With the rising incidence of hematologic malignancies (HMs) in recent years, caregivers of HMs patients have increasingly emerged as a significant factor affecting the treatment of these conditions. This study aimed to explore the association of coping strategies on the relationship between care burden and social support among family caregivers of HMs patients.

A questionnaire survey was conducted involving 207 family caregivers of hospitalized HMs patients in a tertiary hospital in Dalian from October 2023 to May 2024 and 200 valid responses were collected. We used hierarchical linear regression and parallel mediation model to assess the relationships and potential mediating effects among care burden, coping strategies, and social support.

In our study, the care burden showed a medium level and average score was 44.21 ± 15.92. Positive coping strategies (r =  - 0.769, P < 0.01) and social support (r =  - 0.654, P < 0.01) showed a negative correlation with care burden, while negative coping strategies was significantly correlated with care burden (r = 0.788, P < 0.01). According to the mediating effect analysis after covariate adjustment, the relationships between social support and care burden were mediated by coping strategies in total samples and the indirect effect value was -0.955, accounted for 73.57% of the total effect.

Family caregivers of HMs patients with more negative coping strategies and less social support were significantly associated with higher levels of care burden. Coping strategies served as a partial parallel mediator between social support and care burden.

To evaluate the association between high Anti-Müllerian Hormone (AMH) levels and key outcomes of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) in women with Polycystic Ovary Syndrome (PCOS).

A systematic search was performed in MEDLINE (via PubMed), Web of Science, and Scopus, on September 17, 2024.

We included observational studies in PCOS patients stratified by AMH levels that reported any of the IVF/ICSI outcomes of interest, namely: live birth rate, clinical pregnancy rate, miscarriage rate, oocytes retrieved, MII oocytes and fertilization rate.

Two reviewers independently extracted data and assessed risk of bias using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool. Discrepancies were resolved by consensus. Data were pooled using meta-analysis when appropriate. Sensitivity analyses were conducted using a leave-one-out approach.

Thirteen studies met the inclusion criteria. Ten were rated as low risk of bias, two as unclear, and one as high risk, indicating overall fair to strong methodological quality. Women with high AMH levels had a lower live birth rate (odds ratio [OR]: 0.85; 95%CI: 0.71-1.02), which became significant after leave-one-out analysis (OR: 0.80; 95%CI: 0.64-0.99). Clinical pregnancy rates were 2% lower in women with elevated AMH levels (OR: 0.98; 95%CI: 0.82-1.17). Miscarriage rates showed a non-significant 25% increase in women with high AMH levels (OR: 1.25; 95%CI: 0.88-1.76). High AMH levels were associated with more retrieved oocytes in the overall meta-analysis (mean difference: 3.52; 95%CI: 1.70-5.33), with consistent findings in sensitivity analyses. There was no significant difference in fertilization rate between the two groups.

While high AMH levels indicate greater ovarian reserve, they negatively influence reproductive outcomes in PCOS patients. These findings highlight the need for individualized ART strategies and further research to clarify underlying mechanisms.PROSPERO: CRD42024596056.

Human papillomavirus (HPV) is a leading cause of cervical cancer (CC) worldwide. There is growing interest in the potential role of HPV vaccination as adjuvant measure in patients with active infection. This study aimed to assess whether the nonavalent HPV vaccine (9vHPV) promotes faster disease clearance in women with low-grade (LGD) and high-grade disease (HGD).

Retrospective study including women aged 25-60 years who began follow-up in 2018 at a central Portuguese hospital after referral through organized CC screening. A total of 126 patients with HGD (69 vaccinated, 57 unvaccinated) and 277 with LGD (131 vaccinated, 146 unvaccinated) at baseline were followed with HPV cotesting (HPV test + cervical cytology) at 12, 18, 24, 36, and 48 months. Disease clearance was defined as the first negative cotest result. Kaplan-Meier curves and the Log Rank test were used to compare time to clearance between groups.

Among HGD patients, the vaccinated group showed a shorter mean time to disease clearance (17.4 months; 95% CI: 14.88-19.93) compared to the unvaccinated group (20.2 months; 95% CI: 17.07-23.34), although the difference was not statistically significant (p=0.228). In the LGD group, both vaccinated and unvaccinated patients had similar mean clearance times (25.9 months; 95% CI: 23.44-28.43 vs. 26.9 months; 95% CI: 24.41-29.37), also lacking statistical significance (p=0.637).

Main findings suggest a negligible effect of 9vHPV in significantly reducing time to clearance in patients with active infection. Further research is needed to clarify its role in secondary prevention strategies.

To compare the clinical outcome of women with gestational trophoblastic neoplasia (GTN) treated with the conventional EMA/CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) with those treated with the modified EM/CO regimen.

Brazilian multicenter retrospective cohort study evaluated medical records of women diagnosed with GTN who were treated with the standard EMA/CO or with the modified regimen in which actinomycin-D was suppressed (EM/CO). The primary outcome was the occurrence of remission following chemotherapy treatment.

