Intergluteal pilonidal sinus is a common disease among adults, especially males and is related to high morbidity. The rhomboid flap reconstruction for pilonidal sinus is a transposition flap designed to close a 60° rhombus-shaped defect. This rhomboid flap is basically a chain of connecting equilateral triangles with 60° angles. The planning, outlining, and implementation of the rhombus-shaped flap are very challenging and require technical and cognitive skills to avoid any discrepancies and structural problems in flap raising and reconstruction. This can be achieved by introducing a realistic, simulation-based model of pilonidal sinus disease that allows trainees to practise and become familiar with flap measurements and marking, followed by flap elevation and mobilisation. For this research, a prospective design was adopted to evaluate the effect of simulation-based training on surgical performance in Limberg flap reconstruction for pilonidal sinus disease on real patients. The study aimed to determine the effectiveness of simulation-based training in the Limberg flap technique for pilonidal sinus disease using a task trainer. Key Words: Limberg flap, Pilonidal sinus disease, Simulation, Reconstruction, Rhombus.

Liquid biopsy demonstrates clinical utility as a non-invasive tool for discriminating malignant tumours from benign pulmonary nodules, as evidenced by recent research. This systematic review compared the diagnostic performance of current clinical modalities for pulmonary nodules, aiming to generate evidence-based solutions to address the underdiagnosis of malignant nodules and the overdiagnosis of benign lesions. A Bayesian bivariate random-effects model was employed to perform meta-analysis across diagnostic categories, followed by meta-regression and subgroup analyses. Results were visualised using summary receiver operating characteristic curves. Subgroup analysis revealed that liquid biopsy-derived multimodal diagnostic models achieved superior performance (sensitivity: 90.2%; specificity: 83.6%) compared to CT-based evaluation (81.5%, 67.9%) and risk prediction models (68.7%, 70.6%). These findings indicate that multimodal models integrating liquid biopsy, radiological features, and risk prediction significantly outperform single-modality approaches, thereby potentially addressing diagnostic imbalances in pulmonary nodule assessment. Key Words: Liquid biopsy, Pulmonary nodules, Multimodal diagnostic model, Comparative diagnostic test accuracy studies.

To compare the feasibility, safety, and cosmetic satisfaction of ultrasound-guided, indocyanine green (ICG)-assisted robotic lumpectomy with open lumpectomy for benign breast tumours.

A retrospective cohort study. Place and Duration of the Study: Department of Breast Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China, from June to September 2023.

A step-by-step protocol was developed for surgeons to guide ultrasound-guided ICG injections for robotic lumpectomy. Clinicopathological characteristics of the patients, intraoperative data, postoperative complications, and aesthetic outcomes were analysed. Continuous variables were compared using an independent-samples t-test if they were normally distributed; otherwise, the Mann-Whitney U test was used. Categorical variables were compared using a chi-square test or a corrected chi-square test.

A total of 68 patients treated concurrently were included in the study; of whom, 30 underwent a robot-assisted local tumour excision through an axillary incision, while 38 had their tumour excision through a standard open incision over the breast. Operation time was significantly longer in the robotic group (96.0 vs. 42.5 minutes; p <0.001). No significant intergroup difference was found in postoperative complications. Patients who underwent robotic surgery achieved significantly higher rates of the highest level of satisfaction with the wound site (96.7% vs. 52.6%; p <0.001), scar appearance (93.3% vs. 71.1%; p = 0.020), and overall breast look (86.7% vs. 60.6%, p = 0.017).

This surgical approach, using ICG injection and ultrasound guidance, provides a potentially feasible and safe method for tumour localisation during robotic lumpectomy.

Aesthetic outcome, Breast surgery, Indocyanine green, Robot-assisted surgery, Ultrasound-guidance.

To compare operative performance and perioperative outcomes between two-dimensional (2D) and three-dimensional (3D) laparoscopic systems in minimally invasive adrenalectomy.

An observational study. Place and Duration of the Study: Department of Surgical Oncology, Mersin City Training and Research Hospital, Mersin, Turkiye, from January 2023 to November 2025.

Patients who underwent laparoscopic adrenalectomy performed by a single surgeon were retrospectively evaluated. The 2D and 3D laparoscopic systems were compared in operative time, estimated blood loss, tumour size, postoperative complications, conversion to open surgery, and length of hospital stay. Continuous variables were analysed using the independent samples t-test or the Mann-Whitney U test according to the data distribution. Categorical variables were compared using the chi-square or Fisher's exact test. A p-value of <0.05 was considered statistically significant.

A total of 41 patients were included (3D: n = 22; 2D: n = 19). The 3D group demonstrated significantly shorter operative time [62.5 (60-75) vs. 100 (85-120) minutes; p <0.001], lower intraoperative blood loss [20 (18-20) vs. 200 (100-300) mL; p <0.001], and shorter hospital stay [2 (2-3) vs. 4 (3-7) days; p <0.001]. Tumour size was smaller in the 3D group, although the difference was not statistically significant [40.5 (32-47) vs. 50 (39-70) mm; p = 0.069]. Postoperative complication rates were similar between groups.

