Artificial intelligence (AI) has rapidly integrated into thyroid nodule ultrasound diagnosis and malignant risk stratification, fostering a fast-growing interdisciplinary domain encompassing endocrinology, medical imaging, and computational intelligence. Nevertheless, existing bibliometric studies in this field rely on single-database datasets and short time-series windows, lacking systematic elaboration of the dynamic linkage between clinical guideline iterations and AI algorithm evolution. This study conducted a comprehensive bibliometric analysis to fill this research gap, clarify the global intellectual landscape, and reveal the evolutionary rules and emerging frontiers of AI-assisted thyroid nodule diagnosis.

Peer-reviewed articles and reviews on AI in thyroid nodule diagnosis were retrieved from Web of Science and PubMed (2006-2025). After strict data cleaning, 821 valid publications were analyzed using CiteSpace, VOSviewer, and online platforms, examining publication trends, contributions, collaboration networks, citations, and keyword evolution. Latent Dirichlet Allocation (LDA) was applied for topic modeling.

The field showed rapid and sustained growth, with a compound annual growth rate of 24.1%, and a notable acceleration around 2017. In total, 2,870 authors from 75 countries contributed. China led global output, while the United States and South Korea showed higher citation quality. Shanghai Jiao Tong University was the most productive institution. Keyword analysis revealed close coupling with clinical guidelines (ATA, TI-RADS, Bethesda). Core hotspots included ultrasound image analysis, deep learning optimization, and malignant risk stratification. Emerging frontiers involve explainable AI, multimodal data fusion, and standardized clinical validation.

This study establishes a long-time-series, multi-database knowledge map of AI applications in thyroid nodule diagnosis, systematically revealing the global research pattern, spatiotemporal evolution characteristics, and guideline-driven developmental logic of this field. Different from previous single-dimensional bibliometric summaries, this work clarifies how standardized clinical diagnostic criteria chronologically correspond with the iterative progress of radiomics and deep learning research. The findings provide reliable theoretical references for subsequent algorithm optimization, interdisciplinary innovation, and large-scale multicenter prospective validation, facilitating the standardized clinical translation and high-quality development of AI-assisted thyroid diagnostic models and precision endocrinology.

Bacteria-derived carotenoids have attracted increasing attention as natural bioactive compounds with potential pharmaceutical applications, particularly in cancer therapy. However, the chemical composition and anticancer mechanisms of carotenoids from Micrococcus terreus remain largely unexplored. This study aimed to characterize the carotenoid extract from the locally isolated M. terreus SK34 strain (GenBank: PX765938) and to investigate its anticancer activity and underlying mechanisms using integrated in vitro and in silico approaches. Under nonoptimized culture conditions, strain SK34 produced 128 mg/L of carotenoid-rich pigment extract. LC-Q-TOF-MS analysis identified eight carotenoids, including phytoene, β-carotene, astaxanthin, zeaxanthin, β-cryptoxanthin, α-carotene, lycopene, and sarcinaxanthin. The extract exerted selective cytotoxicity against different cancer cell lines (IC₅₀ = 61.91-243.76 μg/mL), particularly the neuroblastoma (SH-SY5Y) cancer cell line, while showing minimal cytotoxicity toward normal human dermal fibroblasts. Gene expression analysis demonstrated the significant upregulation of proapoptotic genes (p53, BAX, CASP3, CASP8, and CASP9) in the SH-SY5Y cell line, together with the downregulation of antiapoptotic genes (BCL-2 and AKT1), whereas autophagy-related genes were not significantly affected. ELISA and flow cytometry analyses further confirmed apoptosis in the SH-SY5Y cell line. Molecular docking analyses revealed that β-carotene, astaxanthin, and zeaxanthin exhibited strong binding affinities toward apoptosis-related proteins, supporting the experimental findings. This study provides the first comprehensive characterization of carotenoids from M. terreus SK34 and highlights their potential as selective apoptosis-inducing agents for future anticancer therapy.

