The Global Burden of Cancer 2013

Identification and exploration of anticancer activity of novel peptides isolated from the edible bivalve Callista chione in hepatic and colon cancer cell lines

Background

The requirement for relevant and safe drugs for cancer treatment is considered a challenge. Recently, marine isolated compounds with various therapeutic targets have attracted many researchers.

Aim

Isolation and identification of potential anticancer peptides from edible Callista chione soft tissues.

Methodology

C. chione specimens were collected and peptides were extracted, purified with FPLC, and tested on normal (hepatocytes and VERO) and cancer (HepG2, and HT-29) cells. Bioactive fractions were tested by tandem mass spectrometry.

Results

Five different fractions were purified according to ionic charges and two fractions (4 and 5) showed a potent anticancer activity with a total anticancer score threshold of ≥ 0.5, and hydrophilicity mean of 1.75 that related to stability and solubility. The apoptotic and autophagy-related markers were significantly up-regulated in both HepG2 and HT-29 cells treated with IC50 of bioactive peptides' fractions 4 and 5, explaining their underlying mechanism of action.

Conclusion

Natural source peptides derived from the soft tissue of C. chione could be exploited for the treatment of cancers and a deep in silico study will be performed for further investigation and deep function identification.

Current status and prospects of targeted therapy for cholangiocarcinoma based on molecular characteristics

Cholangiocarcinoma (CCA) is a serious public health issue due to its insidious onset and dismal prognosis. The past few years have witnessed and highlighted the development of understanding and management of CCA. The combination of gemcitabine and cisplatin (GP) chemotherapy regimen with immunotherapy using immune checkpoint inhibitors has been considered the new standard first-line treatment alternative for advanced CCA. Notably, the proportion of patients with advanced CCA with targetable genetic mutations is approximately 40 %, and these patients may be considered for molecularly targeted therapy in the second-line treatment. In this review, we highlight the advances and progress in targeted therapies for advanced CCA, with special attention to data from Asian populations, including Chinese. In addition, we present in detail the phosphatase tension homolog (PTEN), a novel biomarker for both of first-line chemotherapy and second-line targeted therapy in advanced CCA, and its ability to forecast prognosis in patients with CCA. The mechanisms of rapid resistance to targeted agents warrant further investigation and address in light of the development of new targeted therapies. Precision medicine is gradually playing an increasing role in achieving optimal therapeutic outcomes.

Disability-adjusted life years for colorectal cancer in China, 2017-2030: A prevalence-based analysis focusing on the impact of screening coverage and the application of local weights

BACKGROUND

Most studies have evaluated disability-adjusted life years (DALYs) of colorectal cancer (CRC) patients based on a set of generic disability weights (DWs). This study aimed to apply local CRC-stage-specific DWs to estimate the burden of DALYs for CRC (CRC-DALYs) in populations in China and consider the influence of local screening coverage of CRC.

METHODS

A prevalence-based model was constructed using data from various sources. Years lived with disability (YLDs) were estimated mainly via cumulative prevalence data (based on CRC incidence rates, population numbers, and survival rates), stage-specific proportions of CRC, and DWs of the local population. Years of life lost (YLLs) were calculated based on the CRC mortality rates and standard life expectancies. CRC incidence and mortality rates for the years 2020, 2025, and 2030 were estimated by joinpoint regression, and the corresponding DALYs were predicted. The main assumption was made for CRC screening coverage. Sensitivity analysis was used to assess the impact of population, DWs, and coverage.

RESULTS

In 2017, among the Chinese population, the estimated number of CRC-DALYs was 4,303,314 (11.8% for YLDs). If CRC screening coverage rate in China (2.3%) remains unchanged, the overall DALYs in 2030 are predicted to increase by 37.2% (45.1% of those aged ≥65 years). More optimistically, the DALYs would then decrease by 0.7% in 2030 (from 5,902,454 to 5,860,200) if the coverage could be increased to 25.0%. A sensitivity analysis revealed that using local DWs would change the base-case values by 5.7%.

CONCLUSIONS

The estimated CRC-DALYs in China using population-specific DWs were considerably lower (with a higher percentage of YLDs) than the global burden of disease (GBD) estimates (5,865,004, of 4.6% for YLDs), suggesting the impact extent of applying local parameters. Sustainable scale-up CRC screening needs to be in place to moderate the growth trend of CRC-DALYs in China.

The global burden of cancers attributable to occupational factors, 1990-2021

This study assessed the global cancer burden due to occupational carcinogens (OCs) using data from Global Burden of Disease (GBD) 2021. Mortality and disability-adjusted life years (DALYs) were employed to assess the evolving trend of cancer attributable to occupational risk. The analysis was conducted by age, year, geographical location, and socio-demographic index (SDI). Subsequently, the estimated annual percentage change (EAPC) values were calculated. Globally, asbestos exposure showed the most severe impact on age-standardized death rate (ASDR) and age-standardized DALY rate but decreased significantly. Conversely, diesel engine exhaust exposure increased, with EAPCs of 0.80 for deaths. Trichloroethylene exposure, although low in absolute terms, exhibited the fastest growth with an EAPC of 1.21 in age-standardized DALY rate. Notably, diesel engine exhaust exposure in South Asia and polycyclic aromatic hydrocarbons (PAHs) in Southeast Asia, East Asia, and Oceania increased significantly in age-standardized DALY rate. Regions with low to middle SDI, such as South Asia and sub-Saharan Africa, showed the highest increases in OC-related cancer burdens in age-standardized DALY rate. Lesotho, Kenya, and Egypt exhibited the fastest growth, with EAPCs in age-standardized DALY rate of 3.45, 2.13, and 2.95, respectively. High-income regions like the Netherlands, the United Kingdom, and Italy had the most severe OC-related cancer of ASDR burdens in 2021. OC exposure remains a major contributor to the global cancer burden, especially from asbestos and silica. Exposure to diesel engine exhaust was associated with increased risk of cancers, particularly in low -to -middle SDI regions such as South Asia and sub-Saharan Africa.

2-Dodecyl-6-Methoxycyclohexa-2,5-Diene-1,4-Dione from Averrhoa carambola L. roots: Suppressing hepatocellular carcinoma progression through ROS accumulation and p53 pathway-mediated apoptosis

This study explores the anti-tumor effects of 2-dodecyl-6-methoxycyclohexa-2,5-diene-1,4-dione (DMDD), a compound derived from Averrhoa carambola L roots, on hepatocellular carcinoma (HCC) cells and a xenograft mouse model, focusing on its underlying mechanisms. Cell viability following DMDD treatment was assessed using the CCK-8 assay. Flow cytometry determined changes in cell cycle distribution and apoptosis rates, while migration and invasion capabilities were assessed using wound healing and transwell assays, respectively. Transcriptome sequencing (RNA-seq) was conducted to analyze differential gene expression and pathway enrichment. Z-VAD-FMK, a pan-caspase inhibitor, was used to confirm the apoptotic mechanism induced by DMDD. The expression levels of p53, Bax, Bcl-2, and cleaved caspase 3 were quantified via Western blot analysis. A xenograft mouse model was developed to assess the in vivo effects of DMDD on HCC. DMDD suppressed proliferation, migration, and invasion, and induced apoptosis in Huh7 and Hep3b cells. RNA-seq revealed significant enrichment of p53 and apoptosis signaling pathways among differentially expressed genes. DMDD downregulated Bcl-2 expression and upregulated p53, Bax and cleaved caspase 3. In addition, Z-VAD-FMK partially inhibited DMDD-induced apoptosis. DMDD also inhibited tumor growth in mice. DMDD effectively inhibited tumor growth in HCC cell lines and xenograft models, potentially through ROS elevation and p53-mediated activation of the intrinsic apoptotic pathway.

Old drugs, new challenges: reassigning drugs for cancer therapies

The "War on Cancer" began with the National Cancer Act of 1971 and despite more than 50 years of effort and numerous successes, there still remains much more work to be done. The major challenge remains the complexity and intrinsic polygenicity of neoplastic diseases. Furthermore, the safety of the antitumor therapies still remains a concern given their often off-target effects. Although the amount of money invested in research and development required to introduce a novel FDA-approved drug has continuously increased, the likelihood for a new cancer drug's approval remains limited. One interesting alternative approach, however, is the idea of repurposing of old drugs, which is both faster and less costly than developing new drugs. Repurposed drugs have the potential to address the shortage of new drugs with the added benefit that the safety concerns are already established. That being said, their interactions with other new drugs in combination therapies, however, should be tested. In this review, we discuss the history of repurposed drugs, some successes and failures, as well as the multiple challenges and obstacles that need to be addressed in order to enhance repurposed drugs' potential for new cancer therapies.

The role of generative language systems in increasing patient awareness of colon cancer screening

BACKGROUND

 This study aimed to evaluate the effectiveness of ChatGPT (Chat Generative Pretrained Transformer) in answering patients' questions about colorectal cancer (CRC) screening, with the ultimate goal of enhancing patients' awareness and adherence to national screening programs.

METHODS

 15 questions on CRC screening were posed to ChatGPT4. The answers were rated by 20 gastroenterology experts and 20 nonexperts in three domains (accuracy, completeness, and comprehensibility), and by 100 patients in three dichotomic domains (completeness, comprehensibility, and trustability).

RESULTS

 According to expert rating, the mean (SD) accuracy score was 4.8 (1.1), on a scale ranging from 1 to 6. The mean (SD) scores for completeness and comprehensibility were 2.1 (0.7) and 2.8 (0.4), respectively, on scales ranging from 1 to 3. Overall, the mean (SD) accuracy (4.8 [1.1] vs. 5.6 [0.7]; P < 0.001) and completeness scores (2.1 [0.7] vs. 2.7 [0.4]; P < 0.001) were significantly lower for the experts than for the nonexperts, while comprehensibility was comparable among the two groups (2.8 [0.4] vs. 2.8 [0.3]; P = 0.55). Patients rated all questions as complete, comprehensible, and trustable in between 97 % and 100 % of cases.

