Gastric cancer (GC) is one of the leading causes of cancer-related deaths, particularly in early-stage GC, which is frequently asymptomatic, and there are no reliable molecular markers available for diagnosis.

To identify potential candidate genomic biomarkers for GC with respect to genetic variations and expression changes in genes related to hydrogen sulfide (H₂S) metabolism and antioxidant defence.

We included 15 patients with newly diagnosed gastric adenocarcinoma in a paired case-control molecular design based on tumour tissue and adjacent histologically normal gastric mucosa. Biopsy tissues were used to extract genomic DNA and total RNA. Complementary DNA (cDNA) was synthesised, followed by standard polymerase chain reaction, Sanger sequencing, and quantitative real-time polymerase chain reaction analysis. The selected target genes were cystathionine beta-synthase (CBS), cystathionine gamma-lyase (CTH), 3-mercaptopyruvate sulfurtransferase (MPST), catalase (CAT), and glutathione peroxidase 1 (GPX1).

A total of 53 insertion/deletion/duplication variants without amino acid change and 11 predicted amino acid-changing sites plus multiple homozygous substitution variants were identified through sequence variants screening. Most variants were heterozygous and not present in external databases. Common high-frequency variants included CBS 19,430 C > CG, CTH 28400G > GT, CAT 33470G > GA, and changes associated with GPX1613_618delGGCGGC. Expression analysis indicated upregulation of CBS, CAT, and GPX1 (by approximately 1.40-, 1.73-, and 1.93-fold, respectively), downregulation of MPST (3.11-fold), and slight downregulation of CTH.

Somatic mutations and altered expression of CBS, CTH, MPST, CAT, and GPX1 in GC tissues indicate coordinated remodeling of sulfur metabolism and redox-defence pathways. Nevertheless, the low ROC performance suggests that these genes should not yet be viewed as viable solo diagnostic biomarkers. Instead, they are exploratory molecular signatures and candidate markers that must be validated on larger series of independent patients, matched tumour-normal sequencing, protein/enzyme lateral re-confirmation and functional studies.

Exosome analysis in gastric cancer (GC) serum requires sensitive readout with reduced matrix interference. Circulating GC-related CD63-positive exosomes can indicate vesicle burden and stress-induced secretion. Herein, we developed a dual-mode photothermal/colorimetric aptasensor using CD63 aptamer-functionalized core-shell AuPt nanozymes for detecting GC-related CD63-positive exosomes in serum samples. The innovation of this platform lies in integrating aptamer recognition, Pt-shell peroxidase-like catalysis, and Au-core near-infrared (NIR) photothermal conversion within one nanoprobe. The porous Pt shell showed high TMB affinity (K_m = 0.18 mM), and the Au core enabled 808 nm-responsive photothermal enhancement. Arrhenius analysis showed that 808 nm NIR irradiation decreased the apparent activation energy by 45.9%, while NIR-XPS, photocurrent, impedance, and wavelength-dependent analyses supported localized photothermal heating and plasmon-assisted interfacial charge transfer in the catalytic enhancement. The colorimetric mode achieved a limit of detection of 5.0 × 10² particles/mL and a linear range of 1.0 × 10³ to 1.0 × 10⁶ particles/mL. The photothermal mode covered 1.0 × 10⁵ to 1.0 × 10⁸ particles/mL and reduced hemolysis-induced optical interference. In a preliminary double-blind cohort with 60 serum samples, the assay showed a significant difference between GC patients and healthy donors (P < 0.0001). Biologically, the assay tracked increased particle-level exosome release from SGC-7901 cells under hypoxia and 5-FU stress over 48 h, supporting dynamic monitoring of stress-related vesicle abundance. A portable format combining smartphone RGB analysis and pocket-sized thermal imaging also showed good linearity under fixed imaging conditions. This strategy provides a dual-mode tool for quantitative GC-related exosome analysis and preliminary extracellular vesicle monitoring.

