This study evaluated pet owners' perspectives on the use of FreeStyle Libre® - continuous glucose monitoring system for monitoring their diabetic pet, focusing on the sensor's advantages and disadvantages. It sought to assess owner satisfaction with the sensor's usability, as well as owners' perceived impact on their pet's quality of life and diabetes mellitus control.

An anonymous online survey was retrospectively distributed to 65 diabetic pet owners, with 35 responses received (18 cat and 17 dog owners), resulting in a 53% response rate.

In owners' opinion, enhanced diabetes control was observed in 77% of patients, with 57% indicating improved pet's quality of life (compared with quality of life at the time of diagnosis). Ninety-one percent would use the sensor again, and 94% would recommend it to other owners. In 63% of the pets, the sensor remained attached for 11 to 14 days. One pet actively removed the sensor, while in 28% of cases, it detached spontaneously. Owners reported a moderate stress level for themselves (mean 4.57 ± 3.58, 0 to 10 scale; 10 = highest stress) when using the sensor. Although the sensor cost was rated as moderately high (mean 7.37 ± 2.157, 0 to 10 scale; 10 = expensive), overall owner satisfaction was high as well (median 8, IQR = 2, 0 to 10 scale; 10 = very satisfied). Thirty-one per cent of owners were often concerned about the glucose readings.

Continuous glucose monitoring system FreeStyle Libre® is a user-friendly tool associated with high owner satisfaction and good performance with the potential to enhance both pet's and owner's quality of life.

The World Health Organization's goal of hepatitis C virus (HCV) elimination by 2030 remains a challenge. While type 2 diabetes mellitus (T2DM) is associated with HCV infection, identifying unrecognized cases in low-endemic areas is difficult. This study evaluates the feasibility and outcomes of a hospital-based micro-elimination referral program in T2DM patients and explores chronic kidney disease (CKD) stage as a potential risk stratifier.

In this prospective study (March 2022-May 2023), T2DM patients enrolled in a pay-for-performance program underwent routine anti-HCV antibody screening. Seropositive patients were referred to hepatologists for HCV-RNA testing and direct-acting antiviral (DAA) evaluation. We used multivariable logistic regression to identify baseline predictors of HCV viremia and piecewise generalized estimating equations (GEE) to assess the impact of viremia and DAA therapy on estimated glomerular filtration rate (eGFR) trajectories.

Among 4,402 T2DM patients, 104 (2.4%) were anti-HCV positive. Seroprevalence increased across CKD stages 1 to 5 (1.8%, 2.3%, 2.6%, 3.5%, and 7.8%; p = 0.014). Furthermore, among anti-HCV-positive patients, the proportion of advanced CKD (stages 3-5) significantly increased in those with higher Fibrosis-4 (FIB-4) index scores (p = 0.020). Multivariable analysis of HCV viremia identified lower diastolic blood pressure (OR, 0.968; p = 0.017), total cholesterol (OR, 1.012; p = 0.015), triglycerides (OR, 0.991; p = 0.008), and alanine aminotransferase (OR, 1.011; p = 0.006) as independent predictors. While untreated viremia initially appeared to accelerate eGFR decline, this effect was attenuated after adjusting for age and HbA1c. Moreover, eGFR decline trajectories did not change significantly following DAA therapy.

An in-hospital referral program for T2DM patients is feasible for HCV micro-elimination, using CKD staging as a practical risk stratifier. Despite DAA renal safety, diabetes-associated kidney damage may drive post-cure renal progression, necessitating continuous metabolic management.

ERBB2 (formerly termed HER2)-low gastric cancer (GC) has recently gained attention with the development of novel ERBB2-targeted therapies; however, its clinicopathologic features and prognostic significance compared with ERBB2-null disease remain unclear.

To compare clinicopathologic characteristics of ERBB2-low and ERBB2-null advanced GC and assess whether ERBB2 status is independently associated with survival outcomes.

This international, multicenter retrospective cohort study included patients aged 18 years or older diagnosed with advanced metastatic GC between January 2018 and June 2025 at 6 oncology centers across Turkey and Spain. Eligible patients were those with ERBB2-negative disease (ERBB2-low [immunohistochemistry (IHC) score of 1+ or IHC score of 2+ with negative in situ hybridization] or ERBB2-null [IHC score of 0]), consecutively identified from institutional databases. All eligible patients during the study period were included.

ERBB2 expression status, categorized as ERBB2-low or ERBB2-null.

The primary outcomes were progression-free survival (PFS) and overall survival (OS). Factors associated with PFS or OS were evaluated using univariate and multivariable Cox proportional hazards regression models.

