Diabetic foot ulcers are predominantly attributed to bacterial aetiologies, but invasive fungal infections are an increasingly recognised opportunistic threat in immunocompromised patients. We present the case of a male farmer in his 30s with uncontrolled diabetes who developed a worsening necrotic ulcer on the left tibia following agricultural trauma. Despite treatment with broad-spectrum antibiotics, the wound deteriorated, exhibiting a central black eschar. Deep tissue biopsy revealed hyaline septate hyphae and fungal culture confirmed Fusarium oxysporum, identified by characteristic banana-shaped macroconidia. Management required a multimodal limb-salvage approach involving strict glycaemic control, dual antifungal therapy with liposomal amphotericin B and voriconazole and aggressive serial surgical debridement. Complete healing was achieved after 5 months without amputation. This case highlights the importance of suspecting fungal aetiology in antibiotic-refractory diabetic wounds, particularly in patients with occupational soil exposure.

Breast cancer (BC) remains the leading cause of cancer-related mortality and a major contributor to disease burden among women worldwide. Although PD‑1/PD‑L1‑targeting immune checkpoint inhibitors have become a standard treatment for certain triple‑negative breast cancer subgroups, their use across the broader BC population is limited by intrinsic resistance, an immunosuppressive tumor microenvironment (TME), and treatment‑related adverse effects. The present review offers a comprehensive synthesis of the immunotherapeutic paradigm in BC, spanning ICIs, adoptive cellular therapies (CAR-T, CAR-NK, CAR-M, TIL, TCR-T, and CIK cells), and emerging immune modulators. We critically evaluate pivotal clinical trials, discuss cross-cutting challenges-including biomarker development, therapy resistance, and the practical limitations of cellular products-and highlight rational combinatorial strategies. By contrasting the translational readiness of diverse modalities and outlining a framework for personalized therapy, this review aims to inform future research and clinical practice in harnessing immunity against BC.

Conflicting views in experimental carcinogenesis often arise due to differences in study design among reported studies. For carcinogenicity assessments, regulatory agencies, such as the US Food and Drug Administration (FDA), and intergovernmental advisory organizations, such as the Organization for Economic Co-operation and Development (OECD), specify the use of at least three dose levels plus control group for trend analyses, with the highest dose inducing a measurable toxic response. In addition, there needs to be a sufficient number of animals per group to have adequate power to detect a true carcinogenic effect. Departure from such recommendations can weaken the interpretations of study results. We examine here two recent carcinogenicity studies from Japan and Korea that were conducted following the positive carcinogenicity study of radiofrequency radiation (RFR) in experimental animals by the National Toxicology Program (NTP). The Japan and Korea follow-up studies used fewer animals per group, a single RFR exposure group, and a lower exposure level than the NTP study. Not surprisingly, while the NTP study revealed the carcinogenicity of RFR, the Japanese and Korean studies, which had reduced statistical power compared to the NTP study, issued conclusions conflicting with those of the more substantial NTP study on the health effects of RFR. In general, carcinogenicity studies with weaker doses, fewer exposure groups, and reduced statistical power should not be used to test the validity of more robust studies.

Arterial spin labeling (ASL) enables non-invasive quantification of cerebral blood flow (CBF). The preoperative prognostic value of tumor-specific CBF for subsequent enhancing tumor (ET) volume progression in gliomas remains poorly characterized.

In this study 60 glioma patients (predominantly glioblastoma, WHO grade 4) with preoperative 3T ASL MRI and paired follow-up structural MRI were analyzed. Tumor CBF, surrounding CBF, and whole-brain CBF were quantified from the segmented regions of interest. ET and surrounding non-enhancing FLAIR-hyperintense (SNFH) volume changes were calculated and correlated with preoperative perfusion data. Spearman correlations, Kruskal-Wallis tests, multivariable linear and logistic regression, and ROC analyses were performed.

Higher preoperative tumor CBF strongly predicted net ET volume increase (Spearman r = 0.531, p < 0.0001) and ET progression category (Kruskal-Wallis p = 0.0005). Mean tumor CBF was 147.7 ml/100 g/min in ET-increased versus 124.4 ml/100 g/min in unchanged and 115.8 ml/100 g/min in decreased cases. Tumor CBF remained an independent predictor after adjusting for age, scan interval, and MGMT status (linear regression p = 0.002; logistic regression OR = 2.02 per ml/100 g/min, p = 0.001). Associations with SNFH volume changes were weak and non-significant. Surrounding CBF closely matched whole-brain CBF (Pearson r ≈ 1.00). Tumor CBF alone yielded 5-fold CV AUC = 0.805 for predicting ET progression; the combined model (tumor CBF + ET volume) improved to AUC = 0.858.

Preoperative ASL-derived tumor CBF appears to be an independent non-contrast imaging biomarker for early enhancing tumor progression risk in gliomas.