Remission rate with EMA/CO was 85.3%, with 14.7% of women showing chemoresistance, while with EM/CO, the remission rate was 72.7%, with 27.3% of women chemoresistance, without statistical difference between the groups. A total of 142 women were analyzed, of whom 109 were treated with EMA/CO and 33 received EM/CO. Women who used the EM/CO had higher prevalence of invasive mole (51.5% vs. 14.7%, p<0.0001), lower prevalence of choriocarcinoma (9.1% vs. 26.6%, p=0.035), and lower prevalence of metastases (33.3% vs. 61.5%, p=0.004) compared to women who received the EMA/CO. Women with risk score ≥ 7 had higher prevalence of recurrence (61.5% vs 10.0%, p=0.005) and chemoresistance using the EM/CO (53.8% vs 10.0%, p=0.013) compared to women with score ≤ 6. The pre-treatment serum hCG levels was a moderately significant predictor (AUC: 0.77, 95%CI 0.66-0.88, p<0.0001) for identifying chemoresistance. The number of EM/CO cycles was a strong significant predictor (AUC: 0.81, 95%CI 0.66-0.96, p<0.0001) for identifying toxicity to chemotherapy.

EM/CO had higher prevalence of need for second-line treatment, and chemoresistance.

To translate and culturally validate the VALue of the UteruS (VALUS) instrument in Brazilian Portuguese language and to identify predictors for VALUS score.

A cross-sectional study (February to November 2024) at a tertiary, academic hospital was performed with 164 women presenting symptomatic uterine fibroids (UF) (n=139) or endometrial polyps (n=25) that underwent hysterectomy or myomectomy/polypectomy. The VALUS instrument was translated and culturally validated first. Psychometric variables (internal consistency, test-retest, discriminant validity) were calculated. Women completed the VALUS instrument prior to the decision-making process to undergo surgery. The Uterine Fibroid Symptoms-Quality of Life (UFS-QOL) was also completed for women with UF. Uni- and multivariate linear regression was calculated to seek for associated factors with the VALUS total score.

Women that underwent hysterectomy were older, with higher education, higher parity and frequency of abdominal/pelvic surgeries than the non-hysterectomy group. VALUS scores were statistically higher in the non-hysterectomy for some questions and total score. Internal consistency of the VALUS instrument was excellent (alpha=0.890) and test-retest analysis did not differ between the groups (p=0.891). The UFS-QoL quality of life score presented a negative correlation with VALUS instrument. Multivariate linear regression demonstrated that the presence of abdominal/pelvic surgeries was associated with a lower VALUS score.

VALUS demonstrated adequate internal consistency and reliability, but with low discriminant validity for the prediction of hysterectomy versus uterine-preservation in women with UF or endometrial polyps. Presence of abdominal/pelvic surgery is associated with a lower VALUS score.

Colorectal cancer (CRC) remains a persistent global health challenge, with a rising incidence strongly linked to metabolic dysfunction. Insulin resistance (IR), a hallmark of metabolic dysregulation, is a well-established driver of tumorigenesis and cancer progression. However, the relative predictive value of distinct non-insulin-based surrogate markers of IR for CRC risk assessment remains poorly defined.

This prospective study analyzed data from 385,206 participants in the UK Biobank. Non-insulin-based surrogate markers evaluated included the TyG index, TyG-BMI, the TG/HDL-C ratio, and METS-IR. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CRC. Restricted cubic splines (RCS) assessed dose-response relationships. Incremental predictive value and clinical utility were evaluated via C-index increments and decision curve analysis (DCA). Robustness was verified through extensive subgroup and sensitivity analyses.

Over a median follow-up of 13.8 years, 5,175 incident CRC cases were documented. All four IR surrogates were independently and positively associated with CRC risk (all P < 0.001). In the fully adjusted model, comparing extreme quartiles (Q4 vs. Q1), the HRs (95% CIs) were 1.16 (1.07-1.26) for the TyG index, 1.20 (1.11-1.31) for TyG-BMI, 1.09 (1.01-1.19) for the TG/HDL-C ratio, and 1.21 (1.11-1.32) for METS-IR. RCS revealed significant non-linear relationships for the TyG index and METS-IR, whereas linear trends were observed for the remaining markers in the fully adjusted model. Notably, adding METS-IR and TyG-BMI to the base model yielded the most significant improvements in discrimination (both C-index increments = 0.0015; P < 0.001). Furthermore, DCA confirmed sustained net clinical benefits across practical thresholds. Subgroup analyses revealed significant interactions between the IR surrogate markers and age, sex, and smoking status (P-interaction ≤ 0.05). Multiple sensitivity analyses, including excluding cases diagnosed within the first two years, confirmed the findings' robustness.

Elevated non-insulin-based IR surrogates are robust predictors of CRC risk. The BMI-integrated indices, METS-IR and TyG-BMI, demonstrated superior risk stratification performance. These low-cost, readily available tools may facilitate the early identification of high-risk individuals and inform evidence-based primary prevention strategies.