CONCLUSIONS

 ChatGPT shows good performance, with the potential to enhance awareness about CRC and improve screening outcomes. Generative language systems may be further improved after proper training in accordance with scientific evidence and current guidelines.

Comparative efficacy of different bowel preparations for colonoscopy: A network meta-analysis

BACKGROUND AND AIMS

The quality of a colonoscopy is heavily reliant on the effectiveness of bowel cleansing. Various cleansing solutions are currently available, but their comparative efficacy remains uncertain. This systematic review and network meta-analysis aims to compare the performance of different bowel preparations for colonoscopy.

METHODS

MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing the efficacy of different bowel preparations. The primary outcome was cleansing success (CS), and the secondary outcome was adenoma detection rate (ADR).

RESULTS

On network meta-analysis for CS (22 RCTs, 7179 patients, 14 bowel preparations), 2 L PEG + simethicone (RR = 1.25 [95 %CI = 1.13-1.37]), 2 L PEG + lactulose (RR = 1.22 [95 %CI = 1.10-1.38]) and 1 L PEG + ascorbate (ASC) (RR = 1.03 [95 %CI = 1.01-1.06]) were significantly superior to 2 L PEG + ASC. Overall, 2 L PEG + lactulose resulted as the best product (SUCRA 0.94), followed by 2 L PEG + simethicone (SUCRA 0.93). On network meta-analysis for ADR (17 RCTs, 6639 patients, 11 bowel preparations), only 2 L PEG + simethicone (RR = 1.60 [95 %CI = 1.05-2.43]) resulted significantly superior to 2 L PEG + ASC.

CONCLUSIONS

2 L PEG + simethicone, 2 L PEG + lactulose, and 1 L PEG + ASC seemed to provide high rates of CS, albeit only 2 L PEG + simethicone was associated with significantly higher ADR. Consequently, these products should be preferred for bowel preparation of colonoscopy. Further randomized studies with adequate sample sizes are needed for a more accurate comparison of these products on ADR.

Trans-resveratrol-loaded nanostructured lipid carrier formulations for pulmonary drug delivery using medical nebulizers

Aerosolization is a non-invasive approach of delivering drugs for both localized and systemic effects, specifically pulmonary targeting. The aim of this study was to deliver trans-resveratrol (TR) as an anti-cancer drug entrapped in a new generation versatile carriers nanostructured lipid carrier (NLC) to protect degradation and improve bioavailability via medical nebulizers. Twelve TR-NLC (i.e., F1-F12) formulations were prepared using different combinations and ratios of formulation ingredients via hot high-pressure homogenization. Upon analysis, formulations F1 and F2 demonstrated a particle size of <185 nm, a polydispersity index (PDI) <0.25, Zeta potential values of ∼30 mV and an entrapment efficiency >94%. The aerosolization performance of the F1 and F2 formulations was performed via a next generation impactor (NGI), using medical nebulizers. The air jet nebulizer demonstrated lower drug deposition in the earlier stages (1-2) and significantly higher deposition in the latter stages 3-5 (for both formulations), targeting middle to lower lung deposition. Moreover, the air jet nebulizer exhibited significantly higher emitted dose (ED) (87.44 ± 3.36%), fine particle dose (FPD) (1652.52 ± 9.68 µg) fine particle fraction (FPF) (36.25 ± 4.26%), and respirable fraction (RF) (93.41 ± 4.03%) when the F1 formulation was used as compared to the F2 formulation. Thus, the TR-NLC F1 formulation and air jet nebulizer were identified as the best combination for the delivery and targeting peripheral lungs.

Targeting PI3K in cancer treatment: A comprehensive review with insights from clinical outcomes

The phosphoinositide 3-kinase (PI3K) pathway plays a crucial role in cancer, including cell growth, survival, metabolism, and metastasis. Its major role in tumor growth makes it a key target for cancer therapeutics, offering significant potential to slow tumor progression and enhance patient outcomes. Gain-of-function mutations, gene amplifications, and the loss of regulatory proteins like PTEN are frequently observed in malignancies, contributing to tumor development and resistance to conventional treatments such as chemotherapy and hormone therapy. As a result, PI3K inhibitors have received a lot of interest in cancer research. Several kinds of small-molecule PI3K inhibitors have been developed, including pan-PI3K inhibitors, isoform-specific inhibitors, and dual PI3K/mTOR inhibitors, each targeting a distinct component of the pathway. Some PI3K inhibitors such as idelalisib, copanlisib, duvelisib, alpelisib, and umbralisib have received FDA-approval, and are effective in the treatment of breast cancer and hematologic malignancies. Despite promising results in preclinical and clinical trials, the overall clinical success of PI3K inhibitors has been mixed. While some patients may get substantial advantages, a considerable number of them acquire resistance as a result of feedback activation of alternative pathways, adaptive tumor responses, and treatment-emergent mutations. The resistance mechanisms provide barriers to the sustained efficacy of PI3K-targeted treatments. This study reviews recent advancements in PI3K inhibitors, covering their clinical status, mechanism of action, resistance mechanisms, and strategies to overcome resistance.

SGLT2 inhibitors for prevention and management of cancer treatment-related cardiovascular toxicity: a review of potential mechanisms and clinical insights

More evidence-based strategies are needed for preventing and managing cancer treatment-related cardiovascular toxicity (CTR-CVT). Owing to the growing body of evidence supporting their cardioprotective role in several cardiac injury scenarios, sodium-glucose cotransporter 2 inhibitors (SGLT2i) may be beneficial for preventing and treating CTR-CVT. In October 2024, a search was conducted of the PubMed database to review full studies investigating the cardioprotective role of SGLT2i against CTR-CVT. We identified 44 full published/pre-print studies and 3 ongoing randomised controlled trial across eight types of cancer treatment (anthracyclines, platinum-containing therapy, immune checkpoint inhibitors, HER2-targeted therapies, kinase inhibitors, androgen deprivation therapies, multiple myeloma therapies and 5-fluorouracil). Most studies used animal models and focussed on primary prevention. 43 of the 44 studies found some cardioprotective effect of SGLT2i against CTR-CVT, which in some cases included preventing ejection fraction decline and aberrations in cardiac electrophysiological parameters. Some studies also observed beneficial effects on mortality. A central triad of anti-inflammatory, anti-oxidative and anti-apoptotic mechanisms likely underlie SGLT2i-mediated cardioprotection against CTR-CVT. Overall, this growing body of research suggests that SGLT2i may be a promising candidate for preventing CTR-CVT either as monotherapy or in combination with other cardioprotective drugs. However, the literature is limited in that no prospective randomised controlled trials investigating SGLT2i for the prevention and management of CTR-CVT exist and most existing human retrospective data is based on diabetic populations. Future work must focus on addressing these limitations of the current literature.

Burden of HPV-induced diseases and cost effectiveness of catch-up vaccination in Czech Republic: a model-based study

OBJECTIVES

Human papillomavirus (HPV) infections are highly prevalent sexually transmitted infections, notably associated with various cancers. This study analyses the health and economic impacts of HPV-associated diseases in the Czech Republic and evaluates the cost-effectiveness of a catch-up vaccination program.

METHODS

Utilizing a Markov multistate model, the study assesses the lifetime impacts and costs related to HPV infections. Cohorts of ages 15-21 were simulated to assess the impact of catch-up vaccination outside the 11-year-old age group.

RESULTS

The total quality-adjusted life years (QALYs) for the female and male cohorts (together 119,362 individuals) were higher in the vaccination scenario compared to the non-vaccination scenario. The increase in QALYs was 122,246 and 200,852 respectively, when considering the actual vaccination rates. Across both cohorts, 329 cancer-related deaths were prevented. In the probabilistic sensitivity analysis for the female population, vaccination was the dominant strategy in 99.3% of iterations. In the male population, vaccination was the dominant strategy in 80.3% of iterations. The implementation of catch-up vaccination for the 15-21 age group significantly increased QALY gains and reduced life-years-lost (LYLs). In the female cohort, all analysed rates of catch-up vaccination were the dominant strategy, while in the male cohort, the incremental cost-effectiveness ratios (ICERs) remained consistently below 42,000 CZK/QALY.

CONCLUSIONS

The catch-up vaccination program for 15-21-year-olds is cost-effective and can prevent a significant number of HPV-related cancers in both men and women.

The role and mechanism of epigenetics in anticancer drug-induced cardiotoxicity

Cardiovascular disease is the main factor contributing to the global burden of diseases, and the cardiotoxicity caused by anticancer drugs is an essential component that cannot be ignored. With the development of anticancer drugs, the survival period of cancer patients is prolonged; however, the cardiotoxicity caused by anticancer drugs is becoming increasingly prominent. Currently, cardiovascular disease has emerged as the second leading cause of mortality among long-term cancer survivors. Anticancer drug-induced cardiotoxicity has become a frontier and hot topic. The discovery of epigenetics has given the possibility of environmental changes in gene expression, protein synthesis, and traits. It has been found that epigenetics plays a pivotal role in promoting cardiovascular diseases, such as heart failure, coronary heart disease, and hypertension. In recent years, increasing studies have underscored the crucial roles played by epigenetics in anticancer drug-induced cardiotoxicity. Here, we provide a comprehensive overview of the role and mechanisms of epigenetics in anticancer drug-induced cardiotoxicity.

The mediating effect of intrusive rumination on the relationship between illness uncertainty and fear of cancer recurrence in breast cancer survivors

BACKGROUND

Recently, increased awareness of early diagnosis and treatment options has led to an increase in the number of breast cancer survivors. Psychosocial interventions to increase the quality of life in this group are gaining importance. One of the most common psychological problems in breast cancer survivors is fear of cancer recurrence (FCR). It is essential to elucidate the mechanisms of FCR.

AIMS

This study aimed to examine the mediating effect of intrusive rumination on the relationship between illness uncertainty and FCR in breast cancer survivors.

