes (p < 0.05), including tumor size, morphology, margins, calcification, posterior echo features, blood flow (Adler grading), and tumor hardness. Specifically, luminal A subtype exhibited propensity for spiculated margins, lower blood flow grading, and decreased hardness; luminal B subtype was characterized by angular margins; HER2+ subtype manifested higher blood flow grading, calcification, and elevated hardness. Conversely, TNBC subtype displayed smooth margins, absence of calcification, and heightened hardness.

CONCLUSION

Specific molecular subtypes of breast cancer have unique ultrasonic and elastic imaging characteristics.

Efficacy of first-line radiofrequency ablation combined with systemic chemotherapy plus targeted therapy for initially unresectable colorectal liver metastases

BACKGROUND/OBJECTIVE

The optimal strategy for patients with colorectal liver metastases is still controversially discussed. This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) combined with systemic chemotherapy plus targeted therapy as first-line treatment in patients with initially unresectable colorectal liver metastases (CRLM), to identify prognostic factors and construct nomograms predicting survival.

METHODS

This retrospective study included patients with initially unresectable CRLM treated with (study group n = 74) or without (control group n = 83) RFA at the National Cancer Center from January 2018 to January 2021. Survival curves were assessed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were used to determine prognostic factors and include these factors in the nomograms to predict progression-free survival (PFS) and overall survival (OS).

RESULTS

The study group had significantly better median PFS (17.16 months vs. 8.35 months, p < 0.01) and OS (34.9 months vs. 21.1 months, p < 0.01) than the control group after propensity score matching. Cox regression analyses identified RFA treatment and clinical risk score (CRS) as independent prognostic factors for PFS. The largest diameter of liver metastases, RFA treatment, and CRS were independent prognostic factors for OS. Based on this finding, nomograms with good discrimination and calibration were constructed.

CONCLUSION

RFA combined with systemic chemotherapy plus targeted therapy as first-line treatment could significantly prolong PFS and OS in patients with initially unresectable CRLM compared with systemic chemotherapy plus targeted therapy. The nomograms predicting PFS and OS might help clinicians select personalized treatment.

Machine learning-based integration develops a disulfidptosis-related lncRNA signature for improving outcomes in gastric cancer

Gastric cancer remains one of the deadliest cancers globally due to delayed detection and limited treatment options, underscoring the critical need for innovative prognostic methods. Disulfidptosis, a recently discovered programmed cell death triggered by disulphide stress, presents a fresh avenue for therapeutic exploration. This research examines disulfidptosis-related long noncoding RNAs (DRLs) in gastric cancer, with the goal of leveraging these lncRNAs as potential markers to enhance patient outcomes and treatment approaches. Comprehensive genomic and clinical data from stomach adenocarcinoma (STAD) were obtained from The Cancer Genome Atlas (TCGA). Employing least absolute shrinkage and selection operator (LASSO) regression analysis, a prognostic model was devised incorporating five key DRLs to forecast survival rates. The effectiveness of this model was validated using Kaplan-Meier survival plots, receiver operating characteristic (ROC) curves, and extensive functional enrichment studies. The importance of select lncRNAs and the expression variability of genes tied to disulfidptosis were validated via quantitative real-time PCR (qRT-PCR) and Western blot tests, establishing a solid foundation for their prognostic utility. Analyses of functional enrichment and tumour mutation burden highlighted the biological importance of these DRLs, connecting them to critical cancer pathways and immune responses. These discoveries broaden our comprehension of the molecular framework of gastric cancer and bolster the development of tailored treatment plans, highlighting the substantial role of DRLs in clinical prognosis and therapeutic intervention.

Research trends of neoadjuvant therapy for breast cancer: A bibliometric analysis

The approach of neoadjuvant therapy for breast cancer, which involves administering systemic treatment prior to primary surgery, has undergone substantial advancements in recent decades. This strategy is intended to reduce tumor size, thereby enabling less invasive surgical procedures and enhancing patient outcomes. This study presents a comprehensive bibliometric analysis of research trends in neoadjuvant therapy for breast cancer from 2009 to 2024. Using data extracted from the Web of Science Core Collection, a total of 3,674 articles were analyzed to map the research landscape in this field. The analysis reveals a steady increase in publication output, peaking in 2022, with the United States and China identified as the leading contributors. Key institutions, such as the University of Texas System and MD Anderson Cancer Center, have been instrumental in advancing the research on neoadjuvant therapy. The study also highlights the contributions of influential authors like Sibylle Loibl and Gunter von Minckwitz, as well as major journals such as the Journal of Clinical Oncology. Emerging research topics, including immunotherapy, liquid biopsy, and artificial intelligence, are gaining prominence and represent potential future directions for clinical applications. This bibliometric analysis provides critical insights into global research trends, key contributors, and future developments in the field of neoadjuvant therapy for breast cancer, offering a foundation for future research and clinical practice advancements.

Multidisciplinary management of pituitary macroadenoma

BACKGROUND

Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations. This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas, integrating neurosurgery, endocrinology, radiology, and pathology perspectives.

AIM

To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis, management, and rehabilitation of individuals with pituitary adenomas, to add to already preexisting knowledge, in managing these cases enhancing better ocular and systemic outcomes.

METHODS

A search was conducted on an online publication database (PubMed) using the term “pituitary adenoma” including all results published over twenty years (2004-2024). Results were sorted for relevance, language, and completeness.

RESULTS

A total of 176 records were returned. The guidelines of the PRISMA 2020 statement were followed in this study. A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates. Another 17 records were not available as full-length articles and were also excluded. The references of each included record was further searched for relevant publications. A total of 141 records were therefore used in this minireview.

CONCLUSION

Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact, modern therapeutic strategies offer effective management options. Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life. Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future

MCC in the spotlight: Its dual role in signal regulation and oncogenesis

The mutated in colorectal cancer (MCC) gene is closely associated with the onset and progression of colorectal cancer. MCC plays a critical role in regulating the cell cycle and various signaling pathways and is recognized to inhibit cancer cell proliferation via the β-catenin signaling pathway. β-catenin is a key component of the WNT signaling pathway that influences cell growth, differentiation, survival, and migration, thereby positioning MCC as an important tumor suppressor. Notably, MCC has also been implicated in other cancer types, including lung, liver, and brain cancers. However, the precise mechanisms by which MCC functions in these malignancies remain inadequately understood. Comprehensive investigations into the interactions among MCC, various signaling pathways, and metabolic processes are essential for uncovering the molecular mechanisms of cancer and the pathological features characteristic of different cancer stages. This review presents the structural characteristics of MCC and its cell growth regulation mechanisms and functional roles within tissues, with the aims of enhancing our understanding of the role of MCC in cancer biology and highlighting potential therapeutic strategies targeting this gene.

Circadian clock regulation of myofibroblast fate

Fibrosis-related disorders represent an increasing medical and economic burden on a worldwide scale, accounting for one-third of all disease-related deaths with limited therapeutic options. As central mediators in fibrosis development, myofibroblasts have been gaining increasing attention in the last 20 years as potential targets for fibrosis attenuation and reversal. While various aspects of myofibroblast physiology have been proposed as treatment targets, many of these approaches have shown limited long-term efficacy so far. However, ongoing research is uncovering new potential strategies for targeting myofibroblast activity, offering hope for more effective treatments in the future. The circadian molecular clock is a feature of almost every cell in the human body that dictates the rhythmic nature of various aspects of human physiology and behavior in response to changes in the surrounding environment. The dysregulation of these rhythms with aging is considered to be one of the underlying reasons behind the development of multiple aging-related chronic disorders, with fibrotic tissue scarring being a common pathological complication among the majority of them. Myofibroblast dysregulation due to skewed circadian clockwork might significantly contribute to fibrotic scar persistence. In the current review, we highlight the role of the circadian clock in the context of myofibroblast activation and deactivation and examine its dysregulation as a driver of fibrogenesis.

