To explore the latent class characteristics of psychological resilience in patients with brain glioma, identify influencing factors, and examine differences in psychosocial indicators across latent classes.

A total of 224 patients with brain glioma hospitalized in the Department of Neurosurgery of a tertiary Grade A hospital between January 2023 and December 2024 were selected using convenience sampling. Psychological resilience, anxiety and depression, quality of life, and perceived social support were assessed using the 14-item Resilience Scale (RS-14), Hospital Anxiety and Depression Scale (HADS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and Perceived Social Support Scale (PSSS), respectively. Latent class models were constructed using Mplus 8.3, and univariate analysis and multivariate logistic regression were performed using SPSS 26.0.

Psychological resilience in patients with brain glioma was classified into three latent classes: a low-level profile (25.0%), a moderate-level variable profile (32.6%), and a high-level profile (42.4%). Significant differences were observed among the classes in anxiety (p < 0.001), depression (p = 0.002), symptom burden (p = 0.018), global health status (p = 0.003), and family support (p = 0.018). Multivariate logistic regression analysis showed that age ≥60 years (p = 0.019), WHO grade III-IV glioma (p = 0.004), disease recurrence (p = 0.013), higher anxiety score (p < 0.001), and higher depression score (p = 0.032) were associated with a greater likelihood of belonging to a lower psychological resilience class, whereas college education or above (p = 0.027), monthly household income ≥10,000 RMB (p = 0.016), better global health status (p = 0.013), and higher family support (p = 0.018) were associated with a greater likelihood of belonging to a higher psychological resilience class.

Within this clinical sample, psychological resilience in patients with brain glioma exhibited distinct heterogeneous stratification, with systematic differences in psychological status and social support across latent classes. The identification of resilience subtypes may help clinicians recognize patients who require further psychosocial assessment and may inform the development of stratified psychological support strategies. However, prospective longitudinal and interventional studies are needed to determine whether subtype-based interventions can improve psychological adaptation.

To characterize the association between reported human papillomavirus (HPV) genotype detection patterns with cervical lesion burden and to assess variation by region, year, age, reported prior screening history, and diagnostic category in a province-wide cervical cancer screening program in Guangdong, China.

We conducted a screening program-based cross-sectional study using 1,291,583 individual-level screening records collected during 2017-2022. Aggregate lesion data from Guangzhou, Dongguan, and Zhongshan supplemented city- and region-level lesion analyses. Genotype-specific analyses included 1,244,766 records with genotype-level results. Joinpoint regression and adjusted generalized linear models were used to assess temporal and age-related patterns. Sensitivity analyses retained only the earliest eligible record for each identifiable woman.

High-risk HPV was detected in 63,004 records (4.88%). Low-grade squamous intraepithelial lesions (LSIL), high-grade/microinvasive cervical lesions, and cervical cancer were recorded in 11,106 (0.86%), 6,633 (0.51%), and 382 (0.03%) records, respectively. The cities with the highest pooled proportions differed across lesion categories. Overall low-risk and high-risk HPV positivity showed significant positive annual percentage changes of 19.21 and 8.05%, respectively, whereas no individual high-risk genotype changed significantly. High-risk HPV positivity was highest in Northern Guangdong (5.6%), and HPV16 was the most frequently reported genotype in all four regions. Compared with participants aged <45 years, those aged ≥65 years had adjusted relative risks of 1.52 (95% CI, 1.22-1.91) for high-grade/microinvasive cervical lesions, 5.02 (2.43-10.35) for cervical cancer, and 1.51 (1.39-1.63) for high-risk HPV positivity. Age-related differences in severe lesions were more evident among records with no prior screening reported. The detection proportion of HPV16 increased from 28.6% in LSIL to 50.0% in high-grade/microinvasive cervical lesions and 69.3% in cervical cancer. HPV18 ranked second in cancer (18.3%), whereas HPV52 and HPV58 were more frequent in LSIL and high-grade/microinvasive lesions.

This province-wide screening study linked reported HPV genotype patterns with cervical lesion burden and identified uneven disease burden across Guangdong, a higher burden of severe cervical lesions among older participants with no prior screening reported, and distinct genotype-specific detection patterns across lesion grades. These findings support locally adapted screening and follow-up strategies that prioritize high-burden regions, under-screened older women, and genotype-informed follow-up of HPV-positive women.

The lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) lie deep in the right central compartment. Clearing them is technically demanding and adds to the risk of injury to the nerve and parathyroid glands, whereas occult metastases left behind may cause persistent or recurrent disease. Knowing in advance which patients are likely to have LN-prRLN metastasis would help tailor the extent of central neck dissection.

We retrospectively reviewed 320 patients with papillary thyroid carcinoma (PTC) treated at a single tertiary center between August 2021 and February 2026, all of whom underwent thyroidectomy with right central neck dissection that included separate LN-prRLN harvesting. Candidate clinicopathological variables were screened by univariable logistic regression; non-redundant binary variables with P<0.05 then entered a multivariable Firth penalized-likelihood model, used because a single event among the 166 central-node-negative patients biased the ordinary maximum-likelihood estimate. The independent predictors formed a nomogram, internally validated by 1,000 bootstrap resamples that repeated the entire model-building procedure, and was assessed for discrimination, calibration (including the optimism-corrected calibration slope and the Hosmer-Lemeshow test) and clinical utility (decision curve analysis, DCA).

LN-prRLN metastasis was present in 51 of 320 patients (15.9%). Multifocality (odds ratio [OR] 4.46), tumor diameter >10 mm (OR 2.87), isthmic/near-isthmic location (OR 6.28), central lymph node metastasis (OR 49.15) and lateral lymph node metastasis (OR 13.90) were independent predictors (all P<0.05), whereas capsular invasion was not retained (P = 0.286). The resulting nomogram reached an area under the receiver operating characteristic curve of 0.936 (95% confidence interval 0.901-0.971; optimism-corrected 0.927), with a sensitivity of 0.843 and a specificity of 0.896 at the optimal cutoff of 0.226. Calibration curves lay close to the ideal line (optimism-corrected calibration slope 0.961, intercept -0.024; Hosmer-Lemeshow P = 0.285), and DCA showed a positive net benefit across the clinically plausible range of threshold probabilities.

A nomogram combining multifocality, tumor size, isthmic location, and central and lateral compartment metastasis predicted LN-prRLN metastasis with high discrimination and acceptable internal calibration. Intended for use with preoperative, imaging-based assessment of nodal status, the nomogram requires external validation, ideally multicenter and prospective, before routine use. It should be emphasized, however, that central and lateral nodal status - the two strongest predictors - were coded from the final histopathological report, and because the sensitivity of preoperative ultrasound and contrast-enhanced computed tomography for central compartment metastasis is limited, the performance reported here is an upper bound on what can be expected when the nomogram is used with imaging-based inputs.

China has rapidly expanded its diagnosis-related group (DRG)-based payment reform; however, evidence primarily focuses on urban pilots or specific disease cohorts. There is limited understanding of how DRG implementation affects out-of-pocket (OOP) spending, cost composition, and resource utilization among older adults treated in county-level referral hospitals.

We conducted a retrospective interrupted time series study utilizing administrative inpatient data from a tertiary county-level referral hospital in eastern China. From July 1, 2021, to July 31, 2025, we identified 154,744 admissions among adults aged ≥60. The outcomes assessed included total costs, out-of-pocket costs, drug costs, material costs, examination/laboratory costs, and length of stay (LOS). The primary analysis used admission-level segmented regression with standard errors clustered by calendar month. Supplementary analyses used monthly aggregated models with Newey-West standard errors and exploratory disease-group heterogeneity analyses.

In the adjusted admission-level interrupted time series models, the implementation of DRG was associated with an immediate reduction in OOP costs (β ₂ = -1360.617 CNY) and a more pronounced negative trend post-implementation (β ₃ = -106.705 CNY per month). LOS experienced an immediate increase (β ₂ = 0.831 days) and continued to rise in comparison to the pre-implementation trend (β ₃ = 0.077 days per month). Total-cost findings differed by the analytical level: no statistically significant immediate or slope change was observed in the admission-level model (β₂ = -84.683 CNY; β₃ = 34.844 CNY/month), whereas the monthly aggregated model showed an immediate decrease (β₂ = -851.064 CNY) followed by an upward post-intervention slope change (β₃ = 75.090 CNY/month). Changes in total costs and most cost components were not consistent across different model specifications. Monthly aggregated analyses indicated directionally similar results for OOP costs and LOS. Disease-group analyses revealed that reductions in OOP costs were more substantial for neoplasms, digestive diseases, and circulatory diseases, while increases in LOS were primarily observed in certain circulatory and respiratory conditions.

