Solitary plasmacytoma is a localized form of plasma cell neoplasm and is important to differentiate from multiple myeloma (MM) using clinical assessment, imaging, and bone marrow evaluation. Extramedullary plasmacytoma (EMP) develops from soft tissue and is a rare occurrence, although a large proportion of cases are in the head and neck. We describe a 59-year-old man who presented with a progressively enlarging left-sided neck mass. Imaging revealed a lesion in the left tongue base and supraclavicular and cervical lymphadenopathy. Biopsy of the left tongue base lesion revealed mature plasma cell proliferation, with positivity for CD79a, CD138, and CD38, a low Ki-67 proliferative index, and lambda light-chain restriction. Whole-body positron emission tomography-computed tomography (PET-CT) also revealed hypermetabolic disease at the base of the tongue and the nodes, and bone marrow evaluation was negative for systemic disease. After multidisciplinary review, a diagnosis of primary EMP of the left tongue base with regional nodal involvement was made, and the patient agreed to radical radiotherapy (RT) (50 Gy in 25 fractions over 5 weeks). This case underlines the importance of keeping EMP as a differential in the diagnosis of masses involving the tongue base or oral cavity in the context of cervical lymphadenopathy. PET-CT and bone marrow examination are important for staging and treatment decision-making, and radiotherapy is an important treatment option for localized disease.

Gastric cancer is a leading cause of cancer death worldwide. Targeted therapy is shifting from blocking signaling pathways to precise gene regulation. This review covers three key areas: antibody drugs, RNAi, and nanocarriers. Anti-HER2 agents, VEGFR2 inhibitors, Claudin 18.2-directed therapies and PD-1/PD-L1 inhibitors improve survival in biomarker-selected patients-but resistance and low response rates (ORR < 20% in unselected groups) limit their use. RNAi silences key oncogenes to reverse chemoresistance and reprogram the immunosuppressive tumor microenvironment, but it suffers from rapid degradation, poor endosomal escape, off-target effects, and weak tumor penetration. Nanocarrier systems-including lipid nanoparticles (LNPs), stimuli-responsive micelles, and mesoporous silica-combined with aptamers enable targeted delivery of therapeutic antibodies and siRNA, penetration across stromal barriers, and controlled, tumor microenvironment-triggered cargo release. Altogether, the future of gastric cancer therapy is moving beyond monotherapy to a five-part strategy: antibody targeting, RNA silencing, nanocarrier delivery, AI-guided decisions, and immune remodeling.

Spatial transcriptomics provides unprecedented insights into gene expression in the spatial context of tissues; however, some mainstream techniques lack quantitative analysis of uncertainty.

In this study, we propose a computational framework-Spatial Deconvolution via Deep Gaussian Processes (SDDGP)-that integrates deep Gaussian processes with Bayesian inference for spatially aware deconvolution of spatial transcriptomics data. The framework consists of three tightly coupled components. A multi-layer deep Gaussian process (DGP) captures nonlinear spatial dependencies in cell-type composition by propagating spatial coordinates through successive Gaussian process (GP) layers, each equipped with sparse variational inducing points and a radial basis function (RBF) kernel that can be combined with an external Matern spatial kernel. The DGP output serves as an adaptive, spatially informed prior for per-spot cell-type proportions, which are then estimated via a Negative-Binomial Markov chain Monte Carlo (MCMC) sampler with automatic proposal tuning, thinning, and split-chain convergence diagnostics.

We compared our method with existing approaches on two datasets: a pancreatic ductal adenocarcinoma (PDAC) dataset with matched single-cell RNA sequencing and spatial transcriptomics, and a human thymus dataset. Across both datasets, our method estimated cell type proportions more accurately than existing methods, particularly for rare cell types, and recovered biologically meaningful spatial patterns such as the distribution of T cells and plasma cells in PDAC. The Bayesian formulation also provides a quantification of uncertainty for each estimate, which aids the interpretation of spatial heterogeneity in complex tissues.

To compare tegileridine-based and sufentanil-based patient-controlled intravenous analgesia (PCIA) for postoperative gastrointestinal recovery in elderly patients undergoing laparoscopic colorectal cancer surgery.

In this single-center, double-blind, randomized controlled trial, patients scheduled for elective laparoscopic colorectal cancer surgery were randomized 1:1 to tegileridine-based PCIA (Group T) or sufentanil-based PCIA (Group S). The primary outcome was the Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms (I-FEED) score on postoperative day 3 (POD3). Secondary outcomes included I-FEED scores on POD1-5 (excluding POD3), incidence of postoperative gastrointestinal dysfunction (POGD), time to first flatus and defecation, analgesic outcomes, quality of recovery, and adverse events.

