Sleep disturbance ("insomnia") is common in patients with advanced cancer receiving specialist palliative care. The aim of this scoping review was to determine the clinical relevance of sleep disturbance in this cohort of patients.

Standard methodology was employed, and four databases were searched from inception (Medline, CINAHL, Embase, and APA PsycInfo). Hand searching of relevant sources was also undertaken. Included studies needed to have a sleep focus, and to utilise a validated sleep assessment tool (and/or objective measure of sleep quality).

Sixteen studies met the criteria for inclusion. The studies highlight that sleep disturbance is associated with a range of physical symptoms (e.g. fatigue, drowsiness), a variety of psychological problems (e.g. anxiety, depression), impaired quality of life, and reduced overall survival.

Sleep disturbance is an "orphan" symptom, and the results of this scoping review suggest that it deserves much greater attention. Indeed, healthcare professionals should screen all palliative care patients for the problem and, when identified, perform a thorough assessment and initiate an appropriate treatment.

Cancer-related fatigue (CRF) is one of the most common side effects of cancer treatment, yet there is little consensus on best non-pharmacologic practices to manage this debilitating side effect. The purpose of this study was to describe current non-pharmacologic practice patterns for managing CRF and barriers to rehabilitation.

An electronic survey, developed by the authors using the CHERRIES checklist, was piloted via REDCap™ by nine participants. Data collected included demographics, clinical experience, frequency (none of the time, some of the time, and all of the time) of 15 common non-pharmacologic CRF interventions derived by expert consensus, effectiveness of interventions, and barriers to care for CRF. The survey took approximately 7 min to complete and was distributed via emails or flyers to cancer support groups, listservs, recruitment flyers, and word of mouth. All analyses were descriptive, including frequencies and percentages, and were performed using Microsoft Excel.

One hundred ninety-seven rehabilitation providers completed the survey: physical therapy (60%), occupational therapy (20%), speech-language pathology (9%), and exercise physiology (5%). All disciplines indicated frequently applying more than one of the following within their CRF interventions: therapeutic activities (78%), aerobic/strengthening/flexibility exercise (73.1%), energy conservation strategies (57.4%), and self-management education (48.2%). All professions measured the effectiveness of their fatigue interventions using patients' subjective reports (e.g., fatigue severity). Barriers to receiving care were "appointment fatigue" and financial constraints.

When developing CRF clinical practice guidelines, current rehabilitation practice patterns and survivors' barriers to care should be considered along with the highest level of evidence-based interventions.

The purpose was to evaluate the concordance of prostate cancer therapeutic decisions based on in-bore MRI-targeted biopsies (MRI-TB) alone, with decisions based on combined in-bore MRI-TB and systematic US-guided biopsies.

We included male biopsy-naïve patients, aged between 50 and ≤ 75 years, with PSA greater than 4 and/or a pathological digital rectal examination in this single-centre, exploratory, prospective, interventional study. All patients received T2-weighted MRI between November 2022 and May 2024, presenting a single lesion with a positive Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 3. In-bore MRI-TB were carried out with the assistance of a Remote-Controlled Manipulator. A second operator (radiologist), blind to in-bore MRI-TB results, carried out systematic 12-core TRUS-guided biopsies.We evaluated concordance of therapeutic decisions decided in a multidisciplinary team meeting (MDT1) based on in-bore MRI-TB only, with decisions based on the combined biopsies (MDT2, blind to MDT1 decision). ISUP score and cancer detection concordance, and tolerance and acceptability of the procedures were evaluated.

Fifty patients were included, with average age 63.4 years (SD 6.9). Therapeutic strategies were aligned for 43 patients, with a weighted Cohen's Kappa of 0.81 [95%CI 0.67;0.95], within the very good range. ISUP score concordance was very good (0.82 [0.68;0.97]) and cancer detection concordance was strong (0.63 [0.38;0.89]). Pain was higher after TRUS-guided biopsies. Fourteen (28%) patients preferred in-bore MRI-TB and 7 (14%) preferred TRUS-guided and 29 (58.0%) had no preference. No infections were recorded.