3D laparoscopic adrenalectomy may improve operative performance and perioperative outcomes compared with conventional 2D laparoscopy. However, the retrospective design and relatively small sample size require cautious interpretation of the findings, and larger prospective studies are needed.

Laparoscopic adrenalectomy, Three-dimensional laparoscopy, Adrenal tumours, Minimally invasive surgery, Surgical outcomes.

The aim of the present study was to compare patient satisfaction after robot-assisted radical prostatectomy (RARP) between transverse and vertical camera port incisions, as assessed by wound pain and camera port-related health-related quality of life.

This prospective observational study included 100 consecutive patients who underwent RARP, divided into a transverse incision group (n = 57) and a vertical incision group (n = 43). The primary outcome measure was incisional pain at the camera port used for specimen extraction on postoperative Day 7. Secondary outcome measures included wound satisfaction, particularly at the camera port, assessed using the Derriford Appearance Scale (DAS-59).

The number of patients who reported wound pain on postoperative Day 7 was significantly higher in the transverse group (n = 11, 19.2%) than in the vertical group (n = 1, 2.3%) (p < 0.001). There was no significant difference in total DAS-59 scores between the two groups (p = 0.44). Multivariate logistic regression analysis identified body mass index (odds ratio [OR], 9.5; 95% confidence interval [CI], 1.5-188.8; p < 0.01) and incision type (OR, 11.1; 95% CI, 1.7-219.7; p < 0.007) as factors independently associated with wound pain.

In RARP, vertical camera port incisions were associated with less postoperative wound pain and comparable wound satisfaction during the early postoperative period. From the perspective of surgical invasiveness, a vertical camera port incision may therefore be recommended for RARP.

People with intellectual disability (ID) experience significant health inequities, yet evidence on their participation in cancer screening and access to preventive care remains fragmented. Conducted within the EUCanScreen Joint Action, this scoping review synthesised global evidence to characterise the current landscape of cancer screening for people with ID and identify approaches to support more inclusive screening practices.

Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, we systematically searched MEDLINE, Embase, and Web of Science (2013-2024) for qualitative, quantitative, and mixed-methods studies, supplemented by grey literature. Eligible studies examined participation, barriers, facilitators, or interventions related to six cancers prioritised in European screening policy: breast, cervical, colorectal, prostate, gastric, and lung. Perspectives of people with ID, caregivers, and health care professionals were included. Data were charted and synthesised descriptively, including pathway-based mapping of barriers and facilitators, narrative and visual summaries of screening uptake, and narrative synthesis of intervention studies.

Of 4,387 records screened, 78 met the inclusion criteria. Most studies addressed breast cancer screening (n = 53), cervical screening (n = 44), and colorectal cancer screening (n = 25), which benefit from long-standing organised screening programmes in many countries. In contrast, evidence on prostate cancer screening (n = 3) and gastric cancer screening (n = 1) was sparse, and no studies examined lung cancer screening, reflecting the far more limited implementation of organised screening for these cancers during the study period. Across contexts, people with ID consistently showed lower participation than the general population. Barriers included fear, inaccessible information, and insufficient provider training, while facilitators involved trusted accompaniment, accessible communication, and tailored examination settings. Intervention studies were scarce but suggested potential for educational, organisational, and tailored support strategies to improve accessibility, preparedness, and participation.

Persistent, multi-level barriers hinder equitable cancer screening for people with ID. Tailored, person-centred screening pathways, improved provider education, and enhanced data systems are needed. Coordinated national and EU-level initiatives, such as EUCanScreen, are vital for structural improvements. Future research should prioritise multicomponent intervention development, pathway-level accessibility, and the inclusion of underrepresented groups to strengthen equity in cancer prevention.

Acute myeloid leukemia (AML) is predominantly a disease of older patients with a poor long-term survival. Approval of the combination of venetoclax (VEN) with azacitidine (AZA) or decitabine (DAC) in the European Union in 2021 for the treatment of patients with newly diagnosed AML who are ineligible for induction chemotherapy has become the treatment backbone for older, medically non-fit AML patients. Based on in vitro priming of AML cells to all-trans retinoic acid (ATRA) by DAC, we had previously conducted a randomized phase II trial (DECIDER, AMLSG 14 - 09) in 200 elderly, non-fit AML patients on the effect of ATRA as add-on to DAC. Median overall survival (OS) was 8.2 months with ATRA versus 5.1 months without ATRA (hazard ratio, 0.65; 95% CI, 0.48 to 0.89; P = 0.006). Notably, ATRA did not add toxicity, the combination was active also in patients with adverse genetics, and prolonged time to treatment resistance. Investigating a triple combination of DAC, VEN and ATRA was a logical next step. This randomized double-blind phase III trial compares the efficacy of ATRA versus placebo as add-on to the backbone treatment (DAC and VEN) with respect to OS, objective best response, quality of life and safety. The accompanying translational research will contribute to identify molecular markers for drug efficacy and better tailoring epigenetic therapy.