Among 522 patients with GC (median [IQR] age, 60 [51-69] years; 345 [66.1%] male), 222 (42.5%) had ERBB2-low tumors and 300 (57.5%) had ERBB2-null tumors. Patients with ERBB2-low GC were older (median [IQR], 62 [53-70] years vs 59 [50-67] years; P = .03) and more often male (159 [71.6%] vs 186 [62.0%]; P = .03) and had worse Eastern Cooperative Oncology Group (ECOG) performance status (39 [17.6%] vs 33 [11.0%] had ECOG score ≥2; P = .04). Liver metastases were more common in the ERBB2-low group (107 patients [48.2%] vs 98 [32.7%]; P < .001), as were elevated carcinoembryonic antigen levels (104 of 189 patients [55.0%] vs 89 of 234 [38.0%]; P < .001). Among patients receiving first-line therapy (488 [93.5%]), median PFS was shorter in the ERBB2-low than in the ERBB2-null group (7.2 months [95% CI, 6.2-8.3 months] vs 8.7 months [95% CI, 7.9-9.6 months]; HR, 1.36 [95% CI, 1.11-1.66]; P = .003), as was median OS (15.8 months [95% CI, 14.1-17.5 months] vs 23.1 months [95% CI, 19.4-26.8 months]; HR, 1.34 [95% CI, 1.09-1.64]; P = .006). However, ERBB2 status was not an independent factor associated with survival (PFS: HR, 1.16 [95% CI, 0.93-1.46]; P = .20; OS: HR, 1.13 [95% CI, 0.89-1.44]; P = .31).

In this cohort study of patients with advanced GC, ERBB2-low compared with ERBB2-null tumors were associated with inferior survival; however, ERBB2 status was not an independent factor associated with survival, indicating that survival differences may have been largely attributable to unfavorable baseline clinical characteristics rather than ERBB2 expression itself. These findings suggest that ERBB2-low status alone may be insufficient for prognostic stratification.

Calcified chondroid mesenchymal neoplasm (CCMN) is a recently described and evolving entity that predominantly arises in the distal extremities andtemporomandibular joint (TMJ) region. CCMN is characterized by FN1 and PDGFRA gene fusions. In the TMJ region, most cases previously described as tophaceous pseudogout (i.e., mass-forming calcium pyrophosphate deposition disease) are now being increasingly recognized as CCMN. There is considerable morphologic overlap between CCMN and tophaceous pseudogout (TPG), and the detection of FN1 and PDGFRA gene rearrangements is critical in distinguishing CCMN from TPG. We aim to identify, from our archival records, cases of CCMN that were previously diagnosed as TPG.

We retrospectively reviewed clinical history and histopathology slides of three cases of TMJ region masses initially diagnosed as TPG, and submitted all three cases for targeted RNA sequencing.

Case 1 harbored a canonical FN1::FGFR2 fusion. Case 2 failed targeted RNA sequencing. Case 3 harbored a canonical PDGFRA::USP8 fusion. None of the three cases had clinical history of pseudogout. All three cases were subsequently reclassified as CCMN on review.

CCMN should be considered as a differential diagnosis in first presentations of 'tophaceous pseudogout' associated with chondroid metaplasia, with targeted molecular testing done as part of the diagnostic process.

Brain metastases (BM) occur in approximately 5-15% of patients with metastatic renal cell carcinoma (mRCC) and are associated with substantial morbidity and inferior survival. Although RCC brain metastases frequently demonstrate hemorrhagic features, the spatial distribution of BM and the prognostic significance of lesion-level imaging characteristics remains incompletely defined.

We conducted a retrospective study of adult patients with mRCC who underwent craniotomy for BM at Johns Hopkins Hospital between 2003 and 2021. Clinical characteristics and treatment data were collected at the time of BM diagnosis. We mapped each metastasis to a standardized brain space and used publicly available brain atlases for anatomic and vascular distribution analyses. We reviewed brain MRI and CT imaging at the time of BM diagnosis and assessed the presence of hemosiderin (in MRI) or hemorrhage (in CT) in each BM lesion. We further analyzed the association between BM features with survival outcomes including overall survival (OS) from diagnosis of brain metastasis and central nervous system progression-free survival (CNS-PFS) from date of craniotomy by Kaplan-Meier methods and multivariable Cox regression. Multivariable models were considered exploratory because of the limited sample size.