The arginine metabolism and its deprivation in cancer therapy

Arginine deprivation has emerged as a promising therapeutic strategy in cancer treatment due to the auxotrophy of certain tumors. Many cancers, such as pancreatic, colorectal, and hepatocellular carcinoma, exhibit downregulated argininosuccinate synthetase, making them reliant on external arginine sources. This dependency allows targeted therapies that deplete arginine, inhibiting tumor growth while sparing normal cells. Arginine is crucial for various cellular processes, including protein synthesis and immune function. Its deprivation affects both tumor metabolism and immune responses, potentially enhancing cancer therapy. Studies have explored using enzymes like arginine deiminase and arginase, often modified for increased stability and reduced immunogenicity, to effectively lower arginine levels in the tumor microenvironment. These approaches show promise, particularly in tumors with low argininosuccinate synthetase expression. However, the impact on immune cells and the potential for resistance highlight the need for further research. Combining arginine deprivation with other treatments might improve outcomes, offering a novel approach to combat arginine-dependent cancers.

Shared neoantigens for cancer immunotherapy

Exploration of neoantigens holds the potential to be productive in immuno-oncotherapy. Among tumor-specific antigens, neoantigens result from genetic instability that gives rise to non-synonymous somatic mutations, highly specific to tumor cells. In addition to point mutations, gene rearrangements, indels leading to frameshifts, chromosomal translocations or inversions that may lead to fusion proteins, alternative mRNA splicing, and integration of genetic material of oncogenic viruses into the host genome provide consistent sources of neoantigens that are absent in healthy tissues. Out of these alterations, 2%-3% may generate T cell neoepitopes, possibly detectable by TCRs. Neoantigens are absent in healthy tissues and are thus at low risk of triggering autoimmunity. In addition, the host lymphocytes have not been rendered tolerant toward them and it is possible to induce immune responses against them. Here, we overview the two categories of neoantigens, i.e., private and shared, and their use in immuno-oncotherapy in selected pre-clinical and clinical studies. The vast majority of commonly occurring tumor-specific mutations are cancer causing and are permanently expressed by all malignant tumor cells, preventing the latter from escaping vaccine-induced anti-neoantigen immunity. The use of public neoantigens combined with efficient vaccine platforms can provide non-personalized "off-the-shelf" therapeutic vaccine candidates for broad-spectrum immunotherapy purposes.

miR-660: A novel regulator in human cancer pathogenesis and therapeutic implications

MicroRNAs (miRNAs) are non-coding RNAs that regulate gene expression. Among these, miR-660, located on chromosome Xp11.23, is increasingly studied for its role in cancer due to its abnormal expression in various biological contexts. It is regulated by 8 competing endogenous RNAs (ceRNAs), which adds complexity to its function. miR- 660 targets 19 genes involved in 6 pathways such as PI3K/AKT/mTOR, STAT3, Wnt/β-catenin, p53, NF‑κB, and RAS, influencing cell cycle, proliferation, apoptosis, and invasion/migration. It also plays a role in resistance to chemotherapies like cisplatin, gemcitabine, and sorafenib in lung adenocarcinoma (LUAD), pancreatic ductal adenocarcinoma (PDAC), and hepatocellular carcinoma (HCC), thus highlighting its clinical importance. Additionally, leveraging liposomes as nanocarriers presents a promising avenue for enhancing cancer drug delivery. Our comprehensive study not only elucidates the aberrant expression patterns, biological functions, and regulatory networks of miR-660 and its ceRNAs but also delves into the intricate signaling pathways implicated. We envisage that our findings will furnish a robust framework and serve as a seminal reference for future investigations of miR-660, fostering advancements in cancer research and potentially catalyzing breakthroughs in cancer diagnosis and treatment paradigms.

Nano biosensor unlocks tumor derived immune signals for the early detection of ovarian cancer

Ovarian cancer is a critical health issue for women nowadays. Its impact is significant because of its high mortality rate (324,603 worldwide), late-stage diagnosis and poor survival rate. Lack of screening tests, vague symptoms, misdiagnosis, and age factor makes it even more difficult to detect. Neutrophils, a subset of immune cells, undergo tumor-specific changes as ovarian cancer progresses inside ovarian tumour microenvironment. Therefore, monitoring the time-specific activity of neutrophils in circulation has the potential to aid in the diagnosis of ovarian cancer. Most ovarian tumor-specific antigens are unknown, making it difficult to identify neutrophils associated with ovarian tumor. We present ovarian tumor-associated circulating neutrophil cell profiling as a stand-alone cancer diagnostic method using a liquid biopsy. Using a SERS-functionalized nano probe, the metabolic profiles of neutrophils from ovarian tumor interaction are detected. We demonstrate that neutrophils associated with cancer stem cells have a distinct metabolic profile and are useful in the diagnosis of early ovarian cancer. Using 5 μL of peripheral blood and an artificial neural network, the characteristics of neutrophil profiles in patient blood could distinguish cancer cohort from non-cancer (healthy) with a 90 % sensitivity and 100 % specificity. Our results demonstrate the viability of using circulating neutrophils for non-invasive cancer diagnostics.

Mechanistic study of cancer drug delivery: Current techniques, limitations, and future prospects

Cancer drug delivery remains a critical challenge with systemic toxicity, poor drug bioavailability, and a lack of effective targeting. Overcoming these barriers is essential for improving treatment efficacy and patient outcomes. This review discusses current drug delivery techniques that reshape cancer therapy by offering precise, controlled-release tailored to tumor-specific features. Innovations in nanotechnology, immunotherapy, and gene therapy enable interventions at molecular and cellular levels. Radiomics and pathomics integrate high-dimensional data to optimize diagnostics and treatment planning. Combination therapy addresses the complexities of tumor heterogeneity by synergizing multiple agents within a single therapeutic framework, while peptide-drug conjugates enhance specificity and potency. Hydrogel-based systems and microneedle arrays offer localized, sustained release, significantly improving therapeutic outcomes. However, clinical translation of these advancements faces significant barriers such as drug resistance, off-target effects, scalability, cost, and ethical concerns. Moreover, regulatory complexities and the economic feasibility of these therapies highlight the need for innovative frameworks to make them accessible globally. Therefore, there is a need for innovation in gene and cell therapy, next-generation drug delivery platforms, and personalized medicine. This review focuses on recent advancements in drug delivery techniques over the past decade, evaluating their limitations and exploring potential future directions for transforming cancer treatment.

Eco-friendly nanotherapeutics: Metallic nanoparticles for targeting breast cancer

Breast cancer continues to be a major cause of death among women globally, with triple-negative breast cancer (TNBC) presenting a particularly difficult challenge due to its aggressive behaviour and the lack of effective treatment options. Nanotechnology, particularly the use of silver nanoparticles (AgNPs), has emerged as a promising avenue in oncological research. This review explores into the escalating field of green synthesis of nanoparticles, emphasizing sustainable approaches utilizing plant-based resources. Critical factors influencing nanoparticle synthesis, including reaction conditions, precursor types, and plant phytochemicals, are explored alongside advanced characterization techniques essential for evaluating nanoparticle properties. Special focus is given to the phytofabrication of silver nanoparticles and their multifaceted roles in breast cancer treatment, with detailed insights into their mechanisms, such as inducing apoptosis, generating reactive oxygen species (ROS), and disrupting mitochondrial function, particularly in TNBC cells. The review further highlights the advantages of plant-derived AgNPs, such as biocompatibility and reduced toxicity, while addressing challenges like scalability, reproducibility, and regulatory hurdles. Concluding with future prospects, this paper reflects the potential of green-synthesized AgNPs as a keystone in next-generation cancer therapeutics, paving the way for innovative and eco-friendly approaches in oncology.

The function of microRNA related to cancer-associated fibroblasts in pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignant tumor characterized by a poor prognosis. A prominent feature of PDAC is the rich and dense stroma present in the tumor microenvironment (TME), which significantly hinders drug penetration. Cancer-associated fibroblasts (CAFs), activated fibroblasts originating from various cell sources, including pancreatic stellate cells (PSCs) and mesenchymal stem cells (MSCs), play a critical role in PDAC progression and TME formation. MicroRNAs (miRNAs) are small, single-stranded non-coding RNA molecules that are frequently involved in tumorigenesis and progression, exhibiting either oncolytic or oncogenic activity. Increasing evidence suggests that aberrant expression of miRNAs can mediate interactions between cancer cells and CAFs, thereby providing novel therapeutic targets for PDAC treatment. In this review, we will focus on the potential roles of miRNAs that target CAFs or CAFs-derived exosomes in PDAC progression, highlighting the feasibility of therapeutic strategies aimed at restoring aberrantly expressed miRNAs associated with CAFs, offering new pathways for the clinical management of PDAC.