METHODS

The study was designed to be cross-sectional, and 204 breast cancer survivors were included. Participants were given the Mishel Uncertainty in Illness Scale-Community form (MUIS-C), the severity subscale of the Fear of Cancer Recurrence Inventory, and the Event-Related Rumination Inventory-intrusive rumination subscale. Correlation analyses were conducted, and the structural equation method evaluated the mediation effect.

RESULTS

Most participants (74%) reported some degree of FCR. A significant positive relationship was found between illness uncertainty and FCR (r = 0.325; p ≤ 0.001). The path analysis showed that intrusive rumination partially mediates this relationship.

CONCLUSIONS

This study's results shed light on the relationship between illness uncertainty, rumination, and FCR. Planning psychoeducation programs during follow-up to reduce illness uncertainty may positively affect FCR. In addition, metacognitive therapies that can functionalize the ruminative thinking style can also effectively intervene in FCR.

Elucidating the potential of EGFR mutated NSCLC and identifying its multitargeted inhibitors

Lung cancer is the leading cause of cancer-related fatalities globally, accounting for the highest mortality rate among both men and women. Mutations in the epidermal growth factor receptor (EGFR) gene are frequently found in non-small cell lung cancer (NSCLC). Since curcumin and CB[2]UN support various medicinal applications in drug delivery and design, we investigated the effect of curcumin and CB[2]UN-based drugs in controlling EGFR-mutant NSCLC through a dodecagonal computational approach. Molecular docking studies revealed that the ligands curcumin (-6.9 kcal/mol) and CB[2]UN (-8.1 kcal/mol) bound more strongly to the EGFR-mutant NSCLC proteins with 2ITX and 2ITV, respectively. Molecular dynamics simulation (50 ns) investigation of protein-ligand complexes using RMSD, RMSF, Rg, and SASA indicated that curcumin and CB[2]UN with EGFR-mutant proteins are kinetically stable. In addition, MMPBSA/MMGBSA analysis confirmed the thermodynamic stability of each curcumin and CB[2]UN protein-ligand complex. Finally, KDeep absolute binding affinity calculations show energies of -6.13 kcal/mol and - 5.26 kcal/mol for 2ITX-CUR and 2ITV-CB[2]UN protein-ligand complexes, respectively. Thus, our dodecagonal strategy reveals that 2ITX-CUR and 2ITV-CB[2]UN are more likely to form protein-ligand complexes with more significant binding affinities and excellent stability throughout the 50 ns simulation time.

Carnosic acid inhibits integrin expression and prevents pulmonary metastasis of melanoma

Carnosic acid is a naturally occurring, plant-derived polyphenolic abietane diterpene with antitumor properties. However, its underlying mechanisms are still unclear. Therefore, we investigated the effects of carnosic acid on lung metastasis in a murine melanoma model. C57BL/6 mice were intravenously injected with B16-BL6 cells, followed by carnosic acid treatment. Lung weights were recorded, and tumor cell colonies were counted at the end of the experiment. Integrin expression was evaluated using flow cytometry and cell adhesion assays. Lung weights were significantly lower in the carnosic acid group than in the control group, indicating the suppression of metastasis. Carnosic acid suppressed α4 integrin expression in B16-BL6 cells and inhibited α4 and α9 integrin-dependent cell adhesion. Thus, our data suggest that carnosic acid prevents lung metastasis, possibly by suppressing integrin expression. Our findings support the clinical application of carnosic acid as a potential natural antitumor agent, offering a complementary approach to conventional therapies.

Brain Imaging in Patients with Non-Small Cell Lung Cancer-A Systematic Review

Background: Lung cancer frequently metastasizes to the brain, liver, and adrenal glands with a significant negative prognostic impact on overall survival and quality of life (QoL). To optimize treatment and prognosis, adequate staging with the detection of distant metastases is crucial. The incidence of brain metastases in potentially resectable early-stage non-small cell lung cancer (NSCLC) is as low as 3%; hence, the need for preoperative brain imaging has been a constant matter of debate, especially in stage II. In stages III and IV NSCLC, neuroimaging is an essential part of staging. Methods: A systematic literature search was performed. Publications from 1999 to 2024, focusing on preoperative brain imaging (BI) in the staging of stages I-IV NSCLC, were included. Data extraction included study population characteristics, the modality of BI, the incidence of brain metastases (BMs), and the main outcomes of the studies. The final included studies were selected according to the PRISMA criteria. In the second step, guidelines on BI in NSCLC staging of major importance were identified and compared. Results: A total of 530 articles were identified, of which 25 articles were selected. Four prospective studies and 21 retrospective investigations were included. Most of the investigations focused on BI in the early stages. The main imaging modality for BI was magnetic resonance imaging (MRI), followed by computed tomography (CT). Besides the identified 25 studies, the most important internationally applied guidelines on brain imaging in the staging of NSCLC were reviewed. While some guidelines agree on preoperative BI in NSCLC stage III (Union for International Cancer Control-UICC eighth edition) patients, other guidelines recommend earlier BI starting from clinical stage II. All mentioned guidelines homogenously recommend BI in patients with symptoms suggestive of brain pathologies. Conclusions: BI in NSCLC staging is recommended in neurologically symptomatic patients suggestive of brain metastases as well as NSCLC patients with stage III disease. Neuroimaging in stage IA patients, as well as in pure GGO (Ground-Glass Opacity) lesions, was considered unnecessary. The predominantly applied imaging modality was ce-MRI (contrast-enhanced magnetic resonance imaging). Inconsistency exists concerning BI in stage II. The identification of prognostic factors for developing BM in patients with early-stage NSCLC could help to clarify which subgroup might benefit from preoperative BI.

Astaxanthin mitigates doxorubicin-induced cardiotoxicity via inhibiting ferroptosis and autophagy: a study based on bioinformatic analysis and in vivo/vitro experiments

Background

Doxorubicin (DOX), a widely employed chemotherapeutic agent in cancer treatment, has seen restricted use in recent years owing to its associated cardiotoxicity. Current reports indicate that doxorubicin-induced cardiotoxicity (DIC) is a complex phenomenon involving various modes of cell death. Astaxanthin (ASX), a natural carotenoid pigment, has garnered significant attention for its numerous health benefits. Recent studies have shown that ASX has a broad and effective cardiovascular protective effect. Our study aims to investigate the protective effects of ASX against DIC and elucidate its underlying mechanisms. This has substantial practical significance for the clinical application of DOX.

Methods

Bioinformatic analyses were conducted using transcriptomic data from the gene expression omnibus (GEO) database to identify key mechanisms underlying DIC. Network pharmacology was employed to predict the potential pathways and targets through which ASX exerts its effects on DIC. In vitro experiments, following pretreatment with ASX, H9C2 cells were exposed to DOX. Cell viability, injury and the protein expression levels associated with ferroptosis and autophagy were assessed. In the animal experiments, rats underwent 4 weeks of gavage treatment with various doses of ASX, followed by intraperitoneal injections of DOX every 2 days during the final week. Histological, serum, and protein analyses were conducted to evaluate the effects of ASX on DIC.

Results

The bioinformatics analysis revealed that ferroptosis and autophagy are closely associated with the development of DIC. ASX may exert an anti-DIC effect by modulating ferroptosis and autophagy. The experimental results show that ASX significantly mitigates DOX-induced myocardial tissue damage, inflammatory response, oxidative stress, and damage to H9C2 cells. Mechanistically, ASX markedly ameliorates levels of ferroptosis and autophagy both in vitro and in vivo. Specifically, ASX upregulates solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4), while downregulating the expression of transferrin receptor 1 (TFRC), ferritin heavy chain (FTH1) and ferritin light chain (FTL). Additionally, ASX enhances the expression of P62 and decreases levels of Beclin1 and microtubule-associated proteins light chain 3 (LC3).

Conclusion

Our results indicate that ferroptosis and autophagy are critical factors influencing the occurrence and progression of DOX-induced cardiotoxicity. ASX can alleviate DIC by inhibiting ferroptosis and autophagy.

Integrating AI into Cancer Immunotherapy-A Narrative Review of Current Applications and Future Directions

BACKGROUND

Cancer remains a leading cause of morbidity and mortality worldwide. Traditional treatments like chemotherapy and radiation often result in significant side effects and varied patient outcomes. Immunotherapy has emerged as a promising alternative, harnessing the immune system to target cancer cells. However, the complexity of immune responses and tumor heterogeneity challenges its effectiveness.

OBJECTIVE

This mini-narrative review explores the role of artificial intelligence [AI] in enhancing the efficacy of cancer immunotherapy, predicting patient responses, and discovering novel therapeutic targets.

METHODS

A comprehensive review of the literature was conducted, focusing on studies published between 2010 and 2024 that examined the application of AI in cancer immunotherapy. Databases such as PubMed, Google Scholar, and Web of Science were utilized, and articles were selected based on relevance to the topic.

RESULTS

AI has significantly contributed to identifying biomarkers that predict immunotherapy efficacy by analyzing genomic, transcriptomic, and proteomic data. It also optimizes combination therapies by predicting the most effective treatment protocols. AI-driven predictive models help assess patient response to immunotherapy, guiding clinical decision-making and minimizing side effects. Additionally, AI facilitates the discovery of novel therapeutic targets, such as neoantigens, enabling the development of personalized immunotherapies.

CONCLUSIONS

AI holds immense potential in transforming cancer immunotherapy. However, challenges related to data privacy, algorithm transparency, and clinical integration must be addressed. Overcoming these hurdles will likely make AI a central component of future cancer immunotherapy, offering more personalized and effective treatments.

Factors associated with health-related quality of life in women with paid work at breast cancer diagnosis: a German repeated cross-sectional study over the first five years after primary surgery

BACKGROUND

Evidence suggests a deterioration of health-related quality of life (HRQL) after breast cancer diagnosis and therapy. This study examines sociodemographic and health-related factors that could be associated with the HRQL of working women with breast cancer during the first five years after primary surgery. Second, it explores potential vulnerable groups with respect to HRQL using decision tree analyses.