Forty-six patients with 67 brain metastases were included. The median age was 59 years, and 76.09% were male. 21.74% had renal vein thrombosis at primary diagnosis. International metastatic renal cell carcinoma database consortium (IMDC) risk classification at BM diagnosis was favorable in 19.57%, intermediate in 60.87%, and poor in 19.57%. By lobar distribution, 44.78% were frontal, 20.90% parietal, 17.91% occipital, 8.96% temporal, and 5.97% cerebellar. Lesions were significantly overrepresented in the PCA territory (34.3% observed vs. 16% expected; adjusted P = 0.003) and in the posterior circulation overall (41.8% observed vs. 30% expected; P = 0.045). Hemosiderin deposition was observed in 82.25% of evaluable lesions and hemorrhage on CT in 81.82%. On univariable analysis, renal vein thrombosis (HR 5.00, 95% CI 1.76-14.20, p = 0.003) and hemosiderin deposition (HR 4.91, 95% CI 1.08-22.37, p = 0.040) were associated with shorter CNS-PFS. Exploratory multivariable analyses demonstrated similar associations, with IMDC poor-risk classification (HR 31.55, 95% CI 2.47-403.65, p = 0.008) and renal vein thrombosis (HR 16.19, 95% CI 2.57-101.90, p = 0.003) remaining independently associated with inferior CNS-PFS. For OS, in exploratory multivariable analysis, systemic therapy before brain metastasis (HR 3.80, 95% CI 1.56-9.29, p = 0.003), IMDC poor-risk classification (HR 4.97, 95% CI 1.17-21.12, p = 0.030) and BM hemosiderin (HR 4.36, 95% CI 1.40-13.60, p = 0.011) were associated with shorter OS while immunotherapy post-craniotomy was associated with longer OS (HR 0.21, 95% CI 0.08-0.58, p = 0.003).

In this surgically managed RCC BM cohort, brain metastases from mRCC demonstrate nonrandom spatial distribution, with overrepresentation in posterior circulation and posterior cerebral artery territories. Hemorrhagic imaging feature, specifically hemosiderin deposition, was highly prevalent and showed potential prognostic significance for survival outcomes. These findings support further investigation of spatial and imaging biomarkers in larger prospective studies.

This study aimed to evaluate the level of financial toxicity (FT) among caregivers of patients with advanced cancer, identify key influencing factors, and examine whether benefit finding (BF) mediates the relationship between family resilience (FR) and FT.

A cross-sectional study was conducted from December 2024 to June 2025 in four public hospitals in Henan province, central China. A total of 286 informal caregivers of patients with advanced cancer completed the General Information Questionnaire, the Financial Toxicity Scale for Cancer Family Caregivers, the Family Resilience Questionnaire, and the Benefit Finding Scale. Data were analyzed using SPSS 26.0 and AMOS 24.0.

The mean FT score among caregivers was 57.3 ± 11.6. Multiple linear regression analysis identified several significant factors of FT, including household disposable savings, tumor metastasis, caregiving alone, place of residence, relationship to the patient, FR, and BF (all P < 0.05). BF partially mediated the association between FR and FT, accounting for 28.4% of the total effect.

Primary caregivers of patients with advanced cancer experience substantial FT. Targeted interventions should prioritize caregivers at higher risk-those with limited savings, caring for patients with distant metastasis, providing care alone, living in rural areas, or being the patient's spouse. Beyond demographic and clinical factors, both FR and BF serve as protective resources, offering new insights for designing strategies to alleviate FT among cancer caregivers.

Gamma Knife radiosurgery (GKRS) is a widely accepted treatment modality for brain metastases and has historically relied on pin-based frame fixation, with a frameless option introduced in recent years. Previous studies suggest similar local control and overall survival between frameless and frame-based GKRS, but data on long-term outcomes remain limited. In this study, we sought to evaluate outcomes of single-fraction frameless GKRS for patients treated at our institution between 2018 and 2024.

We retrospectively reviewed the medical records of patients treated with single-fraction frameless GKRS for brain metastases. Patient characteristics, treatment parameters, local control, freedom from distant recurrence, and overall survival were evaluated, as well as toxicity outcomes such as radiation necrosis and new-onset seizures.

Our cohort included 140 patients with a total of 362 brain metastases. Primary tumor types included non-small cell lung (32%), breast (21%), melanoma (16%), and gastrointestinal (9%). Median marginal dose was 20 Gy, with mean target volume of 0.14 cc (0.04-0.56). Median clinical follow-up time was 2.4 years. At 1- and 2-years post-treatment, local control was 98% (95% CI, 96%-100%) and 97% (95% CI, 94%-99%), respectively. Median overall survival was 2.5 years (95% CI, 1.992-4.271). One patient (0.7%) had symptomatic radiation necrosis following treatment.

In this single-institutional experience, frameless GKRS demonstrated excellent oncologic outcomes, adding to the growing body of literature that frameless-based radiosurgical techniques do not compromise locoregional control. To our knowledge, this is the largest single-institution frameless GKRS cohort reported to date.