Among older adult inpatients in a county-level referral hospital in China, DRG-based payment reform was associated with lower patient OOP but longer hospital stays. Its effects on total spending and cost composition were less consistent and varied across disease groups.

The aim of the study was to test the effect of time to nephrectomy (TTN) >3 months on cancer-specific mortality (CSM) in localized renal cell carcinoma (RCC) according to histological subtype (clear-cell, papillary and chromophobe RCC).

Within the Surveillance, Epidemiology and End Results database (SEER; 2004-2020) we identified 18,056 T1b-2 N0 M0 RCC patients treated with nephrectomy. After propensity score matching (PSM), multivariable competing risks regression (CRR) models addressing CSM were fitted.

TTN >3 months was recorded in 2194 (15.8%) of 13,879 clear cell, in 576 (21.7%) of 2656 papillary, and in 217 (14.8%) of 1521 chromophobe RCC patients. The proportion of TTN >3 months increased significantly over time in all three histological subtypes (all P<0.01). After PSM, 60-month CSM rates for TTN >3 vs. ≤3 months were 8.2 vs. 5.9% in clear-cell RCC, which resulted in 1.36-fold higher CSM in multivariable CRR (P<0.001). Conversely, TTN >3 vs. ≤3 months was not related to absolute or relative CSM differences in papillary (5.5 vs. 5.2%, HR: 1.17, P=0.4) and chromophobe RCC (2.3 vs. 2.8%, HR: 0.84, P=0.7).

The proportions of TTN >3 months increased over time across all histological subtypes. However, only in clear-cell RCC, TTN >3 months was associated with higher CSM rates. In consequence, TTN >3 months should be avoided in clear-cell RCC or in all nephrectomy candidates if histological subtype is unknown. Broader use of renal mass biopsy for preoperative distinction of RCC subtypes may help prioritize surgical timing when triage or postponement is necessary.

Current evidence demonstrates that simultaneous surgical management of bladder cancer (BCa) and bladder outlet obstruction (BOO) is oncologically safe, despite well-known concerns. This systematic review and meta-analysis primarily evaluates oncological outcomes of concurrent transurethral resection of bladder tumor (TURBT) and BOO surgery compared to TURBT alone or staged treatments; perioperative safety is descriptively summarized.

A systematic search of PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted from January 2000 to March 2026. Included were NMIBC and BOO surgical studies comparing simultaneous versus staged/control management. Pooled RR and HR were estimated using a random-effects model. Methodological quality was assessed using RoB 2 and ROBINS-I. Publication bias was assessed using funnel plots and Egger's weighted regression test.

Ten studies involved 1401 patients. Compared to the control group, simultaneous surgery was significantly associated with a reduced bladder tumor recurrence risk (pooled RR: 0.80; 95% CI: 0.70-0.91; P=0.001), with low heterogeneity (I²=7%). There were no significant differences in disease progression to stage ≥T2 (RR: 0.74; P=0.22), site-specific recurrence in the bladder neck and prostatic fossa (RR: 0.75; P=0.45). Time-to-recurrence analysis demonstrated similar oncological timeframes for both methods (pooled HR: 1.22; P=0.13). Cohorts are mostly retrospective, randomized controlled trials are limited, and surgical methods vary.

Our analysis demonstrates that simultaneous surgery is not only oncologically safe but also appears to be associated with a lower risk of recurrence. Reducing obstruction may improve bladder dynamics and lower urothelial exposure to urine carcinogens, suggesting that, alongside its established surgical safety, this approach should also be considered for its potential oncological benefits.