Posttransplant EBV-Positive Smooth Muscle Tumors in Children, Adolescents, and Young Adults: A Multi-Institution Experience

Epstein-Barr virus (EBV)-positive smooth muscle tumors (SMTs) are rare tumors seen in immunocompromised patients. There is no clear standard of care for the management and treatment of EBV-SMTs. Patients are often treated with chemotherapy, surgery, and/or radiation. Additional options include antiretroviral treatment, reduction in immunosuppression, and EBV-directed virus-specific T cells (VSTs). This report describes the treatment regimens and outcomes of eight patients with EBV-associated SMTs. Although no consensus treatment for EBV-SMTs has been identified, VSTs show promise in providing a period of stable disease or partial response and surgical removal may offer long-term benefits in cases of localized disease.

High CCR6 expression increases the risk of pediatric Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) is a rare disorder that primarily affects children. Considering the intricate clinical presentation of this disease, the identification of specific biomarkers associated with susceptibility to LCH is essential for timely diagnosis and risk stratification. In this study, we examined the skin specimens from pediatric patients with LCH using RNAscope, immunohistochemistry, and sequencing techniques. We observed a notable correlation between elevated CCR6 expression in pathological tissues and LCH risk classification. Therefore, CCR6 expression may serve as an independent predictor of risk in clinical cases of LCH. Furthermore, the frequency of BRAF V600E mutations correlated with risk stratification. We discovered new mutations-H119Y and R108Q-in MAP2K1 in specimens with BRAF V600E mutations. Moreover, CCR6-positive tumors may exhibit an enhanced recruitment of lymphocytes expressing high CCR7 levels.

Antibody-drug conjugates and radioconjugates targeting carbonic anhydrase IX and XII in hypoxic tumors: Bench to clinical applications

Treating hypoxic tumors is challenging due to their aggressive nature, resistance to standard treatments, often leading to poor outcomes. Hypoxic tumors create a unique environment that reduces the effectiveness of traditional treatments such as chemotherapy and radiotherapy. Human carbonic anhydrases (hCA IX and hCA XII) are involved in tumors survival and metabolism by regulating pH homeostasis, ferroptosis, metastatization, and other processes. Developing drugs that specifically target these enzymes has been demonstrated to disrupt the tumor survival mechanisms, leading to significant antitumor effects. This review discusses recent developments on antibody-drug conjugates (ADCs) and radioconjugates targeting hCA IX and hCA XII in hypoxic tumors. New approaches based on small molecule inhibitors and monoclonal antibodies such as girentuximab provided encouraging results in preclinical research and clinical trials. These advances highlight the potential of hCA-targeted therapies to improve cancer treatment for hypoxic tumors.

A joint photoacoustic imaging and broadband spectral analysis for early-stage intraoperative pathology assessment: A case study with colorectal cancer

Accurate and rapid intraoperative diagnosis of micro-infiltration in early-stage tumors presents a formidable challenge for decades. Here, we propose a novel diagnostic approach, that combines Photoacoustic Morphological Imaging (PAMI) with an in situ broadband Photoacoustic Spectral Analysis (PASA), to implement intraoperative assessment of early-stage tumor while its high-frequencies between 50 and 150 MHz respond to various nuclei specifically. Our system, a broadband Ultraviolet Photoacoustic Microscopy (bUV-PAM), uniquely integrates ultraviolet laser-induced nucleus-specific photoacoustic excitation with broadband photoacoustic detection (up to 176 MHz at -6 dB) via an optical surface wave sensor. This approach facilitates the simultaneous acquisition of morphological and spectral information from unstained tissue sections, yielding a comprehensive dual-modality virtual slice within a single raster scan. Using human colorectal tissue samples, we applied the joint PAMI and in situ PASA approach across 6 case groups. Morphological features in PAMI showed a high concordance with Hematoxylin and Eosin (H&E) staining, whereas micro-infiltrative features were too indistinct to be identified in both PAMI and H&E images. In contrast, the PASA effectively distinguishes between micro-infiltrated and non-infiltrated tissues, a finding validated by subsequent Immunohistochemical (IHC) assessments. The preliminary results suggest that the joint approach holds potential to enhance intraoperative detection of micro-infiltration, thereby offering a promising avenue for accurate and rapid surgical margin assessment.

Leveraging self-signal amplifying poly(acrylic acid)/polyaniline electrodes for label-free electrochemical immunoassays in protein biomarker detection

Accurate quantification of specific biomarkers is essential for clinical diagnosis and evaluating therapeutic efficacy. A self-signal-amplifying poly(acrylic acid) (PAA)/polyaniline (PANI) film-modified disposable and cost-effective screen-printed carbon electrode (SPCE) has been developed for constructing new label-free immunosensors targeting two model biomarkers: human immunoglobulin G (IgG) and alpha-fetoprotein (AFP). The electrochemically deposited PAA/PANI film on the SPCE serves a dual function: both a bio-immobilization support and a signal amplifier, enhancing biomarker detection sensitivity and efficiency. The self-signal amplification properties of PANI streamline the detection process. At the same time, the high-density surface carboxyl groups from embedded PAA enable covalent conjugation with capture antibodies (anti-IgG and anti-AFP). Subsequently, antibody-immobilized PAA/PANI film-modified SPCEs, as immunosensors, successfully detect IgG and AFP without the need for external redox probes. The reductions in the electrochemical PANI signals of the immunosensors are linearly proportional to the logarithm of IgG and AFP concentrations. The proposed immunosensors exhibit sufficiently wide ranges of calibration curves from 0.10 to 50 ng mL-1, with limits of detection of 0.080 ng mL-1 for IgG and 0.090 ng mL-1 for AFP. The sensors exhibit satisfactory sensitivity and selectivity, indicating their potential for accurate and reliable detection.

A Descriptive Phenomenological Study of the Women's Experiences From the Suspicion of Breast Cancer to the Initiation of Treatment

INTRODUCTION

Breast cancer is the most common malignancy among women worldwide. However, scientific research has paid little attention to the lived experiences of these women, from the onset of concerning symptoms to the initiation of curative treatment. This study aimed to explore and understand the experiences of Tunisian women, from the appearance of the first symptoms of suspected breast cancer to the initiation of curative treatment.

METHOD

This descriptive phenomenological qualitative study, inspired by Husserl's philosophy, is the first of its kind in Tunisia to explore the feelings and experiences of women with breast cancer during the early stages of care. Individual interviews were conducted with 13 women diagnosed with breast cancer who had visited the Farhat Hached University Hospital in Sousse. Participants were selected through purposive sampling. Data collection was carried out in September and October 2022. The Giorgi analysis method was used, allowing for the emergence of three main themes.

RESULTS

The analysis of the interviews revealed three themes: Waiting for diagnostic test results, the announcement of the diagnosis, and waiting for treatments. Together, these themes encapsulated the essence of the phenomenon: a balance between vulnerability to various challenges and resilience in managing the journey from diagnosis to treatment, reflecting a life of both struggle and strength. Participants highlighted the psychological, physical and economic challenges they faced and expressed specific needs related to their condition. These needs were particularly evident during the pre-diagnosis phase, the moment of diagnosis disclosure and the waiting period before treatment began.

CONCLUSION

The practical implications derived from the results of this study could help inform medical and nursing practices and guide the development of care delivery strategies to better support women with breast cancer.

