Allogeneic hematopoietic cell transplantation (alloHCT) and chimeric antigen receptor T (CAR T)-cell therapy represent established therapeutic modalities for selected hematologic malignancies but are associated with substantial morbidity, high healthcare costs, and a considerable risk of severe complications, including death. This necessitates specialized and continuous post-treatment care, which is currently insufficiently standardized and still largely delivered predominantly through in-person and nonintegrated processes. We aimed to develop a comprehensive and innovative post-treatment care program for patients after alloHCT and CAR T-cell therapy based on an interdisciplinary, digitally supported, cross-regional and, cross-sectoral approach, and to evaluate its effectiveness in a randomized controlled trial (RCT). Developed by a multidisciplinary team, the intervention involves case managers and home visits by onco nurses, supported by digital components. These include patient-reported monitoring of vital signs and symptoms via a mobile application, video consultations, and virtual case conferences with community-based hematologists. The evaluation of effectiveness includes both quantitative outcomes, such as mortality and rehospitalization rates, and qualitative data derived from semi-structured interviews. The required ethics approvals were obtained in due time, and the three study centers were successfully initiated in 2024. As of January 2026, recruitment has been completed, and a total of 306 patients were successfully enrolled and randomized in a 1:1 ratio to receive either the SPIZ intervention or routine care. Funded and supported by the Federal Joint Committee (G-BA), a positive evaluation could facilitate the integration of the proposed care model into routine clinical practice, thereby strengthening post-treatment care for patients undergoing cellular therapy across Germany.

Patients who have undergone breast cancer (BC) surgery are a high-risk population for frailty. This study aims to analyze risk factors for frailty in these patients, develop a risk prediction model, and validate its predictive performance, thereby providing a reference for frailty prevention in postoperative breast cancer patients.

A total of 286 BC patients who underwent surgical treatment at the Department of Breast Surgery, the First Affiliated Hospital of University of Science and Technology of China (USTC), between October 2024 and March 2025, participated in a cross-sectional study and were surveyed using a general information questionnaire, the Chinese version of the Tilburg Frailty Indicator (TFI), and the Pittsburgh Sleep Quality Index (PSQI). We used logistic regression to analyze factors influencing postoperative frailty in BC patients and constructed a risk prediction nomogram. We evaluated the model's predictive performance using receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow test, and decision curve analysis (DCA), with internal validation conducted via 10-fold cross-validation.

The incidence of postoperative frailty among BC patients was 29.37%. Logistic regression analysis identified the following factors as significant influences on frailty in this population (P < 0.05): a history of diabetes, poor sleep quality, having children as the primary caregivers, urban employee basic medical insurance, higher cholesterol levels, higher body mass index (BMI), higher exercise frequency, and undergoing breast conserving surgery. The results of the Hosmer-Lemeshow test showed that χ ² = 4.436, P = 0.816. The model showed an area under the ROC curve was 0.813 after internal validation.

The created prediction model provided a precise, individualized evaluation of postoperative frailty risk in BC patients. It can be used to identify individuals at high risk of postoperative frailty in BC patients and to guide healthcare professionals in promptly implementing targeted interventions.

Skull base large tumor resections require precise hemodynamic control and neuroprotection. This study compared remimazolam and propofol effects on perioperative stability, postoperative neurocognitive recovery, and inflammatory responses in these patients.

This retrospective study included patients who underwent large skull base tumor resections between March 2020 and February 2022. Patients were assigned to remimazolam or propofol group based on the primary anesthetic used. Hemodynamic parameters such as blood pressure, heart rate (HR), and mean arterial pressure (MAP) were recorded during the perioperative period. Serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were measured preoperatively and on postoperative days 1, 3, and 7. Neurocognitive function was assessed using the Montreal Cognitive Assessment (MoCA).

The analysis included 257 patients (remimazolam group: n=122; propofol group: n=135). The remimazolam group showed higher systolic blood pressure at most measurement points after induction (immediately before tracheal intubation: 108.24 vs. 105.75, P=0.006), diastolic blood pressure (5 min after extubation: 78.29 vs. 74.87, P=0.005), MAP (immediately before tracheal intubation: 74.83 vs. 70.57, P=0.002), and HR (5 min after extubation: 77.14 vs. 72.93, P=0.002). Postoperative MoCA scores were higher in the remimazolam group (24 hours: 24.18 vs. 23.45, P=0.005). The remimazolam group also had lower levels of postoperative TNF-α (40.21 vs. 41.55, P=0.011) and IL-6 (63.15 vs. 65.19, P=0.013). The incidence of hypotension was lower in the remimazolam group (13.93% vs. 27.41%, P=0.008).