This case highlights the diagnostic challenges posed by rare oropharyngeal neurofibromas, their potential to mimic other conditions, and the novel application of transoral robotic surgery (TORS) for the management of an oropharyngeal neurofibroma. A 47-year-old female presented with a 1-year history of a left tonsillar mass. Clinical evaluation, imaging, and biopsy results were inconclusive but raised suspicion for a neoplasm. The patient underwent robotic-assisted tonsillectomy and mass resection. Subsequent histopathological evaluation confirmed a benign spindle cell tumor consistent with neurofibroma. Oropharyngeal neurofibromas may present diagnostic challenges due to their resemblance to common tonsillar pathologies. Imaging and biopsies may not always provide definitive diagnoses, necessitating surgical excision for accurate characterization. This case demonstrates the utility of TORS, offering improved visualization and access while minimizing patient morbidity.

The FL-ALTER study introduces a novel first-line therapeutic approach for patients with EGFR mutation-positive advanced non-small cell lung cancer (NSCLC). This study aimed to evaluate the cost-effectiveness of first-line gefitinib plus anlotinib for Chinese patients diagnosed with stage IIIB-IV EGFR-mutant NSCLC.

A combined decision-tree and Markov model was constructed to predict 5-year cost-effectiveness using follow-up data from the FL-ALTER trial. Efficacy and safety inputs were derived from randomized clinical trials, whereas cost and utility values were sourced from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated from the perspective of the Chinese healthcare system. Furthermore, scenario analyses were performed to evaluate the economic impact of patient assistance programs (PAPs) and drug price negotiations.

Compared with gefitinib plus placebo, first-line gefitinib plus anlotinib yielded an additional 0.16 quality-adjusted life years (QALYs), with an incremental cost-effectiveness ratio (ICER) of $196,652.56/QALY. Deterministic sensitivity analysis revealed that the utility of progression-free survival and the cost of anlotinib were the most influential parameters driving the model outcomes. Probabilistic sensitivity analysis indicated that the combination regimen had no cost-effectiveness advantage at the current Chinese willingness-to-pay (WTP) threshold of $38,043.34/QALY.

Within the Chinese healthcare system, first-line gefitinib plus anlotinib is not cost-effective for advanced EGFR-mutated NSCLC at a WTP threshold of $38,043.34/QALY. However, implementing a PAP or price negotiation for anlotinib could effectively lower incremental costs, rendering this regimen a more economically viable clinical option.

Colorectal cancer (CRC) is a prevalent malignancy associated with alterations in the gut microbiota and host metabolic profiles. This cross-sectional study aimed to characterize gut microbiota and serum metabolite differences among healthy controls (HC), patients with non-metastatic colorectal cancer (CRC-nm), and patients with metastatic colorectal cancer (CRC-m). Stool metagenomic sequencing and untargeted serum metabolomics were performed in 107 participants, followed by exploratory differential analyses and internally cross-validated modeling to identify candidate microbial and metabolic features and evaluate their discriminatory performance. Differential analyses identified two CRC-m-enriched species-level features (Enterocloster clostridioformis and Lactobacillus crispatus) and two CRC-m-depleted features (Megamonas rupellensis and Phocaeicola plebeius) across comparisons with both CRC-nm and HC groups. Metabolomic analysis identified eight pathway-mapped metabolites, mainly involved in amino acid-related metabolic pathways. In modeling analyses, metabolite-only models provided the primary discriminatory signal, whereas adding bacterial features did not improve predictive performance. Integrated microbiota-metabolite models showed lower internal performance than metabolite-only models in some comparisons, including CRC-m versus CRC-nm. Overall, these findings suggest that observed discriminatory performance was primarily driven by serum metabolite features rather than additional bacterial features, and highlight candidate microbial and metabolic markers for future validation. Because all CRC-m cases were stage IV and all CRC-nm cases were stages I-III, these results should be interpreted as exploratory cross-sectional group differences that may reflect disease stage, tumor burden, or broader progression-related changes rather than metastasis-specific biology.

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with limited treatment options. Comprehensive molecular profiling with next-generation sequencing (NGS) may enable personalized therapies, but its feasibility using EUS-guided fine-needle biopsy (EUS-guided FNB) and broad panels in routine practice remains unclear. This study aimed to assess the feasibility of NGS using residual diagnostic tissue from EUS-guided FNB in PDAC, without dedicated sampling.

We performed a retrospective single-center study of patients with PDAC who underwent EUS-guided FNB, analyzing residual paraffin-embedded tissue blocks for NGS using a 63-gene panel. Samples required a minimum tumor cellularity of 20% and tumor area ≥10 mm². Baseline, procedural, and genomic data were compared between NGS-feasible and NGS-unfeasible groups. The primary endpoint was technical success.

Thirty-five patients were included. NGS was successful in 74.3% of cases (26/35) using residual diagnostic material without additional biopsy passes. No significant baseline or procedural differences were observed between groups, except for metastatic disease, which was more frequent in the NGS-unfeasible group (55.6% vs. 11.5%, P = 0.029). KRAS mutations were identified in 73.1% of sequenced cases, predominantly at codon 12.

EUS-guided FNB samples can support NGS from residual diagnostic tissue with high feasibility, avoiding dedicated sampling. This pragmatic approach may streamline molecular profiling and expand access to precision oncology in PDAC.