The current landscape of aromatase inhibitors for the treatment of estrogen receptor-positive breast carcinoma

Estrogen receptor-positive (ER+) breast carcinoma represents a significant portion of breast cancer cases and is characterized by the presence of estrogen receptors that promote tumor growth upon estrogen binding. ER + breast cancer progression involves hormonal influences, interactions within the tumor microenvironment, and genetic mutations that may lead to treatment resistance. Successful therapeutic options include hormonal therapies, particularly aromatase inhibitors (AIs), which aim to block the effects of estrogen or reduce its synthesis. With higher efficacy than tamoxifen, AIs such as anastrozole, letrozole, and exemestane have become widely employed in adjuvant and first-line treatments for advanced breast cancer. AIs function by inhibiting the enzyme aromatase, which converts androgens into estrogens in the peripheral tissues. Because too much estrogen might promote tumor growth, this decrease in estrogen levels is essential for treating ER+ malignancies. To provide a comprehensive overview of AIs in the treatment of ER+ breast cancer, this study examined the pharmacokinetics, clinical uses, mechanisms of action, and problems with treatment resistance. To maximize therapeutic approaches and enhance patient outcomes in the treatment of ER breast cancer, it is imperative to understand these characteristics.

A Survey of Clinical Practices for Hepatocellular Carcinoma Among Experts at Tertiary Hospitals in China From 2020 to 2021

Background

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death in China. The rapid progress in systemic therapies has led to the approval of many therapeutic methods that have quickly changed clinical guidelines and practices. Because of the high heterogeneity of HCC, there are still some gaps between the guidelines and real-world clinical practice. The present study surveyed experts in China to investigate the current treatment concepts and clinical practice regarding HCC.

Methods

A questionnaire survey on the treatment concepts and clinical practice of HCC was administered to 310 experts with senior professional titles in 2020 and 312 experts in 2021. The results were analyzed and compared.

Results

For treating patients with resectable HCC, 28% of hepatobiliary surgeons indicated neoadjuvant therapy, and 7% chose systemic therapy ± locoregional therapy as 1 L therapy in 2021 compared with 20% and 1% in 2020. More experts chose adjuvant treatment within 1 month in 2021 compared with 2020, and 6 months and 12 months were the leading choices for the duration of adjuvant treatment. In 2021, 79% of surgeons and 19% of interventionalists were willing to conduct downstaging/conversion therapy for patients with potentially resectable HCC, and 78% chose tyrosine kinase inhibitors (TKI) + immunotherapy (IO) + locoregional therapy for cases in which R0 resection could not be achieved. For completely unresectable HCC, more experts preferred TKI + IO-based therapy as 1 L therapy in 2021 compared with 2020 (78% vs. 55%). The proportion of experts who indicated TKI + IO-based therapy as 2 L therapy increased from 32% in 2020 to 40% in 2021.

Conclusion

The survey results indicated that in 2021, compared with 2020, more experts opted to administer IO + TKI for the treatment of liver cancer, and more experts and patients were willing to participate in clinical research.

Blood-oxygenation-level-dependent (BOLD) MRI responses to CO2 and O2 inhalation in brain gliomas

PURPOSE

Cerebrovascular abnormalities are intricately involved in gliomas. While static cerebrovascular properties such as cerebral blood flow, volume, and permeability have been extensively studied, dynamic vascular parameters have not been fully understood. This study aimed to characterize the vascular responses to CO2 and O2 inhalation in brain gliomas.

METHODS

In 15 glioma patients, concomitant CO2 and O2 inhalation was applied while BOLD MR images were continuously acquired for nine minutes, resulting in the measurement of O2-reactivity, CO2-reactivity, and bolus arrival time (BAT). Vascular parameters were compared between the tumor regions and contralateral healthy tissue using Student t-tests. The dependence of vascular parameters on glioma grade, glioma subtypes, and molecular biomarkers were assessed using a multiple linear regression.

RESULTS

Visual inspection suggested that reliable O2-reactivity, CO2-reactivity, and BAT maps could be obtained in every patient. Compared to the contralateral healthy tissue, glioma regions on average revealed a diminished O2-reactivity (p < 0.001) and CO2-reactivity (p < 0.001), but a lengthened BAT (p < 0.001). Intra-tumoral heterogeneity in the vascular parameters between core and periphery was also observed. Astrocytomas had a lower CO2-reactivity (p = 0.014) and a longer BAT (p = 0.012) relative to oligodendrogliomas. Glioma grade had no association with O2-reactivity, CO2-reactivity, or BAT. Patients who lost ATRX expression had a lower CO2- and O2-reactivity (p = 0.005 and p = 0.035) compared to patients who retained ATRX expression.

CONCLUSIONS

Gliomas are associated with abnormal CO2- and O2-reactivity measured with MRI. These dynamic parameters may provide new insights into the vascular pathophysiology in gliomas.

Platinum-based chemotherapies-induced nephrotoxicity: mechanisms, potential treatments, and management

Platinum-based chemotherapies are essential in the treatment of several malignancies. However, such medications can damage the kidneys, frequently leading to both acute and chronic kidney disease. Treatment becomes more difficult for such problems. Physicians may alter chemotherapy regimens and utilize kidney-protecting medications to lessen renal damage. New imaging techniques and biomarkers also aid in the early detection of renal issues. To effectively handle the mentioned situation, oncologists, nephrologists, and pharmacists must collaborate. However, additional study is still required to develop customized therapies, discover strategies to minimize kidney injury and produce new platinum medicines. Hereupon, the present review's authors are being sought to address the causes, prospective treatments, and management of nephrotoxicity caused by platinum-based chemotherapy.

Malignant tumors in vagal-innervated organs: Exploring its homeostatic role

Cancer remains a significant global health challenge, with its progression shaped by complex and multifactorial mechanisms. Recent research suggests that the vagus nerve could play a critical role in mediating communication between the tumor microenvironment and the central nervous system (CNS). This review highlights the diversity of vagal afferent receptors, which could position the vagus nerve as a unique pathway for transmitting immune, metabolic, mechanical, and chemical signals from tumors to the CNS. Such signaling could influence systemic disease progression and tumor-related responses. Additionally, the vagus nerve's interactions with the microbiome and the renin-angiotensin system (RAS)-both implicated in cancer biology-further underscore its potential central role in modulating tumor-related processes. Contradictions in the literature, particularly concerning vagal fibers, illustrate the complexity of its involvement in tumor progression, with both tumor-promoting and tumor-suppressive effects reported depending on cancer type and context. These contradictions often overlook certain experimental biases, such as the failure to distinguish between vagal afferent and efferent fibers during vagotomies or the localized parasympathetic effects that cannot always be extrapolated to the systemic level. By focusing on the homeostatic role of the vagus nerve, understanding these mechanisms could open the door to new perspectives in cancer research related to the vagus nerve and lead to potential therapeutic innovations.

Combined preoperative and post-adjuvant-chemotherapy carcinoembryonic antigen levels are prognostic for early recurrence and survival in stage III colon cancer

BACKGROUND

The definitive treatment of stage-III colon cancer is surgery and adjuvant chemotherapy. A combined assessment of pre-operative and post-adjuvant chemotherapy carcinoembryonic antigen (CEA) levels may better prognosticate early recurrence and survival.

METHODS

A cohort of patients who underwent surgery and adjuvant chemotherapy was assessed. The CEA-Square (CEA2) score was defined as the multiplication of preoperative and post-adjuvant chemotherapy CEA levels and was grouped as "≤25(ng/mL)2" and ">25(ng/mL)2.

RESULTS

Among the 432 patients,137 were eligible. CEA2 score (>25 vs ​≤ ​25 (ng/mL)2) was significantly prognostic for early recurrence (34.5 ​% vs. 14.3 ​%, log-rank, p ​< ​0.001). In the multivariable analysis, only the CEA2 score remained associated with early recurrence [HR:3.375, (95 ​% CI:1.488-7.655), p ​= ​0.004]. In a median follow-up of 37.5 months (2.5-101.0), a high CEA2 score [>25 (ng/mL)2] was significantly associated with a worse OS (log-rank, p ​< ​0.001).

CONCLUSION

CEA2 is a simple, practical score combining prognostic values of preoperative and post-adjuvant chemotherapy CEA levels.