In our practice, the treatment of pelvic bone tumors should begin with a multidisciplinary sarcoma-board evaluation that integrates biopsy-proven histology, high-resolution CT/MRI/PET imaging, neurovascular and visceral involvement, Enneking zone, expected survival, and patient-specific functional goals. For potentially curable primary pelvic sarcomas, we consider negative-margin resection the non-negotiable oncologic priority. Limb-salvage internal hemipelvectomy is preferred when an R0 resection can be achieved while preserving limb viability and a meaningful postoperative function; external hemipelvectomy should be reserved for tumors with unreconstructable femoral or iliac vessel involvement, extensive sciatic or lumbosacral plexus invasion, uncontrolled infection, or recurrent disease in which safe margins cannot otherwise be obtained. Histology should drive sequencing: osteosarcoma and Ewing sarcoma generally require effective neoadjuvant systemic therapy before definitive local treatment, whereas conventional chondrosarcoma requires meticulous wide en bloc surgery because chemotherapy and conventional radiotherapy have limited curative value. Reconstruction should not be selected by technology alone. For non-weight-bearing or palliative defects, no reconstruction, flail hip, hip transposition, or standard metastatic acetabular procedures may offer the best time-adjusted quality of life. For long-term survivors with periacetabular, sacroiliac, or spinopelvic instability, we favor anatomy-restoring reconstruction using navigation-assisted resection and carefully planned biological, modular, or patient-specific 3D-printed implants, provided soft-tissue coverage and infection risk are acceptable. Emerging tools such as computer-assisted navigation, robotics, artificial intelligence-based segmentation, liquid biopsy, digital twins, and smart biomaterials should be used to reinforce classic oncologic principles rather than replace them. Their adoption should depend on validated margin benefit, durable functional gain, complication reduction, cost-effectiveness, and equitable access.

Colonic interposition is the preferred option for alimentary tract reconstruction when a gastric conduit pull-up is not feasible. Aim of this study was to evaluate perioperative outcomes of patients undergoing colonic interposition for various indications in our tertiary-care center over a 15-year period.

Following institutional board approval, all consecutive patients who underwent colonic interposition for esophageal replacement were identified from a prospectively maintained database. Comprehensive chart review and descriptive statistical analyses were performed.

Ninety-three patients (62 men, 31 women, median age 65 years, IQR 55.5-72) underwent colonic interposition between January 2009 and December 2023. Benign disease was present in 17.2%, whereas malignancy accounted for 82.8%. A hand-sewn cervical anastomosis was performed in 96.8% of patients. The colonic graft, predominantly based on the left colic artery (89.2%) was routed through the posterior mediastinum in 51.6% and via the retrosternal route in 47.3%. Median operative time was 303 min (IQR 247.5-364). Major complications included anastomotic leakage (28%), anastomotic stenosis (30.1%), pleural empyema (11.8%), and postoperative bleeding (10.8%). The reoperation rate was 38.7%, with a median hospital stay of 29 days (IQR 20-63). In-hospital mortality was 18.3%.

Colonic interposition after esophagectomy is associated with substantial morbidity and mortality, particularly in the salvage and secondary reconstruction setting, and should be confined to experienced, high-volume centers.

FMS_D_007.23-I-1.

The optimal robotic approach for pulmonary segmentectomy remains debated, and objective standards to verify anatomical precision are lacking. We compared the effectiveness of total-port (TP) versus utility-incision (UI) robotic segmentectomy and validated a 3D-CT metric for assessing surgical completeness. A retrospective propensity score-matched and inverse probability of treatment weighting (IPTW) analysis was performed on 418 patients undergoing robotic segmentectomy (January 2020-December 2024). Surgical completeness was objectively assessed using postoperative 3D-CT airway reconstruction, blindly reviewed by independent radiologists, to confirm exact transection of the target bronchus. Secondary outcomes included perioperative complications and blood loss. Of 418 patients, 203 underwent TP and 215 underwent UI. The TP approach was more frequently utilized for complex segmentectomies (59.6% vs. 38.6%; p < 0.001) and required less preoperative localization (1.0% vs. 17.7%; p < 0.001). Interobserver agreement for the 3D-CT completeness metric was substantial (κ = 0.65). In the IPTW-adjusted analysis, the TP group demonstrated significantly higher verified surgical completeness (95.8% vs. 80.0%; adjusted OR, 5.72; p < 0.001). Additionally, the TP group had lower intraoperative blood loss (45.0 vs. 58.3 mL; adjusted mean difference, -13.28 mL; p < 0.001) and fewer 30-day early complications (3.6% vs. 10.3%; adjusted OR, 0.33; p = 0.01). The TP robotic approach offers superior surgical precision and improved perioperative outcomes compared with the UI approach, particularly for complex segments. Postoperative 3D-CT airway reconstruction serves as a highly reproducible metric for auditing surgical quality in thoracic oncology.