Germline TP53 p.R72P polymorphism has been associated with lung cancer susceptibility, somatic TP53 mutation acquisition, and differential apoptotic signaling. Its influence on pathologic response to neoadjuvant immune checkpoint inhibition (ICI) has not been previously evaluated. This study investigates the impact of germline TP53 p.R72P genotype on response to neoadjuvant ICI therapy in nonsmall cell lung cancer (NSCLC). NSCLC patients treated with neoadjuvant anti-PD-1 therapy followed by resection were stratified by germline p.R72P status and the presence of concomitant somatic TP53 mutations. Histopathologic review assessed immunotherapy-associated histopathologic features of tumor regression, and the findings were correlated with PD-L1 tumor proportion scores (TPS) and next-generation sequencing data. The subgroup harboring both germline p.R72P and somatic TP53 mutations achieved a complete pathologic response (cPR) rate of 75% (3 of 4 cases), numerically higher than that observed in p.R72P-positive/TP53-wild-type tumors (25%, 2 of 8 cases), p.R72P-negative/TP53-mutant tumors (50%, 4 of 8 cases), and p.R72P-negative/TP53-wild-type controls (0%, 0 of 6 cases) (p < 0.05). In this single-center, exploratory cohort, germline TP53 p.R72P status was associated with differences in pathologic response to neoadjuvant therapy. Tumors with combined germline p.R72P polymorphism and somatic TP53 mutation might represent a genomic subgroup with a higher cPR rate.

Existential distress is common among patients with advanced cancer receiving palliative care and is associated with hopelessness, loss of meaning, spiritual distress, and desire for death. Meaning-centered psychotherapy (MCP) has shown potential in reducing existential suffering and improving psychological well-being in patients with advanced cancer. This article presents a case report describing the application of MCP in a young woman with advanced cancer experiencing depressive symptoms, trauma-related distress, hopelessness, and loss of meaning near the end of life.

We report the case of a 24-year-old Vietnamese woman with advanced cancer who was referred for psychological intervention because of severe depressive symptoms, emotional instability, passive wishes for death, and childhood relational trauma. Sixteen psychotherapy sessions were delivered within a multidisciplinary palliative care team. The intervention followed a phased approach, beginning with Trauma-Focused Cognitive Behavioral Therapy-informed stabilization and subsequently transitioning to adapted Individual MCP. Clinical outcomes were evaluated using the Depression Anxiety Stress Scale-21, Beck Depression Inventory-II, and qualitative clinical observations.

Psychological reassessment demonstrated marked reductions in depression, anxiety, and stress, accompanied by improved emotional regulation, interpersonal functioning, illness acceptance, and relational reconnection. As her condition deteriorated, psychotherapy increasingly emphasized spiritual reflection, reconciliation, and preparation for death. Before death, she reaffirmed her Christian faith, received baptism, and fulfilled her wish for a Protestant funeral ceremony.

This case illustrates the feasibility of integrating adapted MCP within multidisciplinary palliative care to address existential distress, facilitate meaning reconstruction, support spiritual integration, and promote end-of-life preparation in patients with advanced cancer.