[Frozen sections in hepatobiliary surgery]

Complete removal of the tumor (R0 resection) is one of the most important prognostic factors for overall and recurrence-free survival in patients with hepatobiliary malignancies. Accordingly, the intraoperative confirmation of tumor-free resection margins is of central importance. At the same time, despite extensive preoperative diagnostics intraoperative findings can arise that require immediate histological clarification. For example, the discovery of peritoneal carcinomatosis or previously unknown intrahepatic metastases often leads to the termination of the operation and thus to a change in the oncological concept. In addition, the estimation of the local tumor spread, particularly in the case of biliary tumors related to the liver hilum, is sometimes difficult based on preoperative imaging, so that a timely intraoperative assessment of tissue samples is necessary to confirm the resectability. The possibility of intraoperative frozen section diagnostics is, therefore, of particular importance, especially in complex surgical interventions in the hepatobiliary area.

Ongoing Symptoms and Concerns Experienced by Low-Risk Breast Cancer Survivors Following Active Treatment

INTRODUCTION

Little is known about the symptom burden of breast cancer survivors with early-stage disease. Many studies have focused on symptoms of patients who are undergoing or recently completed systemic therapy. However, with the increased use of Oncotype DX, the proportion of early-stage hormone receptor-positive patients who undergo chemotherapy has declined, making existing studies of the symptom experience less useful for these patients.

OBJECTIVE

The aim of this study was to assess symptom burden for early-stage breast cancer survivors.

METHODS

Eligible survivors had stage I-II, estrogen receptor (ER)- or progesterone receptor (PR)-positive and HER2neu-negative breast cancer, did not receive chemotherapy, were 6 months-5 years post-diagnosis, and were cancer-free. Survivors were enrolled at the University of Wisconsin Breast Center follow-up visits and were emailed a link to a patient-reported outcomes (PRO) survey. Survey domains were informed by American Cancer Society/American Society of Clinical Oncology (ACS/ASCO) survivorship guidelines and survivor/provider stakeholders. The prevalence of clinically significant symptoms are reported.

RESULTS

Overall, 98 patients participated. On average, participants were 61.3 years of age (standard deviation [SD] 11.5) and 2.5 years post-diagnosis (SD 1.2); 71.3% underwent breast-conserving surgery. The average item-level missingness rate was low (2.0%). Most survivors (86.2%) experienced symptoms (38.8% reporting one to two symptoms; 47.9% reporting more than three symptoms).

CONCLUSIONS

Early-stage breast cancer survivors report a high symptom burden. Given nearly 50% of survivors report more than three symptoms, many topics may not be discussed or addressed during time-limited follow-up visits. Some symptoms, such as sexual health, may be less feasible to address in-clinic given their complex/sensitive nature. Use of PROs allows for a comprehensive evaluation and identification of unrecognized needs, representing an opportunity to improve survivorship care.

Radiation-induced sarcomas of the craniofacial region: A systematic review

BACKGROUND

Radiation-induced sarcomas (RIS) are rare entities that have been studied infrequently in large cohorts, with most data derived from case reports or small series. This study aims to systematically evaluate existing data to synthesize and consolidate current knowledge.

METHODS

An electronic literature search was conducted using PubMed and the Cochrane Library. The search included studies and case reports with clinico-histopathological and survival data on craniofacial RIS.

RESULTS

Among 1237 studies identified, 143 studies with 701 patients were included. The average patient age was 48 years, with men nearly twice as likely to develop RIS. RIS had an average latency period of 12 years, with an average radiation dose of 63 Gy. Radiation-induced osteosarcomas (42.1 %) were most common, followed by fibrosarcomas (21.1 %). Nasopharyngeal carcinoma (53.0 %) and retinoblastoma (10.3 %) were the most prevalent primary tumors. 5.4 % of patients received radiotherapy for benign disease. The average latency period in this group was approximately 1.5 times longer than that observed in the group with malignancies; however, the average radiation dose was also approximately 15 Gy lower. Local recurrences occurred after an average of 16 months. The 1-, 2-, and 5-year survival rates were 67.8 %, 47.1 %, and 25.0 %, respectively. Surgical therapy showed the best survival rates (33.3 % after 5 years) while isolated chemotherapy yielded the lowest (0.0 %).

CONCLUSION

The prognosis for craniofacial RIS remains poor despite aggressive treatment. Surgical intervention is the primary therapeutic approach, but optimal treatment regimens and the role of (neo-)adjuvant therapies require further investigation. This study underscores the complexity of managing RIS and highlights the need for ongoing research to improve outcomes.

Subtyping breast lesions via collective intelligence based long-tailed recognition in ultrasound

Breast lesions display a wide spectrum of histological subtypes. Recognizing these subtypes is vital for optimizing patient care and facilitating tailored treatment strategies compared to a simplistic binary classification of malignancy. However, this task relies on invasive biopsy tests, which carry inherent risks and can lead to over-diagnosis, unnecessary expenses, and pain for patients. To avoid this, we propose to infer lesion subtypes from ultrasound images directly. Meanwhile, the incidence rates of different subtypes exhibit a skewed long-tailed distribution that presents substantial challenges for effective recognition. Inspired by collective intelligence in clinical diagnosis to handle complex or rare cases, we proposed a framework-CoDE-to amalgamate diverse expertise of different backbones to bolster robustness across varying scenarios for automated lesion subtyping. It utilizes dual-level balanced individual supervision to fully exploit prior knowledge while considering class imbalance. It is also equipped with a batch-based online competitive distillation module to stimulate dynamic knowledge exchange. Experimental results demonstrate that the model surpassed the state-of-the-art approaches by more than 7.22% in F1-score facing a challenging breast dataset with an imbalance ratio as high as 47.9:1.

A multi-omics analysis of effector and resting treg cells in pan-cancer

Regulatory T cells (Tregs) are critical for maintaining the stability of the immune system and facilitating tumor escape through various mechanisms. Resting T cells are involved in cell-mediated immunity and remain in a resting state until stimulated, while effector T cells promote immune responses. Here, we investigated the roles of two gene signatures, one for resting Tregs (FOXP3 and IL2RA) and another for effector Tregs (FOXP3, CTLA-4, CCR8 and TNFRSF9) in pan-cancer. Using data from The Cancer Genome Atlas (TCGA), The Cancer Proteome Atlas (TCPA) and Gene Expression Omnibus (GEO), we focused on the expression profile of the two signatures, the existence of single nucleotide variants (SNVs) and copy number variants (CNVs), methylation, infiltration of immune cells in the tumor and sensitivity to different drugs. Our analysis revealed that both signatures are differentially expressed across different cancer types, and correlate with patient survival. Furthermore, both types of Tregs influence important pathways in cancer development and progression, like apoptosis, epithelial-to-mesenchymal transition (EMT) and the DNA damage pathway. Moreover, a positive correlation was highlighted between the expression of gene markers in both resting and effector Tregs and immune cell infiltration in adrenocortical carcinoma, while mutations in both signatures correlated with enrichment of specific immune cells, mainly in skin melanoma and endometrial cancer. In addition, we reveal the existence of widespread CNVs and hypomethylation affecting both Treg signatures in most cancer types. Last, we identified a few correlations between the expression of CCR8 and TNFRSF9 and sensitivity to several drugs, including COL-3, Chlorambucil and GSK1070916, in pan-cancer. Overall, these findings highlight new evidence that both Treg signatures are crucial regulators of cancer progression, providing potential clinical outcomes for cancer therapy.

Cyclin-dependent kinase 4 and 6 inhibitors in breast cancer treatment

Breast cancer is the second largest cancer in the world, and it has highest mortality rate in women worldwide. The aberrant activation of the cyclin-dependent kinase 4 and 6 (CDK4/6) pathway plays an important role in uncontrolled breast cancer cell proliferation. Therefore, targeting CDK4/6 to improve overall survival rates has been a strong interest in breast cancer therapeutics. Till date, four CDK4/6 inhibitors have been developed and approved for hormone receptor-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer therapies with great success. However, acquired resistance to CDK4/6 inhibitors has emerged and limits their effectiveness in breast cancer. In this review, we systematically discussed the mechanisms of resistance to CDK4/6 inhibitors including the cell cycle-specific and cell cycle-nonspecific mechanisms. Also, we analyzed combination strategies with other signaling inhibitors in clinical and preclinical settings that further expand the clinical application of CDK4/6 inhibitors in future breast cancer therapies.