Trial participation is increasingly recognised as a crucial component of optimal cancer care, yet patients with advanced cancer receiving palliative care often face significant challenges in meeting the logistical demands of traditional clinical trials. Decentralised clinical trials (DCTs), including teletrials, which conduct study activities outside a central site - frequently in participant's homes or local communities - offer a promising model to overcome these barriers. By enabling remote participation, DCTs can overcome geographical and functional barriers, making trials more accessible to this often-frail population. However, there are important concerns that warrant careful consideration. DCTs may inadvertently fragment care, expose vulnerable patients to novel medications in an isolated setting, and exacerbate digital health inequities. In our experience these challenges can be mitigated through careful trial selection, as well as the implementation of rigorous screening and support systems to ensure both patient suitability and continuity of care. Key measures include close liaison with treating oncologists and palliative care teams, 24/7 clinical phone support, accessible IT assistance during working hours, and collaboration with local trial coordinators when available. This approach not only extends the geographical reach of clinical trial participation for patients with advanced cancer receiving palliative care, but also maintains trial rigour and patient safety.

Chemotherapy-related fatigue, sleep disturbance, and psychological distress significantly impair quality of life (QoL) in cancer patients. Traditional Chinese medicine (TCM) non-pharmacological therapies are increasingly used as supportive care, yet their comparative effectiveness remains unclear. This study aimed to evaluate and compare five TCM-based interventions for improving QoL and emotional well-being in chemotherapy patients.

A systematic review and network meta-analysis was conducted, including randomized controlled trials (RCTs) published through April 2025. Five TCM-based interventions (acupuncture, auricular therapy, manual acupoint therapy, mind-body exercise therapy, and moxibustion) were evaluated. Primary outcomes included QoL, sleep quality, fatigue, general mood, anxiety, and depression. Effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Treatment ranking was determined using surface under the cumulative ranking curve (SUCRA).

Thirty-five RCTs involving 2025 chemotherapy patients were included. Manual acupoint therapy ranked highest for improving QoL (SUCRA 63.4%; SMD vs. control, 2.29; 95% CI, 0.95 to 3.63) and sleep quality (SUCRA 91.9%; SMD vs. auricular therapy, -9.92; 95% CI, -14.83 to -5.01). Mind-body exercise therapy was most effective for enhancing mood (SUCRA 68.0%; SMD vs. control, 0.72; 95% CI, 0.20 to 1.24) and reducing depression (SUCRA 70.8%; SMD vs. control, -0.92; 95% CI, -1.79 to -0.05). Auricular therapy showed the greatest benefit for fatigue (SUCRA 100%; SMD vs. control, -8.13; 95% CI, -10.15 to -6.11) and anxiety (SUCRA 92.9%; SMD vs. control, -1.53; 95% CI, -2.48 to -0.58).

TCM non-pharmacological therapies demonstrate distinct, symptom-specific efficacy in cancer patients undergoing chemotherapy. Manual acupoint therapy is most effective for QoL and sleep, mind-body exercise therapy for mood and depression, and auricular therapy for fatigue and anxiety. These findings support individualized integration of TCM interventions into supportive cancer care.

Cancer risk estimation remains one of the main unresolved challenges in human spaceflight beyond low Earth orbit, where astronauts are exposed to galactic cosmic rays, solar particle events, and high-linear energy transfer (high-LET) secondary radiation. This narrative review summarizes the principal quantitative models used to estimate radiation-induced cancer risk in astronauts, including particle fluence-based cross-sections, mixture models, risk of exposure-induced death (REID)-based operational frameworks, uncertainty distribution approaches, and ensemble models. Early studies estimated 1-year excess cancer mortality at solar minimum as 1.3% in women and 1.1% in men under 10 g/cm² aluminum shielding, whereas later models projected non-leukemia lifetime cancer incidence after 1 Sv dose equivalent/effective dose between 2.20% and 2.98%, depending on sex and age. Earlier REID-based models suggested that the historical 3% REID threshold could be exceeded after approximately 18 months in women and 24 months in men under unfavorable solar conditions, whereas the current NASA radiation standard uses a universal career-effective dose limit of 600 mSv, applied regardless of sex or age. More recent revisions of the NASA Space Cancer Risk model and non-targeted effect scenarios suggest that exploration mission risks may be higher than previously estimated, while uncertainty remains substantial, especially for high-LET radiobiology, mixed-field exposure, and the transfer of terrestrial epidemiological data to the spaceflight setting. Future progress may also involve exploring quantitative imaging biomarkers and tomographic assessments as complementary tools for longitudinal monitoring and early detection of radiation-related tissue changes, although these approaches are not yet validated as components of operational astronaut cancer risk models.