Obesity is associated with a worse prognosis in endometrial cancer (EC) patients. While robotic surgery has overcome many technical challenges of morbid obesity, lymphadenectomies are still performed less frequently, leading to understaging and potential undertreatment in highly obese patients. We aimed to assess whether robotic-assisted laparoscopy (RAL) and the implementation of sentinel lymph node biopsy (SLNB) have enabled guideline-compliant nodal staging in morbidly obese patients. Surgical and oncological outcomes were also assessed. This retrospective single-center cohort study included all patients who underwent primary robotic surgery for EC at Tampere University Hospital, Finland, between March 2009 and December 2022. BMI stratified patients into morbidly obese (BMI ≥ 40 kg/m²) and non-morbidly obese (< 40 kg/m²) groups. Primary outcomes were nodal staging rates, bilateral sentinel lymph node (SLN) detection rates, and surgical complications. Cox regression analysis was used to assess survival outcomes. Of the 749 patients, 127 (17%) were morbidly obese and 622 (83%) had a BMI < 40. Following the implementation of SLNB, successful nodal staging was achieved in 87% of morbidly obese patients, with a bilateral SLN detection rate of 78%. Lymphadenectomies were performed less frequently in morbidly obese patients. Intraoperative and postoperative complication rates did not differ between BMI groups. No conversions were recorded in the final five years of the study. Higher BMI was associated with poorer overall survival (HR 1.04, 95% CI 1.02-1.07, p = 0.002), but not with progression-free survival or disease-specific survival. With robotic-assisted laparoscopy and SLNB, appropriate staging was achieved in most morbidly obese patients in this cohort.

Background: Rectal surgery has evolved through the combined efforts of anatomists and surgeons. Minimally invasive surgery has gained recognition over open surgery due to fewer perioperative complications, and faster postoperative recovery. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science to identify studies published between 2014 and December 2024 comparing laparoscopic surgery (LS) and open surgery (OS) for rectal cancer. Primary outcomes included postoperative complications, number of lymph nodes harvested, overall survival, and disease-free survival. Results: Eight randomized controlled trials and one non-randomized study, including a total of 3,935 patients, were analyzed. LS showed a lower incidence of postoperative complications [OR: 0.64; 95% CI, 0.53, 0.77; p=0.008] and a slight advantage in lymph node harvest (WMD: 0.66; 95% CI: -0.63â?"1.95). No significant differences were found in overall or disease-free survival. Conclusions: LS is a safe and effective option for rectal cancer treatment, offering better postoperative recovery and efficient lymph node retrieval, while maintaining long-term oncological outcomes comparable to OS.

Background: Cardiotoxicity associated with antineoplastic therapy may compromise both cardiovascular outcomes and continuity of cancer treatment. We evaluated a multimodal strategy based on radionuclide imaging and molecular biomarkers for early detection of subclinical cardiac dysfunction and for personalized monitoring applicable in multidisciplinary oncologic care. Methodology: In this prospective, observational, single-center study, 90 adults with breast cancer, lymphoma, or lung cancer receiving potentially cardiotoxic regimens were evaluated at baseline (T0), after 3-4 cycles (T1), at treatment completion (T2), and at 6-month follow-up (T3). Antineoplastic exposure was classified according to dominant cardiotoxic profile, including anthracycline-containing regimens, anti-HER2 therapy, platinum/taxane-based chemotherapy, immunotherapy, and targeted agents when used. Monitoring included clinical assessment, ECG, MUGA/gated SPECT, echocardiography with LVEF and GLS, and serial hs-Tn, NT-proBNP, and sST2. Results: Median age was 56 years, and 62% of patients were women. Mean baseline LVEF was 60Ã+-5% and mean GLS â? '19.5Ã+-2.1%. During treatment, hs-Tn, NT-proBNP, and sST2 increased progressively, while LVEF declined to 57Ã+-6% and GLS to â? '16.6Ã+-2.5% at treatment completion. Imaging-defined cardiac dysfunction occurred in 30% of patients, including overt cardiotoxicity in 10%. Changes in hs-Tn correlated most strongly with GLS (r=â? '0.42, p=0.002). The integrated model showed the best predictive performance (AUC 0.91). Conclusions: Beyond diagnostic value, this multimodal model may support multidisciplinary decision-making in surgical oncology by identifying patients who require intensified surveillance, early cardioprotection, preoperative optimization, or adjustment of treatment sequencing. The findings should be interpreted as clinically promising and hypothesis-generating, requiring multicenter validation before routine implementation.