METHODS

Women diagnosed with breast cancer who had paid work at diagnosis were recruited at 11 breast cancer centers in the Hannover region, Germany, after primary surgery. Assessments took place four times. 455 patients completed mailed questionnaires at 3 weeks after primary surgery. Women were followed up at 6 months, 1 year and on average 5 years after primary surgery. The physical and mental wellbeing dimensions of HRQL were examined through the Short-Form health survey-12. Potential associations between HRQL and health and sociodemographic factors were examined using multiple linear regression. Classification tree analyses were applied to define specific vulnerable groups.

RESULTS

Mastectomy (ß=-2.49; CI:-4.67, -0.30) and chemotherapy (ß=-4.25; CI:-7.04, -1.46) as health related factors were significantly associated with poorer physical wellbeing at 3 weeks and 6 months after primary surgery, respectively. Returning to work (RTW) after having been on sick leave was strongly associated with better HRQL as illustrated by higher sum scores for physical (at 3 weeks: ß=6.21; CI:3.36, 9.05; at 6 months: ß=5.40; CI:3.01, 1.80; at 1 year: ß=8.40; CI:5.31, 11.49) and mental wellbeing (at 6 months: ß=6.03; CI:33.25, 8.81; at 1 year: ß=7.71; CI:4.85, 10.58) until 1 year after primary surgery. However, its significant effect was no more apparent at 5 years after primary surgery. At that stage, income was mostly associated with physical (ß=0.002; CI:0.0002, 0.003) and mental wellbeing (ß=0.002; CI:0.0005, 0.003) with higher summary scores for higher income especially in women aged ≤ 61 years. In addition, living with a partner appeared to be an important positively associated factor with better mental wellbeing in women with breast cancer (at 6 months: ß=3.68; CI: 0.72, 6.63; at 5 years: ß=2.85; CI:0.39, 5.32) and the first splitting node that defined vulnerability at 5 years.

CONCLUSIONS

HRQL in breast cancer appears to be a multidimensional phenomenon associated with disease, treatment and social factors. A special focus should be drawn to women with lower income and those not living with a partner when planning rehabilitation programs and strategies that aim to improve the long term HRQL in breast cancer. As RTW appeared to be positively associated with HRQL, future research should examine potential causal relationships between RTW and HRQL in breast cancer in order to provide evidence needed to plan prevention strategies that aim to improve HRQL after breast cancer.

Digestive cancers: mechanisms, therapeutics and management

Cancers of the digestive system are major contributors to global cancer-associated morbidity and mortality, accounting for 35% of annual cases of cancer deaths. The etiologies, molecular features, and therapeutic management of these cancer entities are highly heterogeneous and complex. Over the last decade, genomic and functional studies have provided unprecedented insights into the biology of digestive cancers, identifying genetic drivers of tumor progression and key interaction points of tumor cells with the immune system. This knowledge is continuously translated into novel treatment concepts and targets, which are dynamically reshaping the therapeutic landscape of these tumors. In this review, we provide a concise overview of the etiology and molecular pathology of the six most common cancers of the digestive system, including esophageal, gastric, biliary tract, pancreatic, hepatocellular, and colorectal cancers. We comprehensively describe the current stage-dependent pharmacological management of these malignancies, including chemo-, targeted, and immunotherapy. For each cancer entity, we provide an overview of recent therapeutic advancements and research progress. Finally, we describe how novel insights into tumor heterogeneity and immune evasion deepen our understanding of therapy resistance and provide an outlook on innovative therapeutic strategies that will shape the future management of digestive cancers, including CAR-T cell therapy, novel antibody-drug conjugates and targeted therapies.

Validation of the Sinhala Translation of the EORTC QLQ-INFO25: Enhancing Information Provision for Cancer Patients in Sri Lanka

Cancer is a major health challenge globally and in Sri Lanka. Providing comprehensive information to patients is crucial for improving treatment outcomes and patient satisfaction, supported by evidence of its effectiveness in managing cancer pain. EORTC QLQ-INFO25, an information module developed by the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group, is aimed at assessing cancer patients' perception of information received during different phases of care. This study aims to validate the Sinhala translation of the EORTC QLQ-INFO25, a module that assesses the quality of patient information, for use among Sri Lankans with cancer. EORTC QLQ-INFO25 underwent forward and backward Sinhala translation, expert reviews, and pilot testing with 15 cancer patients. Questionnaires were administered to patients with cancer at the National Hospital in Colombo, independently or with interviewer assistance. Reliability and validity were statistically analyzed. Of 102 participants, 100 (98.03%) completed the questionnaire. Internal consistency was high (Cronbach's α = 0.89). The multi-item scales demonstrated good convergent validity. Each item showed high correlation with its respective scale. Divergent validity was established as none of the scales had correlations over 0.5 with the EORTC QLQ-C30. Known-group validity revealed significant differences in information satisfaction between genders. Test-retest reliability was high (ICC = 0.86), confirming stability over time. The Sinhala translation of EORTC QLQ-INFO25 demonstrates satisfactory reliability, validity, reproducibility, and compliance for assessing information provision in cancer care among patients in Sri Lanka.

Effectiveness of artificial intelligence assisted colonoscopy on adenoma and polyp miss rate: A meta-analysis of tandem RCTs

BACKGROUND AND AIMS

One-fourth of colorectal neoplasia is missed at screening colonoscopy, representing the leading cause of interval colorectal cancer (I-CRC). This systematic review and meta-analysis summarizes the efficacy of computer-aided colonoscopy (CAC) compared to white-light colonoscopy (WLC) in reducing lesion miss rates.

METHODS

Major databases were systematically searched through May 2024 for tandem-design RCTs comparing lesion miss rates in CAC-first followed by WLC vs WLC-first followed by CAC. The primary outcomes were adenoma miss rate (AMR) and polyp miss rate (PMR). The secondary outcomes were advanced AMR (aAMR) and sessile serrated lesion miss rate (SMR).

RESULTS

Six RCTs (1718 patients) were included. AMR was significantly lower for CAC compared to WLC (RR = 0.46; 95 %CI [0.38-0.55]; P < 0.001). PMR was also lower for CAC compared to WLC (RR = 0.44; 95 %CI [0.33-0.60]; P < 0.001). No significant difference in aAMR (RR = 1.28; 95 %CI [0.34-4.83]; P = 0.71) and SMR (RR = 0.44; 95 %CI [0.15-1.28]; P = 0.13) were observed. Sensitivity analysis including only RCTs performed in CRC screening and surveillance setting confirmed lower AMR (RR = 0.48; 95 %CI [0.39-0.58]; P < 0.001) and PMR (RR = 0.50; 95 %CI [0.37-0.66]; P < 0.001), also showing significantly lower SMR (RR = 0.28; 95 %CI [0.11-0.70]; P = 0.007) for CAC compared to WLC.

CONCLUSIONS

CAC results in significantly lower AMR and PMR compared to WLC overall, and significantly lower AMR, PMR and SMR in the screening/surveillance setting, potentially reducing the incidence of I-CRC.

Evolving Dynamics of Colorectal Cancer in High Socio-Demographic Regions

BACKGROUND

Colorectal cancer (CRC) poses a significant global health challenge, with evolving demographic trends emphasizing the need for accurate forecasting models. Existing forecasting models lack comprehensive coverage. By integrating machine learning algorithms, this study aims to provide more accurate and precise predictions, filling critical gaps in understanding CRC incidence, death, and disability-adjusted life year (DALY) rate trends, especially in high socio-demographic index (SDI) regions. Specific emphasis is placed on exploring age-, sex-, and country-specific variations in CRC trends.

MATERIALS AND METHODS

An ensemble forecasting algorithm integrating Simple Linear Regression, Exponential Smoothing, and Autoregressive Integrated Moving Average, capable of handling a short time series was developed and validated, utilizing a dataset encompassing age-, sex-, and country-specific CRC incidence, mortality, and DALY rates.

RESULTS

Our forecasting models reveal rising trends in CRC burden in the 15-49 years age group (young-onset) and decreasing trends in CRC burden in the 50-74 years age group (late-onset) in high SDI regions with sex-specific variations in incidence, mortality, and DALY rates. Some inflection points for demographic shifts in CRC disease burden, particularly death rates, were identified as early as within the next 5 years. We predict a shift in CRC burden towards females, particularly in older adults.

CONCLUSION

A novel multifactor model was developed for comparing the incidence, mortality, and DALY rates of young- and late-onset CRC in high SDI regions. The rising incidence of young-onset CRC in high SDI regions underscores the need for proactive health strategies. By refining predictive models, adjusting screening guidelines to target younger, high-risk populations, and investing in public awareness and research, we can facilitate early detection and improve outcomes. This study addresses a significant gap in CRC forecasting and provides a robust framework for anticipating demographic shifts in CRC burden, making it an indispensable tool for healthcare planning.

Burdens of Tracheal, Bronchus, and Lung Cancer From 1990 to 2021 in China Compared to the Global Projection of 2036: Findings From the 2021 Global Burden of Disease Study

BACKGROUND

Tracheal, bronchial, and lung cancers (TBL cancers) pose a significant global health challenge, with rising incidence and mortality rates, particularly in China. Studies from the Global Burden of Disease (GBD), 2021, can guide screening and prevention strategies for TBL cancer. This study aims to provide a comprehensive analysis of the burden of TBL cancers in China compared to global data.

METHODS

We conducted an analysis of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. We also performed Joinpoint regression analysis and Bayesian age-period-cohort (BAPC) modeling to project future trends.

RESULTS

From 1990 to 2021, there was a substantial increase in TBL cancer indicators for all sexes in China, with the most significant rise observed in females. The female population showed alarming increases in age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR). While global efforts have managed to stabilize these rates, China's figures remain high, suggesting the impact of persistent risk factors such as smoking and air pollution, coupled with an aging population. Furthermore, we utilized the projection model in China to estimate that these indicators of TBL cancers in females will likely follow continuous and rapid upward trends, while the burden of TBL cancers among males is expected to have a steady trend.