Transgender and gender diverse (TGD) individuals undergoing gender-affirming mastectomy (GAM) face unique challenges related to breast cancer risk assessment and screening. This study aimed to identify factors that influence healthcare professionals' (HCPs) integration of cancer risk evaluation, including genetic assessment, within the context of GAM and pre-surgical planning.

We conducted semi-structured qualitative interviews with 20 healthcare professionals - including six primary care providers, five cancer genetic counselors, six oncologists, and three plastic surgeons - experienced in caring for TGD patients considering or undergoing GAM. Using a social constructivist framework, we applied reflexive thematic analysis to explore HCP perspectives and generate key themes.

We conceptualized five key themes: (1) HCPs perceive no clear ownership for care integration of breast cancer risk assessment; (2) conflicting guidelines force HCPs to rely on their own judgment, resulting in inconsistent practice; (3) care pathways are driven by individual HCP champions rather than standardized protocols; (4) GAM frequently occurs at young ages prior to age of population cancer risk screening initiation, complicating risk discussions; and (5) structural failures in care delivery compromise patient safety.

Improving cancer risk assessment for TGD patients undergoing GAM demands clear institutional accountability, harmonized evidence-based guidelines, standardized care pathways, and genetic counseling embedded into multidisciplinary gender-affirming care teams. These coordinated structural efforts are critical to integrate equitable, personalized, and patient-centered cancer prevention with gender-affirming surgical care.

Assisted Reproductive Technologies (ART) have become nowadays a cornerstone in the management of infertility. While these treatments are generally considered safe, concerns have been raised regarding their potential influence on breast cancer (BC) risk, particularly in specific subgroups of women.

This narrative review aims to evaluate the most relevant past and current literature on the association between ART-related hormonal treatments and breast cancer risk, highlighting potential biological mechanisms, epidemiological evidence, and clinical implications.

A literature search was conducted through PubMed, focusing on medium-to-large cohort and case-control studies, meta-analyses, and guidelines published to date. Evidence was synthesized by distinguishing overall ART/IVF risk estimates from drug-specific findings and subgroup-specific risk modifiers. Particular attention was given to the most recent or most comprehensive reports when multiple publications were derived from the same cohort.

To date, current evidence does not support a real and consistent overall increase in breast cancer risk following ART-related hormonal treatments. Large population-based studies and recent meta-analyses are generally reassuring, particularly when ART-treated women are compared with infertile untreated women rather than with the general population. Some studies report modest risk elevations in selected subgroups, including nulliparous or nulligravid women, women undergoing repeated or high-dose stimulation cycles, and women with hereditary BC predisposition; however, these findings are inconsistent and often limited by residual confounding, small subgroup numbers, and incomplete dose information. Progesterone supplementation appears safe in the context of ART, with no consistent evidence of increased BC risk. Gonadotropins, including hMG, may transiently increase estrogen exposure, but large-scale studies and meta-analyses generally do not confirm a long-term increase in breast cancer incidence.

Female allogeneic hematopoietic cell transplantation (AlloHCT) survivors are at increased risk for human papillomavirus (HPV)-related malignancies due to immunosuppression. Guidelines recommend annual cervical cancer screening for AlloHCT survivors with a cervix aged 21-65. This study explored cervical cancer screening knowledge, behaviors, attitudes, experiences, and preferences-specifically provider-collected versus self-collected methods-and identified adherence barriers and facilitators.

We conducted a mixed-methods observational study of female AlloHCT survivors aged 21-65 who received AlloHCT at Oregon Health & Science University between 2012 and 2023. Participants completed demographic surveys and participated in focus groups exploring screening adherence, perceptions, and preferences.

Twenty-three survivors completed the survey, and 16 joined focus groups in fall 2024. The median participant age was 49 years (range 32-61); most were white (87%) and privately insured (91%). Median age at bone marrow transplantation (BMT) was 41 years (range 19-56). Primary diagnosis included acute myeloid leukemia or myelodysplastic syndrome (65%). Reported complications included graft versus host disease (GVHD) (44%), chronic GVHD (39%), and vaginal GVHD (22%). Awareness of increased cervical cancer risk facilitated screening adherence, while limited access to in-network providers was a barrier. All participants preferred provider-collected screening due to confidence in test accuracy and reassurance from clinician involvement. Psychological factors, particularly worrying about recurrence or secondary cancers, strongly influenced screening preferences.

Cervical cancer screening preferences among AlloHCT survivors were shaped by physical and psychological treatment-related factors. HPV self-collection may be a supplemental option before BMT, between annual clinic visits, or when access barriers arise.

To identify symptom clusters in nasopharyngeal carcinoma (NPC) survivors and to examine the potential indirect pathways that link them to perceived cognitive function via anxiety and depression.