One hundred patients were included in the primary analysis (Group T, n = 51; Group S, n = 49). Compared with Group S, Group T had significantly lower I-FEED scores on POD1 (estimated marginal mean [EMM] difference, -0.60; 95% CI, -1.03 to -0.17; P = 0.006), POD2 (EMM difference, -0.66; 95% CI, -1.14 to -0.18; P = 0.008), and POD3 (EMM difference, -0.72; 95% CI, -1.17 to -0.27; P = 0.002), a lower incidence of POGD (11.8% vs 28.6%; P = 0.036), and a shorter time to first flatus (36 h vs 40 h; P = 0.025). Pain scores, PCIA use, and rescue analgesia were comparable between groups. Quality of Recovery-15 (QoR-15) scores were higher in Group T on POD2 and POD3. Group T also had a lower overall incidence of adverse events (27.5% vs 49.0%; P = 0.027) and a lower incidence of nausea and vomiting (23.5% vs 44.9%; P = 0.024).

In elderly patients undergoing laparoscopic colorectal cancer surgery, tegileridine-based PCIA provided analgesia comparable to sufentanil under the prespecified dosing regimens. It was associated with better gastrointestinal recovery during the first three postoperative days and fewer adverse events. This regimen may be a safe and effective analgesic option in this population.

Ischemic stroke (IS) remains a major cause of mortality and disability worldwide, although the causes of death after stroke have changed. Long-term mortality data from low- and middle-income countries are limited. We investigated the fatality rates and causes of death in patients with IS in Thailand within and beyond 30 days post-discharge.

We conducted a retrospective descriptive study using national hospital database records from 2004-2022. Patients with IS (ICD-10 code I63) were included without age or sex restrictions, with death status followed through 2022. The causes of death included stroke, complications, comorbidities, accidents, suicide, and unknown causes. Mortality was analyzed during hospitalization and ≤30 and >30 days post-discharge.

Among 888,003 patients with IS, the overall mortality was 47.6%: in-hospital 6.4%; ≤30 days post-discharge 8.2%; and >30 days post-discharge 33.1%. Mortality rates increased notably with age, exceeding 80% in those aged > 85 years. Stroke caused most in-hospital (58.6%) and short-term deaths (29.1%), whereas long-term mortality was primarily due to complications (30.7%) and comorbidities (30.5%). The leading comorbid causes were heart disease, dementia, and neoplasm; while pneumonia and sepsis were the primary fatal complications. Age-related debility, COVID-19 infection, and cardiovascular collapse were other major causes.

This nationwide study revealed dynamic changes in post-IS causes, with stroke predominating early deaths, while complications and comorbidities determined long-term outcomes. These findings highlight the need for integrated acute and post-discharge stroke care strategies targeting infection prevention, comorbidity management, and elder care.

Histotripsy is a novel ultrasound-guided ablation technique that has been approved by the US Food and Drug Administration as a medical device for the noninvasive destruction of liver tumors. The noninvasive, nonthermal, nonionizing mechanical mechanism by which it destroys tumor tissues makes it an appealing local therapy option in the treatment of patients with early-stage hepatocellular carcinoma (HCC). In this article, the authors review the current evidence base for histotripsy in HCC and explore its potential role in routine care based on technical, safety, and clinical considerations. They then describe the evidence gaps that remain with respect to histotripsy's treatment efficacy, comparative effectiveness, and safety relative to established local therapy options including thermal ablation, transarterial chemoembolization and radioembolization, and stereotactic body radiotherapy. Although the current body of evidence supports the technical feasibility, short-term safety, and early local tumor control of histotripsy in the treatment of patients with HCC, standardized response assessments, rigorous prospective evaluations of durable oncologic outcomes, and direct comparisons with existing therapies in well-defined patient populations are still needed before histotripsy can be fully integrated into standard HCC care.

Accurate staging and metabolic characterization of cervical cancer remains challenging despite advances in imaging. This study investigates the diagnostic utility of dual-phase [18F]FDG PET/CT in cervical carcinoma, with an emphasis on metabolic biomarkers and prognostic indicators.

A prospective study of 50 patients with histopathologically proven cervical cancer was conducted over 24 months. Patients underwent dual-phase [18F]FDG PET/CT imaging with initial whole-body acquisition at 40-60 minutes post-injection and delayed imaging at 120 minutes post-injection following intravenous furosemide administration. Standardized uptake values (SUV), lesion detection efficacy, lymph node characterization, and extra-pelvic metastatic patterns were analyzed using paired t-tests and chi-square analysis.

Mean SUV in initial images (9.074 ± 6.113) increased significantly to 12.964 ± 7.494 in delayed images (p < 0.001), representing a 42.8% increase in metabolic activity. Delayed imaging detected primary lesions in 48 cases (96%) versus 44 cases (88%) on initial imaging, demonstrating superior sensitivity (91.7%) and specificity (100%). Critically, seven patients (14%) demonstrated lymph node visualization only on delayed imaging, and 14% exhibited SUV kinetics consistent with high-grade malignancy. Parametrial involvement occurred in 66% of cases, with 81.8% demonstrating bilateral involvement. Extra-pelvic metastases including supraclavicular lymphadenopathy (10%), hepatic involvement (10%), and skeletal lesions (8%) were detected with superior specificity compared to conventional modalities. This study identified a novel metabolic phenotype: "delayed-accumulator lesions" (DAL), characterized by significant SUV escalation between initial and delayed imaging, associated with aggressive biological behavior and poor prognostic outcomes. Additionally, a mathematical model incorporating dual-phase SUV kinetics, parametrial invasion status, and bilateral lymph node involvement demonstrated superior prognostic stratification (AUC > 0.92) compared to conventional FIGO staging.