Cytologic Diagnosis of Squamous Cell Carcinoma Arising From a Recurrent Cerebellopontine Angle Epidermoid Cyst in a 61-Year-Old Male

Here, we report an exceptionally rare event of malignant transformation of an intracranial epidermoid cyst into squamous cell carcinoma (SCC), diagnosed through cerebrospinal fluid cytology. A 61-year-old male with a prior history of left retrosigmoid craniotomy and partial resection of a large cerebellopontine angle epidermoid tumor 13 years ago presented with acute mental status changes and weakness. Imaging revealed recurrent epidermoid cyst elements with associated obstructive hydrocephalus. The patient underwent ventriculoperitoneal shunt placement, and cerebrospinal fluid cytology revealed clusters of atypical epithelial cells. Further cytopathological and immunohistochemical (IHC) evaluation confirmed a diagnosis of SCC. Despite the initiation of chemotherapy and immunotherapy, the patient's condition deteriorated, and he passed away 2 months later. This case highlights the need for vigilance in monitoring patients with epidermoid cysts and that early detection through CSF cytology with confirmatory IHC provides a minimally invasive diagnostic pathway to guide rapid clinical decision-making.

In-vitro immune-modulation of triple-negative breast cancer through targeting miR-30a-5p/MALAT1 axis using nano-PDT combinational approach

BACKGROUND

Triple negative breast cancer (TNBC) is an immunogenic tumor; however, its tumor immune microenvironment (TIME) is densely packed with immune suppressive cytokines and immune checkpoints. The immune-suppressive features of TNBC TIME represent a considerable obstacle to any immunotherapeutic approach. The objective of this study was to develop a multimodal in-vitro strategy to manipulate the TNBC TIME and enhance patients' outcomes by employing carefully tailored hybrid chitosan-lipid Nanoparticles (CLNPs), metformin and chlorin e6 (Ce-6)-mediated PDT, alone or combined. Special focus is directed towards evaluation of the role of the selected treatment agents on the non-coding RNAs (ncRNAs) involved in tuning the immuno-oncogenic profile of TNBC, for instance, the miR-30a-5p/MALAT1 network.

METHODS

This study enrolled 30 BC patients. CLNPs and ce-6-loaded CLNPs with different physicochemical features were synthesized and optimized using ionotropic gelation. The intracellular concentration and effects on MDA-MB-231 cellular viability were investigated. UHPLC was used to quantify ce-6. MDA-MB-231 cells were transfected with miR-30a-5p oligonucleotides and MALAT1 siRNAs using lipofection to investigate the interaction between MIF, PD-L1, TNF-α, IL-10, and the miR-30a-5p/MALAT1 ceRNA network. qRT-PCR was used to evaluate IL-10, TNF-α, and MIF expression levels, whereas flow cytometry was used for PD-L1.

RESULTS

Immunophenotyping of BC biopsies revealed significantly elevated levels of immunosuppressive markers, including IL-10, TNF-α, PD-L1, and MIF in BC biopsies compared to its normal counterparts. Upon patient stratification, it was shown that MIF and IL-10 are upregulated in TNBC patients compared to non-TNBC patients. Nonetheless, immune suppressive biomarkers expression investigated in the current study was generally correlated with signs of poor prognosis. CLNPs with mean particle size ranging from 50-150 nm were obtained. CLNPs exhibited different patterns of intracellular uptake, cytotoxicity and modulation of the immunosuppressive markers based on their physicochemical properties and composition. In particular, CLNP4 in-vitro effectively reduced IL-10, TNF-α, MIF, and PD-L1. Loading of Ce-6 into CLNP4 (Ce6-CLNPs) improved the in-vitro cytotoxic effects via PDT. In addition, PDT with Ce6-CLNP4 enhanced the expression of tumor-suppressive miR-30a-5p and decreased oncogenic lncRNA MALAT1 expression in MDA-MB-231 cells, suggesting a potential for modulating the TNBC immuno-oncogenic profile.

CONCLUSION

This study demonstrated that CLNPs and Ce-6-mediated PDT can modulate several key immunosuppressive factors and the miR-30a-5p/MALAT1 axis in TNBC cells. These findings provide a rationale for further in-vivo investigation of this multimodal therapeutic strategy.

Proteomic insights into lymph node metastasis in breast cancer subtypes: Key biomarkers and pathways

BACKGROUND

Breast cancer (BC) is a significant global cause of death in women, primarily due to its diversity and metastatic potential.

METHODS

BC, healthy lymph node (HL), and metastatic lymph node (ML) tissues were collected from 19 patients diagnosed with infiltrating ductal carcinoma. Protein isolation was performed, followed by two-dimensional gel electrophoresis (2DE) and mass spectrometry (MALDI-TOF/TOF) to identify differentially expressed proteins. Bioinformatic analyses, including protein-protein interaction networks and molecular pathways, were conducted using STRING. Kaplan-Meier analysis was performed with KM plotter to evaluate the prognostic significance of identified proteins. Receiver operating characteristic (ROC) curves were generated using TCGA and GTEx data from UCSC Xena and easyROC to assess diagnostic relevance.

RESULTS

Distinct pathways related to cytoskeletal regulation, immune modulation, and oxidative stress response were enriched in each subtype. Key proteins such as TUBA1C, CCT6A, and Vimentin (LNA), CAPZB and ENO1 (LNB), GSTO1 (HER2 OE), and CORO1A and LAP3 (TNBC) were identified as significant in driving metastatic behavior. KM survival analysis showed that CAPZB (LNB) and CORO1A (TNBC) were associated with patient outcomes, while GSTO1 was linked to improved distant metastasis-free survival in HER2 OE. ROC analysis highlighted CAPZB as a strong diagnostic marker.

CONCLUSIONS

These findings form a basis for comprehending the molecular mechanisms underlying metastasis in different subtypes of breast cancer. They may lead to the identification of new therapeutic targets for customized interventions against invasion and metastasis. Further validation is required to confirm their clinical utility in larger cohorts.

Recombinant human‑endostatin combined with sintilimab and chemotherapy in first‑line treatment of locally advanced or metastatic esophageal squamous cell carcinoma

Esophageal cancer is a type of digestive system tumor with a high degree of malignancy. In recent years, research has been conducted on immunotherapy, chemotherapy and radiation therapy for esophageal cancer. However, there are still shortcomings in the improvement of 5-year survival rates. In order to explore more therapy options, the present study evaluated the efficacy and safety of recombinant human-endostatin (rh-endostatin) combined with sintilimab and chemotherapy for the first-line treatment of locally advanced or metastatic esophageal squamous cell carcinoma (ESCC). This retrospective study included data from 31 patients with unresectable locally advanced or metastatic esophageal cancer treated between January 2019 and December 2023, and was approved by the First Affiliated Hospital of Nanjing Medical University (Nanjing, China). All patients received first-line treatment combining rh-endostatin with sintilimab, paclitaxel liposome and platinum. Following the completion of 6 cycles, maintenance therapy with sintilimab was administered until disease progression occurred. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) time, overall survival (OS) time and adverse events (AEs) were observed. Symptomatic or supportive care was administered as needed, according to the clinical discretion of the treating physician. As of July 17, 2024, the median follow-up time was 13.07 months, with a median PFS time of 8.30 months (95% confidence interval, 3.442-13.158 months). For these 31 patients, the ORR was 67.7% (21/31), while the DCR was 93.5% (29/31). The median OS time reached 23.07 months. Furthermore, 77.4% of patients experienced at least one treatment-related AE (TRAE), and grade 3 TRAEs occurred in 8 patients (25.8%). No unexpected AEs were observed. In conclusion, rh-endostatin combined with sintilimab and chemotherapy exhibited positive efficacy and safety in patients with advanced ESCC, providing a promising treatment regimen for these patients.