DECIDER-2 (AMLSG 32 - 21) is a prospective, randomized, double-blind, placebo-controlled, parallel group, multicenter trial. The primary study objective is to compare the efficacy of ATRA versus placebo as add-on to the backbone treatment (DAC and VEN) in terms of OS. The target population is adult AML patients unfit for standard induction chemotherapy. Patients are randomized (1:1) to receive backbone treatment in combination with either ATRA or placebo. Four interim safety analyses were planned with the involvement of the Data Monitoring Committee.

This trial investigates whether the in vitro cooperativity of DAC, VEN, and ATRA prolongs OS in unfit AML patients compared to placebo, offering a novel, low-toxicity triplet combination with a promising risk-benefit ratio.

EU CT number: 2020-005495-36/2023-507461-26-00 (registered 18.11.2020); German clinical trials registry number: DRKS00023646 (registered 23.08.2022).

Quantum dots (QDs) are semiconductor nanoparticles ranging in size from 2 to 10 nm. QDs are increasingly being developed for biomedical imaging, targeted drug delivery, and green energy technology. Here, we describe the novel utilization of biocompatible (CdSe)/ZnS core/shell semiconductor nanoparticles for assessment of reactive oxygen species (ROS) in the context of chemotherapy and radiotherapy, both of which are important modalities in the treatment of cancer. Computational simulations done using COMSOL Multiphysics confirm some of the properties of the QDs used in the described experiments.

Patients with limited life expectancy (LE) are often excluded from oncology trials based on subjective judgment, posing a challenge when contextualizing trial findings with real-world data (RWD). This study evaluated the feasibility of modeling mortality in RWD for relapsed/refractory multiple myeloma (RRMM) to replicate patient exclusion (LE < 6 months) for application in an external control arm study.A targeted literature review (TLR, January 2016-March 2022) was performed to identify mortality prediction models in RRMM. Because no suitable model was found, a de novo mortality model was developed using the COTA database.Twenty-one prognostic factors identified via literature review and clinical experts were included in the models. Cox proportional hazards models with bootstrap validation to correct for optimism were used to identify the best-performing model. A threshold of ≥50% predicted mortality probability within 6 months of the start of the line of therapy (LOT) was used for sensitivity and specificity estimates.Patients (N = 1,112) contributed 2,626 LOTs. A model with the top 20 prognostic factors maximized concordance and accuracy while achieving pre-specified performance thresholds, except for the F1 score. The predicted and observed 6-month mortality probability were both 26%.Mortality prediction for RRMM remains challenging with RWD. The de novo model exhibited strong discrimination performance but low F1 score, suggesting it may be useful to identify patients at highest risk who may be least likely to meet trial LE criteria.

Childhood medulloblastoma (MB) survivors face elevated second primary malignancy (SPM) risk because of multimodal treatment. Prior studies were limited by small samples, older data, and methods that ignored competing risks. We aimed to quantify SPM risk using contemporary SEER data and competing risk methodology.

Using the SEER 17 registries database (2000-2023), we identified 1806 patients diagnosed with MB at ages 0-19 years. Standardized incidence ratios (SIRs) were calculated using the MP-SIR module. Cumulative incidence functions (CIFs) were estimated within a competing risk framework, with non-SPM death as the competing event. Fine-Gray regression was fitted to identify independent predictors of SPM, yielding subdistribution hazard ratios (sHRs).

Of 1806 MB patients, 104 (5.8%) developed SPMs over a mean follow-up of 111 months. The overall SIR was 21.87 (males) and 20.78 (females). The most frequent SPM types were brain/central nervous system tumors (n = 26; SIR = 63.64), thyroid cancer (n = 23; SIR = 75.17 in males), and leukemia (n = 19; SIR = 25.60), with acute myeloid leukemia exhibiting SIRs of 99.41-100.95. On Fine-Gray regression, more recent diagnosis era was the only factor statistically associated with SPM occurrence; compared with 2000-2005, sHRs were 1.72 (95% CI 1.05-2.83; P = 0.031) for 2012-2017 and 2.28 (95% CI 1.04-5.01; P = 0.039) for 2018-2023. This era association should be interpreted cautiously, as it is likely driven by longer follow-up, more intensive surveillance, and declining competing mortality in recently diagnosed cohorts rather than a true increase in the underlying biologic risk of SPM; similarly, the null associations for radiation therapy and chemotherapy do not exclude a true effect, given the limited treatment detail available in SEER. Among 5-year survivors, cumulative SPM incidence surpassed non-SPM death beyond 15 years. Mortality after SPM diagnosis was 51.9%.

Childhood MB survivors face a substantially elevated SPM risk persisting beyond two decades. Brain tumors, thyroid cancer, and therapy-related leukemia predominate. These findings support lifelong surveillance incorporating thyroid screening, neuroimaging, and hematologic monitoring for MB survivors.