Dual-phase [18F]FDG PET/CT provides significantly enhanced metabolic characterization of cervical cancer, identifies novel biological markers predictive of treatment response, and enables metabolically guided precision treatment planning. The identification of delayed-accumulator lesions and dual-phase kinetic modeling represent paradigm shifts in cervical cancer stratification, with the potential to revolutionize treatment intensity selection and surveillance protocols.

Objective.A low-energy x-rays camera-based system has been introduced to image secondary electron bremsstrahlung x-rays, enabling external visualization of proton beam profiles during irradiation. To date, this approach has been demonstrated only in phantom studies and simulations, and has not yet been successfully applied in patients. To overcome this limitation, it is essential to establish the feasibility of SEB x-ray imaging in a clinical condition.Approach.We first optimized the energy window and threshold settings for range estimation by acquiring SEB x-ray images of a water phantom comparable in size to the human lower abdomen, using a cerium doped yttrium aluminum perovskite (YAP(Ce)) x-ray camera with a pinhole collimator. We then performed the firstin vivoSEB x-ray measurement by imaging proton beams during treatment of a patient of prostate cancer with two opposed fields, each delivering an RBE-weighted dose of 1.5 Gy.Main results.In the patient study, SEB x-ray distributions were observed in the measured images using the same energy window as that established in the water phantom study. From these images, the beam ranges were estimated to be within approximately 1 cm of the values calculated by the treatment planning system using the optimized profile threshold. Dynamic imaging at 1 s time intervals was achieved, enabling temporal evaluation of count rate curves.Significance.We present, for the first time, measurements of SEB x-ray images acquired in a patient during proton beam irradiation. These preliminary results indicate thatin vivoSEB x-ray imaging could be a promising approach for clinical real-time beam monitoring in proton therapy.Ethics approval.Ethics approval was obtained from the institutional review board of Kobe Proton Center: approval number: 06-10.

Elicit information from stakeholders to plan implementation of the Extension for Community Healthcare Outcomes (Project ECHO) model in Lebanon to improve cancer diagnosis and treatment in underserved and rural areas.

A qualitative descriptive study guided by the Greenhalgh diffusion of innovation framework. Semi-structured interviews explored five diffusion components: relative advantage, compatibility, low complexity, potential risks, and needed support.

Lebanon.

Twenty-six purposively sampled leaders representing governmental, non-governmental, academic, clinical, and public health sectors.

The interviews were coded and thematically analyzed to characterize the perceived facilitators, barriers, and implementation considerations related to Project ECHO adoption.

Following a standardized introduction to the ECHO model, participants generally perceived the model as acceptable and potentially beneficial for building primary care providers' (PCPs) knowledge and increasing patient access to quality care in underserved communities. Collectively, these leaders recommended careful pilot planning of infrastructure readiness, identification of clinical champions, and the use of performance indicators to monitor and evaluate implementation progress. They identified long-term sustainability, consistent financial support, workforce engagement, and medico-legal considerations as potential barriers to successful ECHO adoption. They viewed the current unstable environment in Lebanon as both a challenge and an opportunity for system transformation through strengthened collaboration, capacity building, and multi-level commitment to improve community health outcomes.

Findings suggest the need for a structured, evidence-based approach to guide the implementation of Project ECHO in Lebanon. Potential early benefits may include strengthening PCP knowledge, confidence, and capacity in underserved communities. The findings provide an evidence-informed foundation for organizations and governmental agencies to support national-level adoption of the ECHO model. Future efforts should prioritize developing a practical action plan that includes provider training, infrastructure development, and sustainable funding to improve cancer care in rural areas.

The incidence of primary central nervous system low-grade B-cell lymphoma (PCNSL-LG) is rare. We aimed to provide the first large-scale analysis of treatment modalities, survival trends, and prognostic factors for PCNSL-LG. Patient data diagnosed between 2000 and 2021 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A total of 267 adult PCNSL-LG patients were included. The year of diagnosis was divided into the time period-1 (2000-2009) and the time period-2 (2010-2021). Radiotherapy alone usage remained stable over time (27.34% vs. 30.22%, p = 0.605). Chemotherapy alone showed a modest, non-significant increase (25.00% vs. 31.66%, p = 0.229), while combined chemoradiotherapy declined significantly from 29.69% to 15.11% (p = 0.004). The 1-, 5-, and 10-year overall survival (OS) rates for all PCNSL-LG patients were 84.3%, 73.4%, and 61.8%, respectively. Overall survival improved significantly, with median OS extending from 11.25 years in period-1 to not reached in period-2 (HR 0.46, 95% CI: 0.28-0.74; p = 0.001). Surgery was associated with improved outcomes compared with non-surgical management (HR 0.47, 95% CI: 0.31-0.72, p < 0.001). In patients with MALT lymphoma histology, no significant prognostic difference was observed across treatment modalities (p = 0.838). This study underscores a marked improvement in survival among PCNSL-LG patients over the past two decades and offers valuable insights for optimizing clinical management and improving patient outcomes.