Design, synthesis, and biological evaluation of novel PROTACs compounds with good ERα degradation ability

A series of ER-PROTACs compounds were designed, synthesized and tested for their ability to degrade estrogen receptor proteins and exhibit Human breast cancer cells (MCF-7) inhibition activity. Molecular docking simulations were performed using Discovery studio. Among these compounds, QDE-003-W had the highest estrogen receptor protein degradation ability and cellular activity, with a DC50 value of 95 nM, for estrogen receptor protein degradation and an IC50 value of 30.2 nM for cellular activity. Furthermore, the molecular docking study revealed that the biological activity of QDE-003-W depended on its suitable linker length, which gave us some reference significance for the study of ER-PROTACs. And compared with fulvestrant, QDE-003-W exhibited more favorable pharmacokinetic (PK) characteristics. No significant adverse side effects were observed under the administration protocol, which indicates that the tested mice had excellent tolerance to both the administration method and the dosage. Such favorable PK characteristics and safety features further enhance the prospects of QDE-003-W as a viable candidate for subsequent preclinical and clinical development.

Hybrid Approaches to Local Management of Pulmonary Metastatic Disease

With increasingly effective systemic therapies for stage IV disease, the addition of local control strategies for a subset of patients with limited metastatic disease has contributed to improved disease control and life prolongation. While surgery has been the mainstay strategy for local control, stereotactic ablative body radiation and percutaneous ablation techniques are alternate methods that have been demonstrated to be safe and effective and offer options to those patients who are unresectable, inoperable, or who do not desire surgery. A hybrid approach combining surgery and radiotherapy can maximize the ability to treat more lesions.

Targeting fibroblast growth factor receptor (FGFR) with inhibitors in head and neck cancers: Their roles, mechanisms and challenges

Head and neck squamous cell carcinoma (HNSCC) is a common and aggressive type of cancer with significant rates of morbidity and mortality. Traditional treatment options, including radiotherapy, chemotherapy, and surgery, are widely used, but their effectiveness can be uncertain. As research in cancer therapies evolves, molecular-targeted therapies are increasingly recognized as promising alternatives for managing malignant tumors. Fibroblast growth factor receptors (FGFRs) have been shown to be one of the essential components in the pathways in the progression of HNSCC. This review aims to summarize and discuss the structure, functions, signaling pathways, abnormal alterations of FGFRs, and their roles in tumorigenesis and development. We have accumulated information from in vitro, in vivo, and clinical studies regarding FGFR inhibitors in HNSCC. However, the efficacy of FGFR inhibitors as a cancer therapy is limited, which may be due to the resistance to FGFR inhibitors. In this review we also discuss the potential mechanisms of FGFR inhibitor resistance in HNSCC. By enriching our understanding of the treatment with and resistance of FGFR inhibitors in HNSCC, researchers may unveil new therapeutic targets or strategies to enhance the efficacy of FGFR inhibitors in this context.

The role of cytokines in shaping the future of Cancer immunotherapy

As essential immune system regulators, cytokines are essential for modulating both innate and adaptive immunological responses. They have become important tools in cancer immunotherapy, improving the immune system's capacity to identify and destroy tumor cells. This article examines the background, workings, and therapeutic uses of cytokines, such as interleukins, interferons, and granulocyte-macropHage colony-stimulating factors, in the management of cancer. It examines the many ways that cytokines affect immune cell activation, signaling pathways, tumor development, metastasis, and prognosis by modifying the tumor microenvironment. Despite the limited effectiveness of cytokine-based monotherapy, recent developments have concentrated on new fusion molecules such as immunocytokines, cytokine delivery improvements, and combination techniques to maximize treatment efficacy while reducing adverse effects. Current FDA-approved cytokine therapeutics and clinical trial results are also included in this study, which offers insights into how cytokines might be used with other therapies including checkpoint inhibitors, chemotherapy, and radiation therapy to address cancer treatment obstacles. This study addresses the intricacies of cytokine interactions in the tumor microenvironment, highlighting the possibility for innovative treatment methods and suggesting fresh techniques for enhancing cytokine-based immunotherapies. PEGylation, viral vector-mediated cytokine gene transfer, antibody-cytokine fusion proteins (immunocytokines), and other innovative cytokine delivery techniques are among the novelties of this work, which focuses on the most recent developments in cytokine-based immunotherapy. Additionally, the study offers a thorough examination of the little-reviewed topic of cytokine usage in conjunction with other treatment techniques. It also discusses the most recent clinical studies and FDA-approved therapies, providing a modern perspective on the developing field of cancer immunotherapy and suggesting creative ways to improve treatment effectiveness while lowering toxicity. BACKGROUND: Cytokines are crucial in cancer immunotherapy for regulating immune responses and modifying the tumor microenvironment (TME). However, challenges with efficacy and safety have driven research into advanced delivery methods and combination therapies to enhance their therapeutic potential.

In vivo simultaneous proton resonance frequency shift thermometry and single reference variable flip angle T1 measurements

PURPOSE

The single reference variable flip angle sequence with a multi-echo stack of stars acquisition (SR-VFA-SoS) simultaneously measures temperature change using proton resonance frequency (PRF) shift and T1-based thermometry methods. This work evaluates SR-VFA-SoS thermometry in MR-guided focused ultrasound in an in vivo rabbit model.

METHODS

Simultaneous PRF shift thermometry and T1-based thermometry were obtained in a New Zealand white rabbit model (n = 7) during MR-guided focused ultrasound surgery using the SR-VFA-SoS sequence at 3 T. Distinct locations in muscle (n = 16), fat (n = 12), or the interface of both tissues (n = 23) were heated. The T1-temperature coefficient of fat was determined using least-squares fitting of inversion recovery-based T1 maps of untreated fat harvested from the animal and was applied to the in vivo measured heat-induced T1 changes to create temperature maps.

RESULTS

Using k-space weighted image contrast reconstruction, temporal resolution of 1.71 s was achieved for simultaneous thermometry at 1.5 × 1.5 × 2 mm voxel resolution. PRF shift thermometry was not sensitive to heating in fat. T1 changes were observed in fat at the ultrasound focus. The mean T1-temperature coefficient for fat was determined to be 1.9%/°C ± 0.2%/°C. Precision was 0.76°C ± 0.18°C for PRF shift thermometry in muscle and 1.93°C ± 0.60°C for T1-based thermometry in fat. Sonications in muscle showed an increase in T1 of 2.4%/°C ± 0.9%/°C.

CONCLUSION

The SR-VFA-SoS sequence was shown to simultaneously measure temperature change using PRF shift and T1-based methods in an in vivo model, providing thermometry for both aqueous and fat tissues.

Expressions of selected microRNAs in gastric cancer patients and their association with Helicobacter pylori and its cag pathogenicity island

BACKGROUND

Helicobacter pylori infection and the resulting inflammation of the stomach are widely recognized as the primary risk factors for the development of gastric cancer (human health). Despite numerous attempts, the correlation between various virulence factors of H. pylori and stomach cancer remains mainly unexplained. The cag pathogenicity island (cagPAI) is a widely recognized indicator of virulence in H. pylori. MicroRNAs play crucial roles in a wide range of biological and pathological processes and dysregulated expressions of miRNAs have been detected in numerous cancer types. However, research on the correlation between H. pylori infection and its cagPAI, as well as the differential expression of microRNAs in gastric cancer, is lacking.

AIM

The aim of this study was to examine the differential expression of miRNAs in 80 patients with gastric cancer, specifically in connection to the presence of H. pylori and its cag pathogenicity island (cagPAI).

METHODS

Biopsies of 80 gastric cancer patients were collected and used for H. pylori DNA isolation and tissue miRNA isolation, and further analyzed for cagPAI and miRNA expression and their association.

RESULTS

Elevated levels of miR-21, miR-155, and miR-223 were detected in malignant tissues. The expression of miR-21 and miR-223 was considerably elevated in biopsies that tested positive for H. pylori, whereas the expression of miR-34a was reduced. H. pylori cagPAI samples that are functionally intact exhibit greater expression of miR-21 and miR-223 compared to cagPAI samples that are partially deleted, in both normal and malignant tissues.