CONCLUSION

Although global efforts have been effective in reducing the burden of TBL cancers over the past three decades, there still remains strong regional and gender heterogeneity. TBL cancers need more screening strategies and medical attention in China and in the female population.

Cognitive-behavioural therapy effectiveness for fear of cancer recurrence: systematic review and meta-analysis

OBJECTIVE

Fear of cancer recurrence is one of the psychological distresses for patients with cancer and cancer survivors, which poses a physical and psychological threat. There is scant evidence on the effectiveness of cognitive-behavioural therapy in reducing fear of cancer recurrence. Therefore, we conducted a systematic review and meta-analysis to assess the effectiveness of cognitive-behavioural therapy for fear of cancer recurrence.

METHOD

The review was reported according to Preferred Reporting Items for Systematic Review and Meta-analyses statement. Seven databases were systematically searched from inception to 31 March 2023. Randomised controlled trials implementing cognitive-behavioural therapy interventions and studies reporting fear of cancer recurrence were included. The methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool 2.

RESULTS

A total of 32 randomised controlled trials involving 1515 cancer survivors and 1845 patients with cancer undergoing treatment were included. The meta-analysis indicated a significant effect of cognitive-behavioural therapy on fear of cancer recurrence in patients with cancer and cancer survivors compared with controls (g=-0.65; 95% CI=-0.86, -0.44; p<0.001). The results of the overall risk of bias indicated some concerns in 4 studies and a high risk in 28 studies.

CONCLUSION

The study indicated the effectiveness of cognitive-behavioural therapy intervention for fear of cancer recurrence in patients with cancer and cancer survivors, which should inform future clinical practice of interventions for the treatment of fear of cancer recurrence.

PROSPERO REGISTRATION NUMBER

CRD42023404948.

The prevalence and clinical significance of EGFR mutations in non-small cell lung cancer patients in Egypt: a screening study

BACKGROUND

Lung cancer is a form of cancer that is responsible for the largest incidence of deaths attributed to cancer worldwide. Non-small cell lung cancer (NSCLC) is the most prevalent of all the subtypes of the disease. Treatment with tyrosine kinase inhibitors (TKI) may help some people who have been diagnosed with non-small cell lung cancer. The presence of actionable mutations in the epidermal growth factor receptor (EGFR) gene is a key predictor of how a patient will respond to a TKI. Thus, the frequency of identification of mutations in EGFR gene in patients with NSCLC can facilitate personalized treatment.

OBJECTIVE

The objective of this study was to screen for mutations in the EGFR gene and to investigate whether there is a correlation between the screened mutations and various clinical and pathological factors, such as gender, smoking history, and age, in tissue samples from patients with NSCLC.

METHODS

The study comprised 333 NSCLC tissue samples from 230 males and 103 females with an average age of 50 years. Exons 18-21 of the EGFR gene have been examined using real-time PCR. Using SPSS, correlations between clinical and demographic variables were examined, and EGFR mutation and clinical features associations were studied.

RESULTS

The study's findings revealed that the incidence rate of EGFR mutation was 24.32% (81/333), with partial deletion of exon 19 (19-Del) and a point mutation of L858R in exon 21 accounting for 66.67% (P < 0.001) and 28.40% (P < 0.001) of the mutant cases, respectively. Patients who had the T790M mutation represent 4.94% (P = 0.004) of total number of patients. Females harbored EGFR mutations (54.32%) with higher frequency than men (45.68%) (P < 0.001), while nonsmokers had EGFR mutations (70.37%) more frequently than current smokers (29.63%) (P < 0.001).

CONCLUSION

The screening study conducted in Egypt reported that the EGFR mutations prevalence was 24.32% among Egyptians with NSCLC. The study also found a slight gender bias, with females having an incidence rate of these mutations higher than males. Additionally, nonsmokers had higher rates of mutations in EGFR gene compared to smokers. According to the findings, somatic EGFR mutations can be employed as a diagnostic tool for non-small cell lung cancer in Egypt, and they can be implemented in conjunction with clinical criteria to identify which patients are more likely to respond favorably to TKIs.

The Challenge of Deep Learning for the Prevention and Automatic Diagnosis of Breast Cancer: A Systematic Review

OBJECTIVES

This review aims to evaluate several convolutional neural network (CNN) models applied to breast cancer detection, to identify and categorize CNN variants in recent studies, and to analyze their specific strengths, limitations, and challenges.

METHODS

Using PRISMA methodology, this review examines studies that focus on deep learning techniques, specifically CNN, for breast cancer detection. Inclusion criteria encompassed studies from the past five years, with duplicates and those unrelated to breast cancer excluded. A total of 62 articles from the IEEE, SCOPUS, and PubMed databases were analyzed, exploring CNN architectures and their applicability in detecting this pathology.

RESULTS

The review found that CNN models with advanced architecture and greater depth exhibit high accuracy and sensitivity in image processing and feature extraction for breast cancer detection. CNN variants that integrate transfer learning proved particularly effective, allowing the use of pre-trained models with less training data required. However, challenges include the need for large, labeled datasets and significant computational resources.

CONCLUSIONS

CNNs represent a promising tool in breast cancer detection, although future research should aim to create models that are more resource-efficient and maintain accuracy while reducing data requirements, thus improving clinical applicability.

Let-7c-5p Targeting CHD7 Hinders Cervical Cancer Migration and Invasion by Regulating Cell Adhesion

Cervical cancer is one of the most common cancers worldwide. Many studies have reported the involvement of various miRNAs in cervical cancer progression. Our study was centered at investigating how let-7c-5p affected cervical cancer migration and invasion by regulating cell adhesion and its molecular mechanism. Bioinformatics was used for the analysis on differentially expressed mRNAs in cervical cancer and the prediction of their upstream regulatory miRNAs. Immunohistochemistry was performed to assess the expression of CHD7 in cervical cancer tissue. qRT-PCR was performed for examining how much let-7c-5p and CHD7 were expressed. Dual-luciferase assay was performed to verify the regulatory relationship between CHD7 and let-7c-5p. The CCK-8 and transwell assays helped in detecting cell viability, invasion and migration. The ability by which cells adhered to each other was detected by employing cell adhesion assay. In addition, the expression levels of the proteins related to cell adhesion and CHD7 were detected by Western blot. A remarkable high expression-level of CHD7 was discovered in cervical cancer tissues and cells. The cell viability, migration and invasiveness could be suppressed by the knockdown of CHD7 which could also attenuate the expression of cell adhesion-related proteins. Bioinformatics analysis showed that CHD7 had an upstream regulatory gene, miRNA-let-7c-5p, which was markedly lowly expressed in cervical cancer tissues and cells. To validate the binding relationship between CHD7 and let-7c-5p, dual-luciferase assay was performed. Rescue experiments revealed that the cancer-inhibiting effect of let-7c-5p in cervical cancer could be reversed by overexpressed CHD7. let-7c-5p regulates cell adhesion and attenuates cervical cancer migration and invasiveness by targeting CHD7. It indicates that the involvement of let-7c-5p/CHD7 axis is of significance in cervical cancer progression, which opens up new possibilities for us to develop novel clinical treatments for cervical cancer.

Cohort profile: Guangzhou breast cancer study (GBCS)

The Guangzhou Breast Cancer Study (GBCS) is a patient-based prospective cohort study designed to identify risk factors and underlying mechanisms for breast cancer (BC) incidence and prognosis, specifically addressing the need for individualized prevention in South China, where BC incidence is notably high. Based in Guangzhou, China, the GBCS began recruitment in 2008, comprises three complementary studies: the Guangzhou breast cancer cohort with 5471 breast cancer patients, a case-control study with 1551 cases and 1605 controls, and an immunohistochemistry (IHC) cohort with 1063 breast cancer patients. Participants are primarily aged 41-60 years. Cohort follow-up is conducted every three months in the first year, every six months in the second and third years, and annually thereafter. High follow-up rates have been achieved until 2023, with 73.5% for the Guangzhou breast cancer cohort and 98.6% for the IHC cohort still active. Baseline data collection included demographic characteristics and breast cancer risk factors, while follow-up data included survival, treatment details, disease history, occupational history, post-diagnostic lifestyle, and laboratory measures, including genetic markers, proteins, and environmental exposures. The study encourages global collaborations and invites interested researchers to contact the corresponding author at xulin27@ mail.sysu.edu.cn with specific research ideas or proposals.

Depside and depsidone-rich hydroalcoholic extract, resourced from the lichen Parmelinella wallichiana (Taylor) Elix & Hale selectively restricts Non-Small Cell Lung Cancer by modulating p53, FOXO1 and PALLADIN genes

The non-specificity of contemporary cancer therapeutics has enticed us to develop safer, anticancer alternatives from natural resources. Lichens are unique natural entities which have long been neglected for explorations in cancer therapy, despite their vast potential. Our present study aims to investigate the anti-cancer potential of a wild lichen Parmelinella wallichiana. The anti-proliferative efficacy of the lichen extracts were screened through MTT assay against a panel of cell lines and the potent hydroalcoholic extract was selected for further evaluation against the most sensitive lung-cancer cell line A549 by implementing a wide range of microscopic and flow cytometric applications. The observations suggest that the extract could selectively induce apoptosis by augmenting ROS and disrupting the mitochondrial membrane potentiality. It was also found that the lichen-induced apoptosis was regulated by two crucial tumor suppressor genes, FOXO1, and p53, along with cell cycle inhibitor p21 which ultimately resulted in robust apoptosis through the up-regulation of pro-apoptotic BAX expression. Moreover, the extract also restricted the cancer progression by down-regulating the PALLADIN expression. Further, an LC-MS-based metabolomic profile highlighted a number of depsides, depsidones and dibenzofurans, which included atranorin, physodalic acid, salazinic acid, constictic acid and usnic acid. Then, an in silico docking with these lichen-derived metabolites against the PI3Kα receptor predicted these compounds has a binding affinity close to a standard PI3Kα inhibitor copanlisib. The study concludes that the extract restricts lung cancer possibly through the PI3Kα/FOXO1 axis and thus Parmelinella wallichiana represents a potential resource for anti-lung cancer drug development in future.