Penile cancer (PC) is a rare malignancy with significant geographic variability in its incidence and clinical management. In the absence of large-scale trials, international guidelines serve as primary tools for therapeutic decision-making. This review aims to systematically compare current recommendations and methodological quality across three major guidelines - EAU-ASCO (2025), NCCN (2025), and ESMO (2024) - focusing on treatment strategies for primary tumors, lymph node management, systemic therapy, and follow-up protocols.

A structured comparative analysis was conducted using a predefined protocol. Guideline content was independently reviewed by two uro-oncology experts across four domains. The strength of recommendation (SoR) and level of evidence (LoE) were extracted when available. Methodological rigor was evaluated using the AGREE II instrument, with two independent reviewers scoring 23 items across six domains. Domain scores were standardized and categorized as high (>70%), moderate (50-70%), or low quality (<50%). All the disagreements were solved by a senior reviewer.

There was substantial concordance in early-stage tumor management and the use of platinum-based chemotherapy for advanced diseases. However, discrepancies emerged in surgical margins, lymph node evaluation thresholds, and second-line systemic therapy. Follow-up strategies varied widely in structure and comprehensiveness. AGREE II appraisal revealed marked differences in guideline development quality: EAU-ASCO scored highest across all domains, followed by NCCN and ESMO. Limitations include exclusion of regional guidelines and heterogeneity in evidence grading systems.

International PC guidelines align on core principles; however, notable divergences persist due to evidence gaps and regional practices. Evaluating both clinical content and development quality enhances understanding of guideline credibility and applicability.

Cachexia is a multifactorial muscle wasting syndrome and is responsible for 20%-40% of cancer-related deaths, yet no FDA-approved therapies exist. Preclinical studies suggest that metastatic bone disease may contribute to muscle wasting, but this relationship has not been evaluated in clinical populations. This study evaluated whether metastatic bone disease at diagnosis is associated with longitudinal skeletal muscle loss and whether metastatic bone disease and longitudinal skeletal muscle loss are associated with overall survival in patients with kidney cancer.

A total of 293 patients (66.9% male, 33.1% female, median age 60 years) were retrospectively identified with either localised kidney cancer, extraosseous metastatic disease, or osseous metastatic disease at diagnosis. Clinical and demographic variables and treatments were recorded. Body composition was quantified over time for a subset by body mass index (BMI) (N = 221) and CT analysis at the L3 vertebral level (N = 99). Longitudinal changes were analysed using linear regression, and overall survival was assessed with Kaplan-Meier and multivariable Cox proportional hazards models.

Patients with osseous metastatic disease had a reduction in BMI over time compared with those with localised or extraosseous metastatic disease (median of -3.6% per year, compared with +0.7% and -2.6% respectively, p < 0.01). Skeletal muscle loss was greatest for those with osseous metastasis (-7.5% per year, compared with -0.8% and -1.2% respectively, p < 0.01). Multivariable linear regression demonstrated osseous metastasis at diagnosis was strongly associated with muscle loss (β coefficient of -20.9 [95% confidence interval (CI): -35.56 to -6.27]). In multivariable Cox regression analysis, osseous metastasis at diagnosis was associated with an increased risk of death (HR 15.8; 95% CI: 2.00 to 124.95; p < 0.01), as was longitudinal skeletal muscle loss (HR 1.02 for each 1% loss per year; 95% CI: 1.01 to 1.04; p < 0.01).

This study provides the first clinical evidence that metastatic bone disease is strongly associated with skeletal muscle loss and reduced survival in kidney cancer patients. These findings extend prior preclinical observations into the clinical setting and support further investigation into the possibility that tumour-bone-muscle interactions drive systemic muscle wasting. Importantly, the observation that severe muscle loss is strongly associated with mortality in kidney cancer highlights the need to consider cachexia as a modifiable determinant of outcomes, not just a byproduct of advanced disease.

Pegaspargase-related severe acute pancreatitis (SAP) combined with persistent multiple organ dysfunction syndrome (MODS) is a life-threatening adverse reaction in children receiving acute lymphoblastic leukemia (ALL) chemotherapy. Standard intensive supportive care often fails to halt progressive organ damage, while clinical data regarding therapeutic plasma exchange (TPE) as a rescue intervention in pediatric populations remain scarce. Guidelines released by the American Society for Apheresis (ASFA) do not recommend routine TPE administration for all patients diagnosed with acute pancreatitis.