Artificial intelligence (AI) can support lesion detection in gadolinium-based contrast agent-enhanced (GBCA-enhanced) breast MRI. However, its effectiveness on virtual contrast-enhanced (vCE) images remains unclear. This feasibility study evaluated the publicly available MAMA-MIA nnU-Net model trained on GBCA-enhanced data using an independent cohort of both GBCA-enhanced and vCE breast MRI.

This IRB-approved retrospective study included the publicly available nnU-Net model trained on n = 1506 MAMA-MIA breast MRI scans and a cohort of n = 2126 in-house 3T breast MRI scans. A generative adversarial network (Pix2Pix-GAN) was developed on n = 1870 of the in-house scans and used to generate vCE data on the remaining independent n = 256 in-house cases. The MAMA-MIA nnU-net was applied to both GBCA-enhanced (GBCA) and corresponding vCE images. Ground-truth segmentations of malignant lesions served to calculate the Dice score, Hausdorff distance, and lesion dimension differences.

The final test set comprised n = 250 cases (n = 69 malignant, n = 181 benign). Lesion detection rates were 91% (n = 63/n = 69; 95% confidence interval (CI): 82.3-96.0%) for GBCA and 84% (n = 58/n = 69; 95% CI: 73.7-90.9%) for vCE. Two lesions missed in GBCA were identified by vCE. The Hausdorff distances were similar (GBCA: 6.4 (IQR: 3.2-9.3; 95% CI: 5.2-7.8) mm; vCE: 6.7 (IQR: 3.9-9.7; 95% CI: 5.3-8.0) mm, p = 0.564). The Dice scores showed minor differences (GBCA: 0.829 (IQR: 0.723-0.900; 95% CI: 0.786-0.865) vs. vCE: 0.826 (IQR: 0.720-0.857; 95% CI: 0.770-0.836); p < 0.001). vCE images had slightly higher non-target tissue segmentation (median 6072 mm³ vs. 5754 mm³).

A GBCA-trained algorithm demonstrated some cross-domain transferability to vCE images, albeit with a reduced case-level sensitivity of 84% (95% CI: 73.7-90.9%) vs. 91% (95% CI: 82.3-96.0%). Based on these preliminary results, further research, including larger cohorts and more diverse datasets, is warranted.

Background/Objectives: Differences among scanners and reconstruction methods may limit the comparability of quantitative metrics derived from fluorodeoxyglucose positron emission tomography (FDG PET)/computed tomography (CT). Although harmonization reduces inter-scanner variability in standardized uptake values (SUVs), its impact on the preservation of lesion-level ranking in real-world clinical datasets remains unclear. Here, we evaluated the robustness of PET quantitative metrics, particularly focusing on rank preservation after harmonization. Methods: Phantom and clinical data retrospectively acquired from three institutions using four PET/CT scanner types were analyzed. Harmonization parameters were derived from National Electrical Manufacturers Association IEC Body Phantom data, using the oldest scanner as the reference, and were directly applied to the clinical datasets. Clinical evaluation included head and neck malignant melanoma (HNMM; high FDG avidity) and adenoid cystic carcinoma (ACC; low FDG avidity). Rank preservation between pre- and post-harmonization values was assessed using Spearman's rank correlation coefficient (ρ). Results: Phantom-based harmonization reduced inter-scanner differences and enabled consistent evaluation in clinical datasets (HNMM: 34 patients, 93 lesions; ACC: 18 patients, 38 lesions). SUVpeak demonstrated the highest rank preservation across tumor types and lesion sizes (ρ = 0.94-1.00). Metabolic tumor volume (MTV) showed a high rank correlation in HNMM with an absolute threshold (MTV2.5; ρ = 0.99), but robustness varied depending on threshold definition, tumor type, and lesion size. Tumor-to-liver ratios showed moderate rank preservation. Conclusions: Our results suggested that SUVpeak is the most robust preservation of lesion ranking across tumor types after harmonization, suggesting its suitability as a reliable imaging biomarker in multicenter studies. Meanwhile, careful standardization is needed when using MTV-based metrics for prognostic evaluation.