Recent advances in microfluidic chip technologies for applications as preclinical testing devices for the diagnosis and treatment of triple-negative breast cancers

The leading cause of cancer-related death among female patients is breast cancer. Among all the types of breast cancer, triple-negative breast cancer (TNBC) is the most dangerous molecular subtype of breast cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression. Since there is no particular therapeutic strategy for TNBC that has been shown to worsen the disease prognosis, 3D models are superior to 2D models as a predictive tool for drug discovery because they more accurately reflect the in vivo biological components of humans. Importantly, all 3D models struggle to gather many high-quality tumour cells from clinical tumours. Physicians may not get huge tumour tissues from patients, and clinical tumours may have necrosis, fat, and blood vessel components. Therefore, there is an immediate need to find an efficient method to consistently and quickly produce a large number of homogeneous tumour models for individual treatment without cell wastage. Microfluidic technologies, which are specifically engineered to manipulate small quantities of fluids, have been utilised to produce particles for drug delivery applications. This development is indicative of a recent trend, as it provides the ability to regulate particle size and material composition. This review focuses on the topic of tumor-on-a-chip, microfluidic chip manufacturing, and drug screening for triple-negative breast cancer. Particular emphasis is placed on cancer biomarker diagnostics, 3D preclinical model development, and treatment strategies for triple-negative breast cancer.

The prevalence of anxiety symptoms/disorders in cancer patients: a meta-analysis

OBJECTIVE

Cancer can have negative effects on mental health. The aim of this study was to investigate the prevalence of anxiety symptoms/disorders in cancer patients' worldwide using meta-analysis.

METHODS

The study population was cancer patients who had cancer at the time of the study. The outcome studied in this study was anxiety symptoms/disorders. PubMed and Scopus were searched based on the syntax of keywords, this search was limited to articles published in English until September 2021. For this meta-analysis, data on the prevalence of anxiety were first extracted for each of the eligible studies. The random-effects method was used for the pool of all studies. Subgroup analysis was performed based on sex, anxiety disorders, cancer site, and continents. Heterogeneity in the studies was also assessed.

RESULT

After evaluating and screening the studies, eighty-four studies were included in the meta-analysis. Prevalence of anxiety symptoms/disorders in cancer patients showed that this prevalence is 23% (I2 = 99.59) in the 95% confidence interval between 22-25%. This prevalence was 20% (I 2 = 96.06%) in the 95% confidence interval between 15-24% in men and this prevalence is 31% (I 2 = 99.72%) in the 95% confidence interval between 28-34% in women. The highest prevalence of anxiety was in patients with ovarian, breast, and lung cancers.

DISCUSSION

It showed a high prevalence of anxiety symptoms/disorders in cancer patients, in addition to therapeutic interventions for cancer, the necessary interventions should be made on the anxiety of these patients. Methodological limitation was the heterogeneity between the studies included in the meta-analysis. Some types of cancer sites could not be studied because the number of studies was small or the site of cancer was not identified.

Nutrition Modulation of Cardiotoxicity in Breast Cancer: A Scoping Review

BACKGROUND/OBJECTIVES

Advancements in breast cancer therapeutics, such as anthracyclines, are improving cancer survival rates but can have side effects that limit their use. Cardiotoxicity, defined as damage to the heart caused by cancer therapeutics, is characterised by a significant reduction in left ventricular ejection fraction (LVEF) and symptoms of cardiac dysfunction. Multiple oral supplements exist with antioxidant and anti-inflammatory properties that have the potential to lower cardiotoxicity risk and ameliorate the complications associated with left ventricular dysfunction. In this review, we evaluate the current status of using nutritional interventions to modulate cardiotoxicity.

METHODS

We used specific keywords to search for articles that met our predetermined inclusion and exclusion criteria to review the evidence and provide insights for future research.

RESULTS

Seven studies were identified as eligible for this review: six focused on oral supplementation strategies in breast cancer patients undergoing chemotherapy, and one focused on nutritional counselling and adherence to the Mediterranean diet in breast cancer survivors' post-treatment. There was a significantly attenuated reduction in LVEF in five studies that monitored cardiometabolic health, and there were significant improvements in blood serum levels of cardiac biomarkers across all studies.

CONCLUSIONS

Current evidence suggests that appropriate nutritional interventions, alongside chemotherapy, can modulate the risk of cardiotoxic side effects. This highlights the potential of oral antioxidant supplementation and Mediterranean diet counselling to decrease tertiary cancer therapy costs associated with cardiovascular complications.

Knockdown of circXPO1 inhibits the development of oral squamous cell carcinoma cells

BACKGROUND

Circular RNAs (circRNAs) have emerged as pivotal regulators of cellular processes in human malignancies, including oral squamous cell carcinoma (OSCC).

METHODS

Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to detect RNA expression levels of circXPO1, miR-524-5p and cyclin D1 (CCND1). Colony formation assay and 5-Ethynyl-2'-deoxyuridine (EdU) assay were performed to analyze cell proliferation, while transwell assay was carried out to investigate the cell migration and invasion. Cell apoptosis was assessed by flow cytometry. Protein expression analysis was implemented by Western blot assay. Additionally, lactate production and glucose consumption were investigated using a lactate assay kit and glucose assay kit, respectively. The in vivo tumorigenic potential of circXPO1 was evaluated using a xenograft mouse model assay.

RESULTS

Elevated levels of circXPO1 and CCND1, alongside reduced miR-524-5p expression were decreased in OSCC tissues and cells. Knockdown of circXPO1 in OSCC cells inhibited their proliferative, migratory and invasive capacities, as well as glycolysis, prompting apoptosis. Moreover, circXPO1 silencing hindered tumor growth in vivo. MiR-524-5p could be sequestered by circXPO1, and its inhibition could counteract the beneficial effects of circXPO1 knockdown on OSCC progression.

CONCLUSION

Knockdown of circXPO1 inhibited OSCC progression by up-regulating miR-524-5p and down-regulating CCND1 expression, which might provide potential targets for OSCC treatment.

Early taxane exposure and neurotoxicity in breast cancer patients

INTRODUCTION

Breast cancer is the most diagnosed tumor and a leading cause of cancer death in women worldwide. Taxanes are the most used chemotherapeutic agents and are strictly connected to neurotoxicity. Taxane-induced neuropathy (TIN) significantly impacts patients' quality of life (QOL). Early identification and management of TIN could improve preventive strategies to preserve patients' QOL during and after breast cancer treatment.

OBJECTIVE

This prospective, observational study aimed to evaluate the taxane-induced neuropathy (TIN) in early breast cancer patients treated with weekly paclitaxel at an earlier stage and identify any correlation between TIN and QOL.

METHODS

Data from stage I-III breast cancer patients treated with taxane-based therapy between 2018 and 2022 were collected at the Medical Oncology Unit of the University Hospital of Cagliari. Peripheral neuropathy was evaluated using the NCI-CTCAE scale (National Cancer Institute, Common Terminology Criteria for Adverse Events) at every drug administration. In contrast, QOL was assessed using EORTC QLC-CIPN20 and FACT-Taxane questionnaire at baseline (T0), after 4 weeks (T1) and 12 (T2) weeks of treatment. Statistical analysis was performed to evaluate the correlation between neurotoxicity and QOL.

RESULTS

Neurotoxicity incidence peaked at the third, fourth, and sixth week of treatment, with patients reporting grade 1 and 2 neurotoxicity. Simultaneously with increasing doses of paclitaxel, significant differences in QOL were observed in early treatment cycles relating to TIN presentation. Patients with higher neurotoxicity grades reported lower QOL scores.

CONCLUSIONS

Despite the absence of effective treatments to prevent paclitaxel-induced neurotoxicity, symptoms are managed through dosage reduction, delay, or treatment interruption. Future research should focus on identifying neuroprotective measures to avoid an irreversible decline in the quality of life for breast cancer survivors.

Cervical cancer screening service utilisation and related factors among women on antiretroviral therapy in public health facilities of Asella town, Ethiopia, cross-sectional study

BACKGROUND

Cervical cancer is the predominant form of cancer in Ethiopia, accounting for the majority of malignant cases. Women account for two-thirds of cancer-related deaths in the country. Cervical cancer screening (CCS) can help prevent disease development, but screening rates are unacceptably low. The greatest number of women were in the most vulnerable group, and the availability of wheal data on their use of CCSs was limited. This study aimed to evaluate the use of CCS and the factors that influence its use among HIV-positive women receiving antiretroviral therapy at public health facilities.

METHODS

This study used a cross-sectional study design. A total of 396 (97.5%) HIV-positive women participated in this study between March 10 and May 30, 2023. Participants enrolled in public health facilities in Asella town were selected through systematic random sampling, and data were collected through on-site interviews using a pretested, structured questionnaire. The data were analysed using the Statistical Package for Social Science, Version 26. Logistic regression analysis was used to identify the determining factors.

RESULTS

The findings from this study indicated that 30.3% of individuals used cervical cancer screening services. Those women who had knowledge about cervical cancer had a 2.54 times greater likelihood of receiving CCS than those who were not informed (adjusted odds ratio [AOR] = (2.54; 95% confidence interval [CI]: 1.42-4.56). Women with a history of sexually transmitted diseases were twice as likely to use CCS as those without such a history (AOR = 2.05, 95% CI = 1.13-3.73). Furthermore, women with a positive attitude towards CCS were found to be significant predictors of utilisation, showing a greater than threefold greater likelihood of using these services (AOR = 3.21; 95% CI: 1.78-5.81).

CONCLUSIONS

The proportion of HIV-positive women who underwent cervical cancer screening (CCS) was significantly lower than the recommended guideline of 80%. To enhance the uptake of screening among women with HIV, healthcare professionals should focus on enhancing awareness about cervical cancer, improving attitudes towards CCS, and advancing knowledge about the disease. Healthcare providers' collaboration with both government and nongovernmental stakeholders plays a crucial role in addressing the challenges of accessibility and attendance at screening services.