MRI-targeted biopsies reduce pain for patients. However, while there was excellent concordance between the two methods for therapeutic decisions and ISUP scores, the lower concordance for cancer detection means that systematic biopsies cannot yet be omitted for prostate cancer diagnosis.

Primary spinal cord tumors (PSCTs) are rare in children, accounting for 2-4% of pediatric central nervous system tumors, with limited data available from low- and middle-income countries (LMICs). Variability in clinical presentation, histopathological patterns, and treatment practices in resource-constrained settings further challenges early diagnosis and optimal management. This study describes the epidemiology, clinical features, histopathology, and treatment outcomes of pediatric PSCTs managed at three major tertiary care centers in Pakistan.

We conducted a retrospective, multicenter review of all children and adolescents diagnosed with PSCTs between January 2010 and December 2024 at three tertiary care cancer hospitals. Demographics, presenting symptoms, MRI features, surgical details, histopathology, and outcomes were extracted using REDCap and analyzed using R version 4.2.0.

Among 47 pediatric patients, the median age at diagnosis was 14 years (IQR 9-16), with a mean symptom duration of 7.5 ± 9.1 months. Most tumors were intradural (97.8%), predominantly intramedullary (63.6%). Limb weakness (80.9%) and back pain (66.0%) were the most common symptoms of presentation. Ependymomas were the most frequent histopathology (36.2%), followed by gliomas (25.5%), including four high-grade gliomas. Of 39 patients who underwent treatment, GTR was achieved in 53.8%, while STR was performed in 30.8%. Surgical complications occurred in six patients, and treatment-related complications occurred in three patients. All patients with high-grade gliomas died during treatment.

This multicenter study provides the most comprehensive pediatric PSCT dataset from Pakistan, highlighting delayed presentations, predominance of intramedullary tumors, and significant histopathological variability. Outcomes remain limited for high-grade tumors, underscoring the need for earlier diagnosis, standardized multidisciplinary care, and strengthened neurosurgical capacity in LMICs.

We report 2 cases of primary hepatic perivascular epithelioid cell tumor(PEComa), treated with laparoscopic partial liver resection. Case 1: A 44-year-old woman who presented with abdominal pain. Abdominal dynamic contrast-enhanced computed tomography(Dy-CT)revealed a low-enhancing liver tumor in both the arterial and venous phases. She underwent laparoscopic partial liver resection of segment 5 for diagnostic and therapeutic purposes. Histopathological examination confirmed the diagnosis of PEComa. Case 2: A 40-year-old woman was found to have a hepatic tumor was during an annual health checkup. Dy-CT demonstrated arterial-phase enhancement of the tumor with early visualization of the hepatic vein adjacent to the tumor. The tumor was preoperatively diagnosed as hepatocellular carcinoma, and laparoscopic partial liver resection of segment 3 was performed. Histopathological examination confirmed the diagnosis of PEComa. Preoperative diagnosis of hepatic PEComa remains challenging due to its rarity. However, early visualization of draining hepatic veins during the arterial-phase may aid in its diagnosis. Surgical resection is generally recommended, as PEComa may exhibit malignant potential in rare cases.

A man in his 50s with a known history of ulcerative colitis under regular surveillance in our gastroenterology department. He presented with right lower quadrant abdominal pain and a sense of abdominal distension. Contrast-enhanced CT revealed a well-circumscribed, mildly enhancing intra-abdominal mass measuring 12×8×13 cm. MRI showed a heterogeneously hyperintense lesion. Differential diagnoses included gastrointestinal stromal tumor(GIST)and other mesenteric tumors. For definitive diagnosis and treatment, an open surgical resection was performed. The tumor originated from the mesentery of the terminal ileum and was adherent to the descending portion of the duodenum. Ileocecal resection and wedge resection of the duodenum were performed, and the tumor was excised. Histopathological examination confirmed the diagnosis of an intra-abdominal desmoid tumor arising from the mesentery.