For patients with large skull base tumor resections, remimazolam offers better hemodynamic stability, improved early neurocognitive recovery, and milder inflammatory responses compared to propofol.

Personalised neoantigen vaccines are patient-specific immunotherapies designed to target tumour-restricted antigens arising from genomic and transcriptomic alterations, including single-nucleotide variants, insertions and deletions, frameshifts, gene fusions and aberrant splicing. Early clinical studies have established manufacturing feasibility and immunogenicity, while randomised phase 2b evidence in resected melanoma has provided a signal of clinical activity that requires confirmation in larger trials. Clinical development nevertheless remains concentrated in high-income academic centres, raising questions about equitable implementation in Southeast Asia. This narrative review evaluates the published clinical evidence and the documented health-system capacity of the 11 ASEAN member states. Regional capacity is heterogeneous: national or institutional genomic programmes and tertiary molecular services are documented in several countries, whereas routine nationwide availability, public reimbursement and equitable geographic access remain incompletely characterised. Potential implementation barriers include access to clinical-grade tumour-normal sequencing, bioinformatics and molecular pathology expertise, patient-specific GMP manufacturing, chain-of-identity control, product release testing, temperature-controlled distribution, financing and country-specific regulatory requirements. Current immunopeptidomic training datasets provide uneven HLA coverage, and published neoantigen-prediction tools have not undergone prespecified, prospective, allele-stratified validation across representative Southeast Asian HLA class I and class II repertoires. Their regional transportability should therefore be considered uncertain rather than assumed to be either equivalent or inferior. A staged hub-and-spoke model linking clinical centres, national genomic nodes and a limited number of regional GMP facilities could support prospective implementation studies. Whether personalised neoantigen vaccines reduce or widen existing cancer inequities will depend on evidence-based patient selection, health-system investment, sustainable financing and nationally appropriate regulatory oversight.

Cystic echinococcosis (CE) is a chronic zoonotic infection caused by Echinococcus granulosus that most commonly affects the liver and lungs. In disseminated disease, the combination of bilateral pulmonary nodules, cavitary consolidation, mediastinal lymphadenopathy, and hepatic lesions can closely mimic metastatic malignancy on cross-sectional imaging and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). This case highlights disseminated CE mimicking pulmonary embolism (PE) and metastatic malignancy. This is a case of a previously healthy 27-year-old woman who presented with acute dyspnea, pleuritic chest pain, fever, and productive cough and was referred for suspected PE; however, CT pulmonary angiography ruled out PE and revealed bilateral pulmonary nodules, cavitary right middle lobe consolidation, mediastinal lymphadenopathy, and multiple hepatic lesions initially interpreted as metastatic malignancy. FDG PET/CT showed intensely hypermetabolic pulmonary and mediastinal disease (SUVmax (maximum standardized uptake value), 15.6), while the hepatic lesions were isometabolic, suggesting a separate etiology. Liver MRI showed well-defined cystic lesions across multiple hepatic segments consistent with hydatid cysts, and Echinococcus serology was positive (titer, 1:640). Bronchoalveolar lavage (BAL) was negative for malignancy and alternative infections. She was treated with albendazole 400 mg twice daily, and five-week follow-up CT showed cavitary transformation of pulmonary nodules consistent with treatment-related cyst degeneration. Disseminated CE can mimic both PE and metastatic malignancy. In patients from endemic regions, discordant FDG PRT/CT findings - hypermetabolic pulmonary lesions with isometabolic hepatic cysts - should prompt consideration of CE. A multidisciplinary approach integrating multimodal imaging and serology is essential for accurate diagnosis and to avoid unnecessary invasive procedures.

To investigate the clinical efficacy, adverse reactions, and physical growth and neurodevelopment effects of oral propranolol in infants with proliferative hemangiomas and to compare these outcomes with those of oral prednisone.