BACKGROUND Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor of endothelial origin with variable clinical behavior, posing significant diagnostic and therapeutic challenges. Due to its nonspecific presentation and diverse imaging features, it is frequently misdiagnosed. We present a unique case of HEHE with recurrent liver involvement and distant metastases over a 14-year period, emphasizing diagnostic markers, treatment strategies, and the prognostic value of serial biomarker assessment. CASE REPORT A 48-year-old woman underwent right partial hepatectomy in 2011 after a routine health check-up incidentally revealed a liver lesion. Histological examination revealed characteristic epithelioid and dendritic tumor cells, confirmed by immunohistochemistry (CD31+, CD34+, Ki-67 5%). Postoperative surveillance detected tumor recurrence 7 years later in the left lobe, necessitating laparoscopic left partial hepatectomy. In 2020, further progression to the caudate lobe and regional lymph nodes prompted complex resection, with Ki-67 rising to 15%. Serial Ki-67 assessments across sequential specimens demonstrated a progressive increase in proliferative activity: 5% (2011), 15% (2020), and ultimately 40% in a pleural metastasis biopsy (2024), correlating closely with clinical progression. The patient received repeated surgical resections and adjuvant interferon alpha-2b, with palliative nab-paclitaxel attempted during the terminal stage but proving ineffective. The patient died in August 2025, approximately 14 years after initial diagnosis. CONCLUSIONS This case highlights the importance of the Ki-67 index as a dynamic biomarker for monitoring tumor evolution and guiding treatment decisions in recurrent HEHE. Regular long-term follow-up and a multidisciplinary approach are crucial for managing this unpredictable neoplasm, given its potential for late recurrence and metastasis.

Antibody‒drug conjugates (ADCs) represent a major advance in precision oncology, yet their effectiveness depends critically on adequate target antigen expression. Tumour heterogeneity and dynamic antigen expression during treatment pose major challenges for conventional tissue biopsies used in patient selection. Liquid biopsy components such as circulating tumour cells (CTCs) enable real-time, minimally invasive monitoring of tumour burden, molecular characteristics and target antigen status. This review evaluates the potential of CTC analysis to overcome the key challenges in ADC therapy, including real-time target profiling, enhanced patient stratification and longitudinal monitoring of treatment response. While acknowledging that direct clinical evidence for CTC-guided ADC selection remains limited and prospective validation is still needed, we integrate clinical evidence from CTC-guided trials across different cancer types and propose pragmatic decision-making frameworks to incorporate CTC testing into ADC treatment strategies. We also examine how artificial intelligence (AI) has improved CTC detection accuracy and discuss exploratory AI models for multi-omics integration and hypothetical AI-guided ADC recommendation systems, clearly distinguishing these by their current level of clinical evidence. Liquid biopsy-guided ADC selection has the potential to enable more personalised cancer treatment as CTC technologies advance and standardisation improves.

Acrokeratosis paraneoplastica (Bazex syndrome) is an obligate paraneoplastic dermatosis characterized by symmetrical acral psoriasiform lesions and nail dystrophy.

We conducted a PRISMA-compliant systematic review of 99 publications (89 case reports, 10 case series) describing 106 patients to re-examine the syndrome's epidemiology, oncologic associations, clinical features, treatment response, and prognosis.

The mean age at onset was 63.5 years (median: 62.5 years; interquartile range (IQR): 57-70 years); men comprised 72.6% (n = 77; 95% CI, 63.5-80.2%), yielding a male-to-female ratio of 2.7:1. Squamous cell carcinoma accounted for 51.9% (55/106; 95% CI, 42.5-61.2%) of associated malignancies, followed by adenocarcinomas (18.9%; 95% CI, 12.6-27.4%) and hematologic neoplasms (8.5%; 95% CI, 4.5-15.4%). Cutaneous lesions preceded the cancer diagnosis in 80.6% (83/103) of patients with reported chronology, with a median lead-time of 5 months (IQR 2-10 months). Nail involvement was documented in 73.6% (78/106). Following oncologic therapy, complete cutaneous clearance occurred in 36.8% (95% CI, 28.2-46.3%) and partial improvement in 30.2% (95% CI, 22.3-39.5%) of cases. In univariable analyses, distant metastasis (p = 0.021) and an aerodigestive primary site (p = 0.026) were nominally associated with reported mortality, although neither remained significant after multiple-comparison correction.

Bazex syndrome should be suspected in patients presenting with treatment-resistant acral psoriasiform lesions and nail dystrophy, prompting rigorous malignancy screening.