This retrospective analysis describes a 7-year-old female patient newly diagnosed with B-cell precursor ALL, who developed SAP and refractory MODS 48 h after pegaspargase infusion. SAP diagnosis complied with the 2012 Revised Atlanta Classification, and MODS severity was quantified using the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scoring system. After 24 h of maximum standardized supportive care failed to reverse clinical deterioration, a single standardized TPE session was implemented. A chronological care timeline and serial laboratory biomarker table were constructed to quantify the dynamic therapeutic response of the patient.

Non-invasive ventilation was applied to relieve intractable respiratory distress; invasive mechanical ventilation and vasopressor support were unnecessary throughout hospitalization. Severe epigastric pain disappeared within six hours after TPE, and respiratory support was successfully withdrawn 24 h post-intervention. Significant declines in pancreatic enzyme levels, extreme hypertriglyceridemia and systemic inflammatory mediators were observed, alongside full recovery of respiratory, renal and hematologic organ function. No adverse events linked to apheresis occurred during treatment. The patient recovered completely from pancreatitis, resumed scheduled maintenance chemotherapy, and maintained minimal residual disease (MRD)-negative hematologic remission at the 3-month outpatient follow-up. Clinical improvement was mainly attributed to extracorporeal clearance of triglycerides and pro-inflammatory cytokines; due to the pharmacokinetic characteristics of pegaspargase at 48 h post-administration, the removal of this chemotherapeutic agent via TPE was negligible.

Single-session TPE can rapidly reverse refractory MODS triggered by pegaspargase-induced SAP when conventional supportive treatments show no efficacy. Nevertheless, complete clinical recovery cannot be solely attributed to apheresis, as continuous multi-organ supportive management was provided throughout the treatment course. TPE can be regarded as a targeted rescue strategy for carefully selected critically ill pediatric patients, yet existing meta-analyses and ASFA consensus statements do not support its universal routine use. Large-scale prospective pediatric cohort studies are required to determine the optimal timing and treatment cycles of TPE.

Clinical and genomic data of patients with EGFR-mutant NSCLC were collected from publicly available cBioPortal cohorts. Cohort composition, stage availability, recurrent co-mutations, and study-origin heterogeneity were evaluated. Patients harboring EGFR Del19 or L858R mutations and available survival information were included for survival analyses. Genomic landscapes were analyzed using a standardized Del19/L858R survival cohort. Survival outcomes were evaluated using Kaplan-Meier curves and Cox regression models, including sensitivity analyses adjusted for study origin and available tumor stage. Co-mutation burden and TP53/ATM-defined DDR-related alterations were further assessed as exploratory prognostic features.

A total of 1,024 EGFR-mutant NSCLC patients were identified. Among them, 844 patients harbored Del19 or L858R mutations. Among the 844 patients with EGFR Del19 or L858R mutations, 820 had complete survival information and were included in survival analyses (Del19, n = 429; L858R, n = 391). An apparent OS difference was observed between Del19 and L858R tumors in the pooled cBioPortal cohort; however, this association was attenuated after accounting for study-origin heterogeneity and was therefore interpreted as exploratory. TP53 mutation was the most robust adverse prognostic factor and remained independently associated with inferior survival after adjustment for study origin. PIK3CA mutation also remained associated with poorer OS in the study-origin-adjusted model, whereas EGFR subtype and CDKN2A mutation were not retained as independent prognostic factors after accounting for study-level heterogeneity. Increasing co-mutation burden was associated with progressively shorter OS. TP53/ATM-defined DDR-related alterations were associated with inferior OS in exploratory analysis, but this result was largely driven by TP53 because ATM-only alterations were rare and not significantly associated with OS.

Our study demonstrates that prognosis in EGFR-mutant NSCLC is strongly influenced by broader genomic context, particularly TP53 mutation and overall co-mutation burden. EGFR subtype-specific survival differences and TP53/ATM-defined DDR-related findings should be interpreted cautiously because of study-origin heterogeneity, incomplete clinical annotation, and the limited DDR gene definition.