A retrospective analysis was conducted on 150 infants with proliferative infantile hemangiomas (IHs) treated at our hospital between October 2023 and October 2025. On the basis of outpatient treatment regimens, 77 infants who received oral propranolol were included in the study group, and 73 infants who received oral prednisone were included in the control group. Clinical data, treatment outcomes, adverse reactions, height, weight, head circumference, and neurodevelopment (assessed by using the Gesell Developmental Scale) were collected from medical records. After 3-6 months of treatment, clinical efficacy was evaluated with the Achauer efficacy grading system, and adverse reactions, physical growth parameters, and neurodevelopmental indicators were compared between the two groups.

After 3-6 months of treatment, the clinical efficacy in the study group was significantly better than that in the control group (p < 0.05). The incidence of common adverse reactions, including hypotension, hypoglycemia, constipation, diarrhea, and vomiting, did not significantly differ between the two groups (p > 0.05). However, the incidence of respiratory tract infections was significantly lower in the study group than in the control group (p < 0.05). The infants in the study group also had significantly greater height, weight, and head circumference than those in the control group (p < 0.05). Neurodevelopmental assessment showed that developmental quotients in gross motor, fine motor, adaptive behavior, language, and personal-social domains were all significantly higher in the study group than in the control group (p < 0.05).

Compared with oral prednisone, oral propranolol demonstrates superior therapeutic efficacy in the treatment of proliferative IHs and is associated with fewer respiratory infections and better physical and short-term neurodevelopmental outcomes. These findings suggest that propranolol may offer advantages over prednisone in terms of efficacy, safety, and developmental outcomes, supporting its use as a preferred first-line therapy for proliferative IHs. However, given the limited sample size and short follow-up of this study, large prospective studies are warranted to confirm these observations.

Anlotinib was approved for advanced soft tissue sarcoma (STS) but validated biomarkers and optimal treatment patterns remain unclear. This study evaluated the efficacy, safety and prognostic factors of anlotinib-based regimens, and assessed whether the addition of PD-1 inhibitors is associated with improved outcomes in advanced STS.

Data from patients with advanced STS receiving anlotinib between January 2019 and December 2024 were retrospectively analyzed. Survival was assessed using Kaplan-Meier and Cox regression. Landmark analyses at 2, 3, and 4 months were performed to address potential immortal time bias. Proportional hazards assumptions were assessed using Schoenfeld residuals, and sensitivity analyses included stratified Cox models and ridge regression.

Of the 227 patients screened, 84 were included in the study. The median follow-up time was 30 months. The median PFS and OS were 10 months and 26 months, respectively. Anlotinib plus immunotherapy regimen achieved the highest ORR (37.5%) and numerically the longest median PFS (20 months) and OS (29 months) among all treatment patterns, though adjusted comparisons versus monotherapy were not statistically significant. Anlotinib maintenance therapy was associated with longer PFS (HR 0.30, 95% CI 0.13-0.66, P = 0.003) and OS (HR 0.15, 95% CI 0.05-0.51, P = 0.002) compared with monotherapy. Treatment-emergent hypothyroidism was a favorable prognostic factor (PFS HR 0.24, OS HR 0.21, both P < 0.001).

The addition of PD-1 inhibitors to anlotinib was associated with numerically longer survival and a high disease control rate in a small subgroup with a higher proportion of immunotherapy-sensitive histologies; these descriptive findings warrant further prospective evaluation. Treatment-emergent hypothyroidism was identified as an independent favorable prognostic factor. Maintenance therapy was associated with prolonged survival, but this finding should be interpreted cautiously due to potential selection bias and violation of the proportional hazards assumption.

Bladder cancer (BLCA) is a common urinary tract malignancy with significant global burden, yet the prognostic relevance of dietary restriction-related genes (DRRGs) in BLCA remains unclear.

Prognostic DRRGs in BLCA were identified based on publicly available databases by differential expression analysis, univariate Cox regression analysis, Mendelian randomization (MR) analysis and LASSO regression analysis. A risk model was built and evaluated, after which a nomogram was established and assessed by using the risk score and clinical characteristics. Following this, analysis of functional enrichment, immune infiltration, genetic mutation and drug sensitivity were performed based on the risk model. Importantly, cell annotation and identification of potential key cells were conducted by single-cell RNA sequencing (scRNA-seq) analysis. The expression levels of target DRRGs were examined by qRT-PCR and western blot methods. Cell transfection, in vivo and in vitro assays were performed to analyze the impacts of target DRRGs on BLCA cells' biological behaviors.