Non-communicable diseases in the world over the past century: a secondary data analysis

Introduction

We analyzed the changes in the top 10 non-communicable diseases (NCDs) over the past century across the World Health Organization (WHO) regions.

Materials and methods

The data were extracted from the Global Burden of Disease (GBD) studies. After we accessed this source, all NCDs were sorted according to their prevalence in 2019, and the 10 most common NCDs were selected. Then, the incidence, prevalence, and mortality rates of these 10 NCDs were compared to the rates in 2000.

Results

Diabetes and kidney disease had the highest increase in incidence (49.4%) and prevalence (28%) in the Eastern Mediterranean region. Substance use disorders had a huge increase (138%) in the mortality rates among women in the Americas region. On the other hand, women in Southeast Asia experienced the greatest decrease in incidence (-19.8%), prevalence (-15.8%), and mortality rates (-66%).

Conclusion

In recent years, nearly all NCDs have shown an increase, yet mortality rates have declined across all regions. Lifestyle can be a major cause of this increase, but advancements in health and medical services, such as screening and treatment, have played a crucial role in improving survival rates.

Clinical Utility of Circulating Tumor DNA for Detecting Lung Cancer Mutations by Targeted Next-Generation Sequencing With Insufficient Tumor Samples

BACKGROUND

Circulating tumor deoxyribonucleic acid (ctDNA) is increasingly applied in clinical practice. This study aimed to explore clinical utility of a minimal invasive and sensitive way of ctDNA for next-generation sequencing in non-small cell lung cancer (NSCLC) with inadequate tumor samples.

METHODS

Targeted DNA sequencing was performed on tissue biopsies and matched plasma samples from 60 patients with NSCLC.

RESULTS

A total of 13 driving genes were detected in 60 matched tissue DNA (tDNA) and ctDNA samples. Overall concordance rate was 75.47%, with 77.55% sensitivity and 50% specificity. Epidermal growth factor receptor (EGFR) mutations were the most common in both tDNA and ctDNA samples. Among other mutated genes were tumor protein p53 (TP53), erb-b2 receptor tyrosine kinase 2 (ERBB2), anaplastic lymphoma kinase (ALK), cyclin-dependent kinase inhibitor 2A (CDKN2A), ros proto-oncogene 1, and receptor tyrosine kinase (ROS1). Mutations in b-raf proto-oncogene, serine/threonine kinase (BRAF), cluster of differentiation 274 (CD274), neurotrophin receptor tyrosine kinase 1 (NTRK1), and rearranged during transfection (RET) occurred only in plasma. The majority of mutations in both samples were single-nucleotide variants. Deletions were found in EGFR, BRAF, and TP53 in ctDNA, whereas in tDNA, deletions were only found in EGFR. In ALK, single nucleic acid-site amplification occurred simultaneously in tissue and plasma, but insertions and copy number variations were detected only in plasma.

CONCLUSIONS

Identifying ctDNA mutations by targeted sequencing in plasma is feasible, showing the clinical value of ctDNA-targeted sequencing in NSCLC patients when tumor tissue sampling is insufficient or even impossible.

The impact of short-course total neoadjuvant therapy, long-course chemoradiotherapy, and upfront surgery on the technical difficulty of total mesorectal excision: an observational study with an intraoperative perspective

PURPOSE

Total neoadjuvant therapy (TNT) is becoming the standard of care for locally advanced rectal cancer. However, surgery is deferred for months after completion, which may lead to fibrosis and increased surgical difficulty. The aim of this study was to assess whether TNT (TNT-RAPIDO) is associated with increased difficulty of total mesorectal excision (TME) compared with long-course chemoradiotherapy (LCRT) and upfront surgery.

METHODS

Twelve laparoscopic videos of low anterior resection with TME for rectal cancer were prospectively collected from January 2020 to October 2021, with 4 videos in each arm. Seven colorectal surgeons assessed the videos independently, graded the difficulty of TME using a visual analog scale and attempted to identify which category the videos belonged to.

RESULTS

The median age was 67 years, and 10 patients were male. The median interval to surgery from radiotherapy was 13 weeks in the LCRT group and 24 weeks in the TNT-RAPIDO group. There was no significant difference in the visual analog scale for difficulty in TME between the 3 groups (LCRT, 3.2; TNT-RAPIDO, 4.6; upfront, 4.1; P=0.12). A subgroup analysis showed similar difficulty between groups (LCRT 3.2 vs. TNT-RAPIDO 4.6, P=0.05; TNT-RAPIDO 4.6 vs. upfront 4.1, P=0.54). During video assessments, surgeons correctly identified the prior treatment modality in 42% of the cases. TNT-RAPIDO videos had the highest recognition rate (71%), significantly outperforming both LCRT (29%) and upfront surgery (25%, P=0.01).

CONCLUSION

TNT does not appear to increase the surgical difficulty of TME.

Evolving therapeutic landscape of advanced biliary tract cancer: from chemotherapy to molecular targets

Biliary tract cancer, the second most common type of liver cancer, remains a therapeutic challenge due to its late diagnosis and poor prognosis. In recent years, it has become evident that classical chemotherapy might not be the optimal treatment for patients with biliary tract cancer, especially after failure of first-line therapy. Finding new treatment options and strategies to improve the survival of these patients is therefore crucial. With the rise and increasing availability of genetic testing in patients with tumor, novel treatment approaches targeting specific genetic alterations have recently been proposed and have demonstrated their safety and efficacy in numerous clinical trials. In this review, we will first consider chemotherapy options and the new possibility of combining chemotherapy with immune checkpoint inhibitors in first-line treatment. We will then provide an overview of genomic alterations and their potential for targeted therapy especially in second-line therapy. In addition to the most common alterations such as isocitrate dehydrogenase 1 or 2 (IDH1/2) mutations, fibroblast growth factor receptor 2 (FGFR2) fusions, and alterations, we will also discuss less frequently encountered alterations such as BRAF V600E mutation and neurotrophic tyrosine kinase receptor gene (NTRK) fusion. We highlight the importance of molecular profiling in guiding therapeutic decisions and emphasize the need for continued research to optimize and expand targeted treatment strategies for this aggressive malignancy.

Sensitive and reliable lab-on-paper biosensor for label-free detection of exosomes by electrochemical impedance spectroscopy

A new, sensitive, and cost-effective lab-on-paper-based immunosensor was designed based on electrochemical impedance spectroscopy (EIS) for the detection of exosomes. EIS was selected as the determination method since there was a surface blockage in electron transfer by binding the exosomes to the transducer. Briefly, the carbon working electrode (WE) on the paper electrode (PE) was modified with gold particles (AuPs@PE) and then conjugated with anti-CD9 (Anti-CD9/AuPs@PE) for the detection of exosomes. Variables involved in the biosensor design were optimized with the univariate mode. The developed method presents the limit of detection of  8.7 × 102 exosomes mL-1, which is lower than that of many other available methods under the best conditions. The biosensor was also tested with urine samples from cancer patients with high recoveries. Due to this  a unique, low-cost, biodegradable technology is presented that can directly measure exosomes without labeling them for early cancer or metastasis detection.

The clinicopathological significance and prognostic impact of 14-3-3σ/stratifin expression on patients with surgically resectable intrahepatic cholangiocarcinoma

INTRODUCTION

Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer after hepatocellular carcinoma. Through data mining of publicly available iCCA transcriptomic datasets from the Gene Expression Omnibus, we identified SFN as the most significantly up-regulated gene in iCCA compared to normal tissue, focusing on the Gene Ontology term "cell proliferation" (GO:0008283). SFN encodes the 14-3-3σ protein, also known as stratifin, which plays crucial roles in various cellular processes.

MATERIALS AND METHODS

Immunohistochemistry was used to assess stratifin expression in 182 patients with localized iCCAs undergoing surgical resection. Patients were divided into low and high expression groups, and the association between stratifin expression and clinicopathological features was analyzed. Univariate and multivariate survival analyses were performed to assess overall survival (OS), disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MeFS).

RESULTS

Elevated stratifin expression in iCCAs was significantly associated with the absence of hepatitis, positive surgical margins, advanced primary tumor stages, and higher histological grades (all p ≤ 0.011). Survival analyses demonstrated a significant negative association between stratifin expression and all prognostic indicators, including OS, DSS, LRFS, and MeFS (all p ≤ 0.0004). Multivariate analysis revealed that stratifin overexpression was significantly correlated with poorer outcomes in terms of DSS, LRFS, and MeFS (all p < 0.001).

CONCLUSIONS

These findings suggest that stratifin may play a crucial role in iCCA oncogenesis and tumor progression, serving as a potential novel prognostic biomarker.

Novel engineered IL-2 Nemvaleukin alfa combined with PD1 checkpoint blockade enhances the systemic anti-tumor responses of radiation therapy

BACKGROUND

Combining interleukin-2 (IL-2) with radiotherapy (RT) and immune checkpoint blockade (ICB) has emerged as a promising approach to address ICB resistance. However, conventional IL-2 cytokine therapy faces constraints owing to its brief half-life and adverse effects. RDB 1462, the mouse ortholog of Nemvaleukin alfa, is an engineered IL-2 with an intermediate affinity that selectively stimulates antitumor CD8 T and NK cells while limiting regulatory T cell expansion. This study aimed to evaluate the antitumor activity and mechanism of action of the combination of RDB 1462, RT, and anti-PD1 in mouse tumor models.

METHODS

Two bilateral lung adenocarcinoma murine models were established using 344SQ-Parental and 344SQ anti-PD1-resistant cell lines. Primary tumors were treated with RT, and secondary tumors were observed for evidence of abscopal effects. We performed immune phenotyping by flow cytometry, analyzed 770 immune-related genes using NanoString, and performed T cell receptor (TCR) repertoire analysis. Serum pro-inflammatory cytokine markers were analyzed by 23-plex kit.