This cross-sectional study recruited 556 NPC survivors by convenience sampling between November, 2024, and May, 2025. Data were collected using the Anderson Symptom Inventory, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and Functional Assessment of Cancer Therapy, and symptom clusters were identified using exploratory factor analysis. Symptom relationships with anxiety, depression, and perceived cognitive function were analyzed through structural equation modeling.

Two distinct symptom clusters were recognized, a therapy side-effect cluster and a psychoneurological-physical cluster that exerted a direct negative association with perceived cognitive function through both a direct pathway (β = -0.126, 95% CI [-0.149, -0.096]) and three indirect mediating pathways: the independent indirect effects of anxiety (β = -0.064, 95% CI [-0.086, -0.048]), depression (β = -0.094, 95% CI [-0.110, -0.083]), and the sequential pathway of anxiety-depression (β = -0.154, 95% CI [-0.172, -0.137]). These indirect effects represented 14.60%, 21.50%, and 35.20% of the total effect, respectively.

This study highlights the chain-mediating role of anxiety and depression in the relationship between symptom clusters and perceived cognitive function in NPC survivors. Effective management of symptom clusters and timely alleviation of anxiety and depression may be associated with the mitigation of perceived cognitive difficulties in this population.

Stereotactic radiosurgery (SRS) has emerged as a promising modality for improving local tumor control (LTC); however, data on its use for spinal metastases (SM) specifically from cholangiocarcinoma remain limited. In this single-institution retrospective analysis, we aimed to evaluate the safety and efficacy of SRS for SM from cholangiocarcinoma, exploring the role of biologically effective dose (BED) thresholds. Demographic, clinical, radiographic, and dosimetric variables, including Bilsky grade, Karnofsky Performance Status (KPS), and BED, were collected. The treatment response was assessed using a combination of radiologic, metabolic, and clinical criteria. Survival outcomes were calculated using Kaplan-Meier methods, and statistical analyses accounted for lesion clustering within patients. Seventeen SM identified in eight patients (mean age 68 years; SD± 8.2 years) were analyzed. The mean lesion volume at the time of treatment was 37.4 cm³ (SD± 23.8 cm³) and the median prescription dose was 20 Gy (IQR = 20-28 Gy). In exploratory comparisons, lesions with Bilsky ≥1c showed lower 3-month clinical response stability than lower-grade lesions (25% vs. 85% stable; p = 0.04). Patients with KPS > 70 tended to receive higher BED₁₀ values, although this exploratory comparison did not reach statistical significance (p = 0.05). Most notably, no local progression occurred in lesions treated with BED₁₀ >60 Gy (0/5) versus 25% progression (3/12) with BED₁₀ ≤60 Gy, representing a hypothesis-generating signal that warrants further investigation. CTCAE grade ≥ 3 adverse events were not evidenced after the treatment. A 1-year LTC rate of 86% along with a median overall survival of 12 months, was achieved using SRS. This largest series to date demonstrates that SRS provides durable LTC with a favorable safety profile for spinal cholangiocarcinoma metastases. Bilsky grade and KPS may inform clinical decision-making, while BED₁₀ thresholds show a promising hypothesis-generating signal for LTC that requires validation in larger studies.

Persistent dizziness is a frequent and disabling symptom after retrosigmoid microsurgery for vestibular schwannoma (VS), negatively affecting quality of life. While vestibular outcomes are well studied, the contribution of psychological factors to persistent dizziness remains insufficiently understood. This cross-sectional study included 93 patients with VS, of whom 80.6% reported postoperative dizziness. Psychological factors were assessed using validated self-report questionnaires covering premorbid mental health conditions, personality traits, somatization, anxiety, depression, and psychological distress. Dizziness-related impairment was quantified using the Dizziness Handicap Inventory (DHI). Associations were examined using Spearman correlations with bootstrap resampling, followed by multivariable linear regression to identify independent predictors of dizziness handicap. Dizziness handicap was robustly associated with vestibular symptom burden, somatization, anxiety, and psychological distress. Higher anxiety and somatization scores were consistently related to greater dizziness-related impairment, particularly in emotional and functional domains. Higher scores on the GBI Social Support subscale, reflecting surgery-related changes in the need for and reliance on social support rather than baseline social support resources, were associated with greater dizziness handicap and independently predicted higher DHI scores. Personality traits showed heterogeneous associations; conscientiousness was positively associated with physical dizziness handicap and showed a trend-level association with overall handicap, potentially reflecting increased symptom monitoring or health awareness. Given the cross-sectional design and absence of objective vestibular testing, causal relationships cannot be established. Persistent dizziness after VS surgery likely reflects multifactorial mechanisms involving vestibular, psychological, and functional contributors. Future longitudinal studies integrating comprehensive neuro-otological assessments are needed to clarify temporal relationships and underlying mechanisms.