CONCLUSION

Thus, the novelty of our study lies in its focus on the differential expression of specific miRNAs in relation to the functional integrity of the cagPAI in H. pylori-infected gastric cancer patients, offering a more detailed understanding of the interplay between H. pylori virulence factors and miRNA regulation than previous studies.

Disparities in Access to Minimally Invasive Surgery in Low and Middle-Income Countries

BackgroundAlthough every human being has a basic right to access quality health care, the unfortunate reality is that inequities still exist in the year 2025. The inequities may be readily visible in low and middle-income countries (LMICs), and they are most apparent in the specialties that require significant allocations of human and institutional resources, such as the provision on minimally invasive surgery (MIS).PurposeThis discursive paper explores the reasons for the disparities, taking into account the fundamental differences between the health care environments in LMICs and high-income countries.Research DesignThis is a discursive paper that considers expert opinions on the inequities in healthcare in LMICsStudy SampleThis study discusses the availability of MIS in the health care environments in LMICs of the Anglophone Caribbean.Data Collection and/or AnalysisA literature review of all published data from LMICs in the Anglophone Caribbean.ResultsThis disursive paper explores the reasons for disparity in access to MIS and proposes strategies to restore equity in LMICs.ConclusionsIt is possible to overcome these challenges, but it requires strong leadership, development of creative solutions, and a concerted effort to change the health care environment.

Database study of risk factors for breast cancer-related lymphedema: a statistical analysis of 2359 cases over 10 years

PURPOSE

Identifying risk factors for breast cancer-related lymphedema (BCRL) is crucial for its prevention, necessitating large-scale epidemiological studies. Despite their suitability for large-scale surveys, to our knowledge, databases have not been the basis of any study done to investigate BCRL risk factors. This study aimed to test the hypothesis that a database-based study would be useful for identifying BCRL risk factors.

METHODS

Patients with breast cancer diagnosed between April 2009 and March 2020 were identified from the Hiroshima University Hospital's medical database. This retrospective observational study validated the risk factors for BCRL using logistic regression analysis (p < 0.05).

RESULTS

Among the total 4471 breast cancer patients identified, 2359 met the study criteria, with a BCRL incidence of 4.8%. Identified risk factors included obesity with a BMI of 25-30 (OR = 3.066, 95% CI 1.408-6.677), severe obesity with a BMI > 30 (OR = 5.791, 95% CI 2.239-14.97), surgical axillary lymph node dissection (OR = 3.212, 95% CI 1.918-5.378), chemotherapy with docetaxel (OR = 1.795, 95% CI 1.062-3.032), and conventional radiation to the breast or chest wall including lymph nodes in the irradiated area (OR = 3.299, 95% CI 1.842-5.910).

CONCLUSIONS

The BCRL risk factors identified by our database analysis were in line with those documented in previous studies, indicating the usefulness of database-based studies. Future studies should include more patients and study items.

Imaging of cystic fibrosis manifestations in the abdomen

Cystic fibrosis is a common inherited autosomal recessive disease affecting 35,000 persons in the United States. It is caused by mutations of the cystic fibrosis transmembrane regulator (CFTR) gene, located on the long arm of chromosome 7.This protein carries chlorine in the membranes of epithelial cells of exocrine glands. Mutations in the CFTR gene results in production of abnormally viscous mucus. Although it primarily affects the lungs, cystic fibrosis is a multisystem disease with involvement of extra thoracic organs including the liver, pancreas, kidneys and digestive tract.With advances in the management of cystic fibrosis resulting in improved life expectancy, cystic fibrosis patients are surviving into adulthood and extrapulmonary disease has become more commonplace. It is essential that radiologists are aware of the spectrum of potential manifestations of cystic fibrosis to allow accurate diagnosis.The purpose of this manuscript is to provide an overview of the pathophysiology and imaging findings of abdominal entities unique to patients with cystic fibrosis. We will present a wide spectrum of renal, pancreatic, gastrointestinal, hepatobiliary and post-transplant cases describing the typical findings that will assist radiologists in providing a timely diagnosis for patients with cystic fibrosis.

Combining CEUS and CT/MRI LI-RADS major imaging features: diagnostic accuracy for classification of indeterminate liver observations in patients at risk for HCC

PURPOSE

To determine the diagnostic accuracy of combining CEUS and CT/MRI LI-RADS major imaging features for the improved categorization of liver observations indeterminate on both CT/MRI and CEUS.

MATERIALS AND METHODS

A retrospective analysis using a database from a prospective study conducted at 11 centers in North America and Europe from 2018 to 2022 included a total of 109 participants at risk for HCC who had liver observations with indeterminate characterization (LR3, LR-4, and LR-M) on both CEUS and CT/MRI. The individual CEUS and CT/MRI LI-RADS major features were extracted from the original study and analyzed in various combinations. Reference standards included biopsy, explant histology, and follow-up CT/MRI. The diagnostic performance of the combinations of LI-RADS major features for definitive diagnosis of HCC was calculated. A reverse, stepwise logistical regression sub-analysis was also performed.

RESULTS

This study included 114 observations indeterminate on both CT/MRI and CEUS. These observations were categorized as LR-3 (n = 37), LR-4 (n = 41), and LR-M (n = 36) on CT/MRI and LR-3 (n = 48), LR-4 (n = 36), LR-M (n = 29), and LR-TIV (n = 1) on CEUS. Of them, 43.0% (49/114) were confirmed as HCC, 37.3% (43/114) non-malignant, and 19.3% (22/114) non-hepatocellular malignancies. The highest diagnostic accuracy among the combinations of imaging features was achieved in CT/MRI LR-3 observations, where the combination of CEUS arterial phase hyper-enhancement (APHE) + CT/MRI APHE had 96.7% specificity, 75.0% positive predictive value (PPV), and 86.5% accuracy for HCC.

CONCLUSION

The combination of LI-RADS major features on CT/MRI and CEUS showed higher specificity, PPV, and accuracy compared to individual modalities' assessments, particularly for CT/MRI LR-3 observations.

Examining the Impact of Biopsy Technique on Clinical and Pathologic Outcomes in Dermatofibrosarcoma Protuberans: An International, Multi-Institutional Study

BACKGROUND

The National Comprehensive Cancer Network (NCCN) guidelines recommend preoperative biopsy for diagnosing dermatofibrosarcoma protuberans (DFSP) but limited data support this approach. We characterized DFSP diagnostic practices and compared clinical outcomes based on technique.

METHODS

Data were collected for adult patients who underwent resection for initial DFSP presentation between 2003 and 2021 at 10 international institutions. Patients were categorized by excisional versus preoperative biopsy (incisional, punch, core needle biopsies, or fine needle aspiration), and univariate and multivariable analyses were performed.

RESULTS

The cohort included 321 patients, with excisional biopsy performed in 51.4% and preoperative biopsy performed in 48.6% of patients. Biopsy type was stable throughout the study period (p = 0.08). There were no differences in sex, disease presentation, or preoperative imaging. In unadjusted analysis, biopsy varied by practitioner specialty, with general surgeons performing nearly 50% of excisional biopsies. Despite similar planned circumferential margins and anatomic location, preoperative biopsy was associated with higher index R0 rate (60.1% vs. 78.6%), fewer total excisions, and fewer complications (38.2% vs. 25.6%, all p < 0.05). However, adjuvant radiotherapy (11.7% vs. 6.0%) and final R0 rates (91.5% vs. 88.4%) were comparable regardless of technique (p > 0.05). In adjusted analysis, excisional biopsy was associated with extremity tumors (odds ratio [OR] 1.79, confidence interval [CI] 1.21-2.66, p = 0.004), treatment in non-academic settings (OR 2.28, CI 1.10-4.73, p = 0.03), and inversely with preoperative imaging (OR 0.47, CI 0.24-0.93, p = 0.03).

CONCLUSION

Preoperative biopsy is associated with margin-negative resection, fewer re-excisions, and reduced complications. Clinical suspicion of DFSP is paramount, and preoperative imaging may critically inform biopsy selection prior to index resection.