RESULTS

Compared to native IL-2 (RDB 1475), RDB 1462 demonstrated superior systemic antitumoral responses, attributable, at least in part, to augmented levels of CD4 and CD8 T cells with the latter. Our findings reveal substantial reductions in primary and secondary tumor volumes compared to monotherapy controls, with some variability observed among different dosing schedules of RDB 1462 combined with RT. Blood and tumor tissue-based flow cytometric phenotyping reveals an increase in effector memory CD8 and CD4 T cells and a decrease in immunosuppressive cells accompanied by a significant increase in IL-2, IFN-γ, and GM-CSF levels in the combination group. Transcriptomic profiling and TCR sequencing reveal favorable gene expression and T cell repertoire patterns with the dual combination. Furthermore, integrating anti-PD1 therapy with RT and RDB 1462 further reduced primary and secondary tumor volumes, prolonged survival, and decreased lung metastasis. Observations of immune cell profiles indicated that RT with escalating doses of RDB 1462 significantly reduced tumor growth and increased tumor-specific immune cell populations.

CONCLUSION

The addition of Nemvaleukin therapy may enhance responses to RT alone and in combination with anti-PD1.

Epidemiology Characteristics and Potential Cervical Cancer Screening Value of Vulvar Human Papillomavirus in Chinese Women: A Multicenter Cross-Sectional Study

CONTEXT.—

Noninvasive self-sampling is a convenient option that may be highly accepted by women for home-based detection, which could increase the screening rate for cervical cancer (CC) and reduce its incidence and mortality.

OBJECTIVE.—

To compare the distribution of high-risk human papillomavirus (hr-HPV) between the vulva and cervix and to explore the clinical value of vulvar HPV detection in CC screening.

DESIGN.—

The study was nested within a clinical trial on a recombinant HPV 9-valent vaccine for women ages 20 to 45 years. Women with paired vulvar and cervical specimens were included and underwent cytology and HPV detection. The consistency of HPV detection between vulvar and cervical specimens was evaluated using Cohen κ statistics. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the diagnostic accuracy of primary CC screening. The primary end points were cervical intraepithelial neoplasia (CIN) grade 2/3 or worse (CIN2+/3+).

RESULTS.—

A total of 7999 women were enrolled, and 83/33 cases were diagnosed as CIN2+/CIN3+. The HPV-positive rate in vulvar specimens (1785 of 7999; 22.32%) was higher than that in cervical specimens (1390 of 7999; 17.38%), and there were no significant differences in the distribution of hr-HPV genotypes between the vulva and cervix in patients with CIN2+/CIN3+. Vulva-based HPV primary screening showed sensitivity, specificity, PPV, and NPV comparable to those for cervix-based HPV primary CC screening in the detection of CIN3+.

CONCLUSIONS.—

The distribution of vulvar and cervical HPV was similar in patients with CIN2+/CIN3+. Vulva-based HPV primary CC screening had acceptable diagnostic efficacy and might be used as a modality for primary CC screening.

Effects of TET2-mediated methylation reconstruction on A2058 melanoma cell sensitivity to matrix stiffness in a 3D culture system

Matrix stiffness is a crucial factor in the tumor microenvironment, impacting tumor progression and development. TET2 is vital for epigenetic regulation in melanoma and is significantly reduced in advanced melanomas compared with nevi and thin melanomas. However, it is unclear how TET2 mediates the effect of matrix stiffness on melanoma cells. This study utilized A2058 cell lines and prepared different stiffness collagen hydrogels to evaluate TET2 overexpression (TET2OE) and mutant (TET2M) melanoma cells' activity, proliferation, and invasion. A2058 melanoma cells' viability and invasion decreased with increased matrix stiffness, with TET2OE cells experiencing a more significant impact than TET2M cells. Methylation analysis revealed that TET2 determines gene methylation levels, influencing cell-ECM interactions. Transcriptome analysis confirmed that TET2 promotes matrix stiffness's effect on melanoma cell fate. This research provides promising directions and opportunities for melanoma treatment.

The clinical effect of endoscopic and open surgery in the treatment of thyroid cancer and their effect on the blood coagulation state: a comparative study

Purpose

This study was performed to compare the therapeutic efficacy of endoscopic surgery and open surgery and their effects on postoperative blood coagulation state in patients with thyroid cancer, and to provide evidence for the prevention measurement of thrombosis in the perioperative period.

Methods

One hundred patients with thyroid cancer who received treatment in our hospital from January 2021 to December 2021, were randomly divided into an endoscopic group and an open surgery group, with 50 patients in each group. The patients in the open surgery group were treated by traditional open surgery, while patients in the endoscopic group accepted endoscopic surgery. The clinically therapeutic effect and blood coagulation of the 2 groups were compared.

Results

Intraoperative blood loss and length of hospital stay were lower, and operative time was longer in the endoscopic group than in the open surgery group (P < 0.05). The 24-hour postoperative fibrinogen and D-dimer levels were higher in both groups than in the preoperative period, while PT was shorter (P < 0.05). There were no significant differences in postoperative complications and follow-up between the 2 groups (P > 0.05), but the incidence of complications, postoperative metastases, and thrombosis was relatively low in the endoscopic group.

Conclusion

In the treatment of patients with thyroid cancer, endoscopic surgery has the advantages of less blood loss, fewer complications, and so on. Endoscopic and open surgery can lead to a hypercoagulable state, but the effect of endoscopic surgery is better than that of open surgery.

Microbiota in gastrointestinal malignancies

This manuscript provides an overview of the microbiota profile associated with precancerous lesions in the esophagus, stomach, and large bowel. The critical review of the available data reveals significant variability in the methods used for microbiota profiling. This variability may affect the reliable identification of specific biological links between histologically profiled neoplastic diseases and the microbiota population. Overall, this critical review reveals significant links between microbiota communities and the different lesions within the spectrum of the oncogenetic cascade in various epidemiological contexts and anatomical districts.

Cost-effectiveness of pembrolizumab plus chemotherapy vs. chemotherapy as first-line treatment for advanced biliary tract cancer in China and the US

Background: Pembrolizumab is a potentially valuable treatment. However, patients, doctors, and healthcare decision-makers are uncertain about its cost-effectiveness and an appropriate pricing for this new therapy. This study aims to appraise the cost-effectiveness of pembrolizumab as a first-line treatment for advanced biliary tract cancer (BTC) patients in China and the United States (US). Methods: A Markov model was constructed from the perspectives of healthcare systems in both China and the US for pharmacoeconomic evaluation. Patient baseline characteristics and key clinical data were sourced from the KEYNOTE-966 trial (ClinicalTrials.gov, NCT04003636). Costs and utilities were collected from drug cost websites and published literature. Cumulative costs (in USD), life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured and compared. Price simulations were conducted under given willingness-to-pay (WTP) thresholds to provide pricing scheme references. The model's robustness was analyzed through one-way sensitivity analysis and probabilistic sensitivity analysis. Results: Basic data analysis illustrates that pembrolizumab ($2662.41/100 mg) in combination with chemotherapy regimen was not cost-effective relative to chemotherapy regimens at the WTP threshold of $38,201.19 in China, and the additional cost relative to chemotherapy regimens was $77,114.94 (ICER $556,689.47/QALY) while increasing 0.14 QALYs. Pembrolizumab ($54.71/1 mg) also increased efficacy by 0.14 QALYs in the US, but remained also not cost-effective at the US WTP threshold of $229,044, and the total cost increased by $160,425.24 (ICER $1,109,462.92/QALY). Conclusion: Compared with chemotherapy, pembrolizumab plus chemotherapy reduces the disease of burden. However, at its current price, it may not be a cost-effective treatment for advanced BTC in both China and the US. This study can aid decision-makers in making optimal choices.

The smart nanocarrier containing zein/starch co-biopolymers enhanced by graphitic carbon nitride; exploring opportunities in brain cancer treatment

In this investigation, we present an innovative pH-responsive nanocomposite designed to address challenges associated with using 5-Fluorouracil (5-FU) in cancer therapy. The nanocomposite containing zein (Z), starch (S), and graphitic carbon nitride (g-C3N4) macromolecules is synthesized by a water-in-oil-in-water (W/O/W) double emulsion technique, serving as a carrier for 5-FU. The S/Z hydrogel matrix's entrapment and loading efficiency are greatly improved by adding g-C3N4 nanosheets, reaching noteworthy values of 45.25 % and 86.5 %, respectively, for drug loading efficiency and entrapment efficiency. Characterization through FTIR and XRD validates the successful loading of 5-FU, elucidating the chemical bonding within the nanocomposite and crystalline characteristics. Structural analysis using FESEM, along with DLS and zeta potential measurements, reveals an average nanocomposite size of 193.48 nm, indicating a controlled structure, and a zeta potential of -42.32 mV, signifying a negatively charged surface. Studies on the in vitro release of drugs reveal that 5-FU is delivered more effectively and sustainably in acidic environments than in physiological circumstances. This highlights the fact that the created nanocarrier is pH-sensitive. Modeling release kinetics involves finding the right mathematical conditions representing underlying physicochemical processes. Employing curve-fitting techniques, predominant release mechanisms are identified, and optimal-fitting kinetic models are determined. The Baker kinetic model performed best at pH 7.4, indicating that the leading cause of the drug release was polymer swelling. In contrast, the Higuchi model was most accurate for drug release at pH 5.4, illuminating the diffusion and dissolution mechanisms involved in diffusion. To be more precise, the mechanism of release at pH 7.4 and 5.4 was anomalous transport (dissolution-controlled), according to the Korsmeyer-Peppas mathematical model. The pH-dependent swelling and degradation behavior of S/Z/g-C3N4@5-FU nanocomposite showed higher swelling and faster degradation in acidic environments compared to neutral conditions. Crucially, outcomes from the MTT test affirm the significant cytotoxicity of the 5-FU-loaded nanocomposite against U-87 MG brain cancer cells, while simultaneously indicating non-toxicity towards L929 fibroblast cells. These cumulative findings underscore the potential of the engineered S/Z/g-C3N4@5-FU as a productive and targeted therapeutic approach for cancer cells.