The 2022 revision of the Japanese Classification of Esophageal Cancer reclassified certain lymph node metastases previously considered locoregional as distant lymph node metastasis. Consequently, some patients previously diagnosed with stage IVA or III disease and treated with definitive chemoradiotherapy (dCRT) are now categorized as stage IVB disease with distant lymph node metastasis (IVB-Lym). We retrospectively evaluated the outcomes of dCRT in patients initially diagnosed with stage IVA or III disease and subsequently reclassified under the revised system. Among patients with esophageal cancer who underwent dCRT between January 2017 and December 2020 at our institution, 65 were reclassified as stage IVA (n = 19) or stage IVB-Lym (n = 46). Best overall response, overall survival (OS), progression-free survival (PFS) and chemotherapy-related adverse events (AEs) were evaluated. Complete or partial response was achieved in 84.2% of patients with stage IVA and 84.4% of those with stage IVB-Lym. The median OS and PFS were 26 and 8 months, respectively, in the stage IVA group and 35 and 9 months, respectively, in the stage IVB-Lym group. No significant differences were observed in OS (P = 0.69) or PFS (P = 0.67) between the two groups. The incidence and severity of AEs were generally comparable. No significant differences in efficacy or toxicity were observed between patients with reclassified stage IVB-Lym and those with stage IVA disease. These findings suggest that dCRT may be considered a treatment option for carefully selected patients with stage IVB-Lym following comprehensive clinical evaluation.

Recent evidence suggests the JAK2V617F mutation may confer an elevated risk of ischemic stroke, likely mediated by systemic inflammation, abnormal cell activation, and endothelial dysfunction. The JAK2V617F mutation is an acquired driver mutation reported in up to 11.3% of patients with ischemic stroke in a recent Danish case-control study. It is the main driver mutation in Philadelphia-negative myeloproliferative neoplasms and even in the absence of overt myeloproliferative neoplasm, an increasingly recognized risk factor for cardiovascular disease. In this review, we summarize current knowledge on the biological role of the JAK2V617F mutation in thrombosis, its contribution to cerebrovascular risk, and the emerging relevance of JAK2V617F in stroke neurology. Current knowledge underscores the value of JAK2V617F testing in stroke patients for early detection of myeloproliferative neoplasms or pre-myeloproliferative neoplasm states and personalized secondary stroke prevention. Further studies are needed to refine risk stratification, evaluate targeted interventions, and determine the clinical utility of integrating JAK2V617F mutation profiling into stroke care.

This study evaluated the clinical outcomes and safety of risk-adapted stereotactic body radiotherapy (SBRT) using non-standard fractionation schedules for lung tumors adjacent to organs at risk (OARs). We retrospectively analyzed 81 consecutive patients (92 lesions, 2008-25) who received SBRT, including repeat irradiation outside prior fields, with non-standard regimens (56 Gy/7 fractions [fr], 50 Gy/10 fr, 60 Gy/10 fr, 48 Gy/6 fr and 35 Gy/5 fr). Endpoints included overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), locoregional progression-free survival, local control (LC) and Grade ≥ 3 adverse events. At a median follow-up of 22.2 months (IQR, 12.1-42.9), the median OS was 26.4 months (95% CI: 17.2-43.0), with 1- and 3-year OS rates of 78.6% and 44.1%, respectively. The median PFS was 14.5 months (95% CI: 9.4-21.1), and the median CSS was 43.7 months (95% CI, 22.7-64.4). Median LC was not reached. No significant survival disparities were identified between primary and metastatic cohorts. Grade ≥ 3 toxicities occurred in 10 patients (12.3%), including two Grade 5 events. The 3-year cumulative incidence of Grade ≥ 3 toxicity in ultracentral tumors was 12.6%, with no significant differences among groups. In conclusion, risk-adapted SBRT with increased fractionation demonstrated encouraging LC while maintaining an acceptable toxicity profile for central and ultracentral lung tumors. However, the risk of severe toxicity remains, requiring careful patient selection and optimized OAR dose constraints.