Three candidate prognostic DRRGs (RBP7, SREBF1 and ZFP64) were screened. The risk model classified BLCA patients two risk groups, and high-risk patients showed worse survival. The AUC values of this model in the training and validation cohorts were generally within the range of 0.60-0.66, suggesting some but limited discriminatory ability. The risk score, age, T stage, and N stage were identified as independent prognostic factors, and the nomogram constructed from these factors showed moderate predictive performance. The two risk groups differed in signaling pathways, immune cell infiltration, immune checkpoints, mutated genes, immunotherapy-related predictive indicators, and drug sensitivity. scRNA-seq analysis annotated eight cell types, among which T cells showed differential expression of the candidate DRRGs and were identified as a potential key cell type associated with prognostic DRRG expression. Experiments showed that SREBF1 and ZFP64 were over-expressed at mRNA and protein levels in BLCA tissues. Knockdown of SREBF1 or ZFP64 inhibited multiple malignant phenotypes of BLCA cells.

This study screened RBP7, SREBF1, and ZFP64 from a previously computationally inferred DR-related gene category as candidate prognostic genes in BLCA and established a risk model with moderate predictive performance, providing clues for further investigation of this malignancy.

Adrenocortical carcinoma is a rare and aggressive malignancy for which high-quality evidence to guide clinical decision-making remains limited. This scoping review aimed to map and synthesize the extent, nature, and direction of evidence across five therapeutic domains in the management of adrenocortical carcinoma. Following the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance, MEDLINE, Embase, and the Cochrane Library were searched without date restrictions. Eligible sources included clinical trials, observational studies, systematic reviews, and clinical guidelines addressing any treatment modality for adrenocortical carcinoma. Data were extracted using a standardized form and synthesized narratively across domains. Evidence visualizations and an intervention-by-domain matrix were developed to identify areas of consistency, uncertainty, and research gaps. Forty-nine studies met the inclusion criteria. Complete tumor resection with negative margins consistently emerged as the strongest prognostic factor. Minimally invasive adrenalectomy showed comparable outcomes only in carefully selected low-risk patients. Adjuvant mitotane demonstrated potential benefit in high-risk disease but not in low- to intermediate-risk patients. In metastatic disease, multimodal management incorporating etoposide, doxorubicin, cisplatin, and mitotane, together with metastasectomy and local therapies, was associated with improved outcomes in selected cases. Recurrence was frequent and often occurred early, particularly in large or invasive tumors. Cortisol-secreting tumors were associated with higher postoperative morbidity and earlier recurrence. Although the available evidence is predominantly retrospective and heterogeneous, consistent patterns emerge that can inform clinical management. This review provides a structured evidence base for future consensus development and highlights priorities for further research.

Small intestinal neuroendocrine tumours (siNETs) are usually indolent neoplasms, most of which are classified as grade 1 with very low proliferative activity. In practice, Ki-67 in G1 siNETs is often reported simply as '<3%', limiting prognostic discrimination. Digital pathology now enables reliable automated quantification of very low Ki-67 values. We investigated whether precise Ki-67 quantification could improve prognostic stratification in G1 siNETs.

We retrospectively included 63 consecutive patients who underwent surgery for a G1 siNET at Beaujon Hospital between 2001 and 2017. Ki-67 was quantified on primary tumours (PTs) and, when available, lymph node and liver metastases, using QuPath automated image analysis. Ki-67 was assessed in the highest-proliferation hotspot (0.4 mm²; >2,000 tumour cells; Ki-67_max) and as the mean of five hotspots (Ki-67_mean). The primary endpoint was recurrence-free survival (RFS).

Among 63 patients, 33 underwent curative-intent surgery (median age: 56 years; 69% male). Median tumour size was 20 mm. At surgery, 87% were node-positive and 67% had synchronous metastases. Median Ki-67_max/Ki-67_mean in PTs was 0.99%/0.71%. In localised disease, Ki-67_max predicted RFS (AUROC = 0.84). Median follow-up was 60.2 months. Median RFS was 112 months in patients with Ki-67_max ≥1%, whereas no recurrences occurred in those with Ki-67_max <1% (P = 0.04). Ki-67_mean provided no additional prognostic value.

Precise digital Ki-67 quantification refines prognostic stratification in G1 siNETs. Tumours with Ki-67 <1% may represent a biologically distinct 'G0' subgroup associated with extremely low recurrence risk after curative surgery.