A 77-year-old man was referred for treatment of a type 3 lesion located on the greater curvature of the gastric angle, which was detected by esophagogastroduodenoscopy. CT imaging showed no evidence of lymph node metastasis or distant metastases; and the clinical stage was cT2N0M0, cStage Ⅰ. The patient had a complex surgical history, including radical cystectomy with ileal conduit creation for invasive bladder cancer, followed by emergency surgeries for rectal perforation, which was managed with peritoneal lavage and drainage, and sigmoid colostomy. He also had another emergency surgery for perforation of sigmoid colon. Negative pressure wound therapy and subsequent skin grafting were performed for abdominal closure. Comorbidities included variant angina, asthma, and restrictive pulmonary dysfunction. Due to anticipated extensive adhesions, the limited access to the abdominal cavity, and the patient's poor ADL, a standard gastrectomy was not feasible. Local gastrectomy with limited lymphadenectomy was successfully performed. Pathology revealed adenocarcinoma, pT3N0M0, pStage ⅡA. The patient recovered without major complications. This case highlights the feasibility of performing local gastrectomy in high-risk patients with limited surgical access.

The patient was a 70-year-old male with highly advanced gastric cancer, 2 liver metastases(S3 and S8), and pancreatic invasion. Three courses of S-1+L-OHP(SOX therapy)were administered as conversion surgery chemotherapy, and total gastrectomy and combined resection of the body and tail of the pancreas and spleen and partial resection of the liver(S3 and S8)were performed as conversion surgery. S-1 therapy was continued for 1 year as postoperative adjuvant chemotherapy. A left adrenal metastasis was detected on CT 1 year and 6 months after the operation. PET-CT revealed no other areas suspicious of recurrence; therefore, left adrenalectomy was performed through the retroperitoneal space. Radical resection was not performed because of severe adhesions and scarring from the previous surgery. Paclitaxel+ramucirumab chemotherapy was initiated, and after 10 courses, tumor disappearance was observed on enhanced CT and PET-CT. The re-enlargement was observed 1 year later. The patient underwent re-administration of paclitaxel+ramucirumab, SOX+ nivolumab therapy, and nivolumab monotherapy, but all showed PD on imaging. After 8 courses of CPT-11 monotherapy, CR was again observed on imaging. Five years and 3 months after the initial surgery and 3 years and 8 months after adrenal metastasis resection, the patient was alive and well without recurrence.

A man in his 70s underwent an upper gastrointestinal series during a routine medical check-up, which revealed an abnormality in the stomach. Subsequent investigations, including computed tomography, endoscopy, and pathological examination, confirmed the diagnosis of gastric neuroendocrine carcinoma, a small cell type with multiple synchronous liver metastases(cT3[SE]N1H1PXM0, Stage Ⅳ). Following a comprehensive treatment involving 35 courses of S-1+CDDP chemotherapy, the primary lesion and multiple liver metastases resolved. For the next 8 years, the patient continued maintenance therapy with S-1 alone. The patient has survived for 15 years without recurrence.

Doxorubicin (DOX) chemotherapy for breast cancer is constrained by systemic toxicity and limited tumor selectivity, underscoring the need for polysaccharide-based carriers in which pH responsiveness arises from intrinsic polymer properties rather than chemical modification. In this study, a carbohydrate-centered biomimetic nanocarrier was developed using chitosan as the primary structural and pH-responsive matrix, integrating zinc oxide nanoparticles (ZnO) and carbon quantum dots (CQDs) through a W1/O/W2 double-emulsion process, followed by surface association with bone marrow-derived mesenchymal stem cell (BM-MSC) exosomal membranes. The resulting CS/ZnO/CQDs@DOX nanocarriers exhibited an average hydrodynamic diameter of ∼180 nm, which increased to ∼205 nm after exosome association, accompanied by partial surface charge shielding. Physicochemical analyses supported a predominantly non-covalent assembly without evidence of alteration of the chitosan backbone, yielding a high encapsulation efficiency (88.75 ± 2.1%) and a drug loading of 6.8 ± 0.5 wt%. In vitro studies revealed pronounced pH-dependent doxorubicin release and enhanced cytotoxicity toward MCF-7 cells (IC₅₀ = 0.8 ± 0.1 μM), while maintaining minimal toxicity toward normal cells. Overall, these findings demonstrate that chitosan-driven pH responsiveness, complemented by inorganic components and biomimetic surface camouflaging, provides an effective and chemically conservative strategy for carbohydrate-based drug delivery design.