To explore the association between household coal use duration and upper gastrointestinal cancer and precancerous lesions.

This study is a cross-sectional study. The research subjects were selected from those in Lucheng District and Pingshun County of Shanxi Province who participated in the upper gastrointestinal cancer screening and had complete data. The demographic characteristics, disease history, lifestyle, and household coal usage were collected through standardized questionnaires. A multivariable logistic regression model was used to assess the association between the duration of household coal usage and upper gastrointestinal cancer and precancerous lesions. Subgroup analysis was conducted based on age, gender, region, smoking status, and alcohol consumption. Sensitivity analysis was used to verify the robustness of the results.

A total of 55,820 participants were included, including 783 cases with upper gastrointestinal cancer and precancerous lesions and 55,037 controls. After adjustment for potential confounders, a positive association was observed between the duration of household coal use and upper gastrointestinal cancer and precancerous lesions (OR = 1.13, 95% CI: 1.05-1.24, P = 0.003). Stratified analyses showed statistically significant associations among women, individuals aged ≥65 years, non-smokers, non-drinkers, and residents of Pingshun County. Nevertheless, interaction tests were not statistically significant across all subgroup variables (all P for interaction > 0.05), indicating no evidence of effect modification. Sensitivity analyses demonstrated the stability and robustness of the observed association.

A positive association was observed between the duration of household coal use and upper gastrointestinal cancer and precancerous lesions. Given the cross-sectional nature of this study, causal inferences cannot be established. Prospective studies are warranted to further validate these findings.

Breast cancer significantly affects women globally, with women from low- and middle-income countries like Nigeria presenting late and at significant risk of mortality due to poor early screening. Yet a gap remains in the co-production of a media campaign intervention with women who are not or partially up to date with breast cancer screening using an interpretative phenomenological analytical lens.

Underpinned by a qualitative coproduction approach, a purposive sampling technique was adopted to recruit 11 participants, comprising women who are not or partially up to date with breast cancer from Delta state, who took part in a focus group discussion lasting approximately 90 min. The data was analysed using an interpretative phenomenological analysis lens.

Based on the analyses the study identified the following five superordinate main themes, (i) Misinformation, fear, and the silencing effect of limited awareness, (ii) Inclusive awareness through multi-platform communication, (iii) Concise, compassionate messaging to motivate early screening, (iv) Empowering messages to counter myths and encourage action and (v), Authenticity underpinned by relatability in delivering persuasive health messages.

This study offers valuable insights and original contributions to inform public health messaging policies globally on how culturally attuned, emotionally safe messaging can dismantle barriers and support earlier, more confident engagement with breast cancer screening. It also recommends the testing of the intervention to determine its effectiveness.

Left ventricular (LV) masses, ranging from neoplasms to thrombi, pose diagnostic challenges and significant embolic risks. The traditional surgical approach often involves a ventriculotomy, which can contribute to compromised myocardial function. In the present case series, we aim to report three patients with LV masses of different etiologies managed surgically at a tertiary care center. In the first case, a suspected myxoma attached to the anterior papillary muscle was excised via a trans-mitral approach. Histopathology revealed a rare non-valvular papillary fibroelastoma. In the second case, the patient presented with ischemic cardiomyopathy (left ventricular ejection fraction (LVEF) 40%) and a small apical thrombus, which was managed via a trans-aortic approach, allowing extraction through the aortic valve to preserve ventricular geometry. The third case was a patient with ischemic heart disease (post-percutaneous coronary intervention (post-PCI)) and severe LV dysfunction (LVEF 30%) who presented with a massive (5 × 4 cm) anterior wall thrombus. Access was achieved via the trans-mitral route, facilitating complete extraction of the large burden without ventriculotomy. In this series, we suggest a tiered approach toward LV masses depending on the mass size, location, and patient hemodynamics. Utilizing natural valve orifices (trans-atrial and trans-aortic) to avoid ventriculotomy, particularly in patients with compromised ejection fractions, may improve surgical outcomes by preserving ventricular physiology.

Immune checkpoint inhibitors (ICIs) have become a cornerstone of treatment for metastatic renal cell carcinoma (mRCC). Nivolumab monotherapy remains an established option in previously treated patients; however, real-world data (RWD) from Central and Eastern Europe are limited.

We conducted a retrospective multicenter cohort study using data from the RENIS II registry, including 501 patients with mRCC treated with nivolumab in the second or later line between 2013 and 2025 across the Czech Republic and Slovakia. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), safety, and exploratory analyses of baseline inflammatory indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII]).

Median OS was 24.2 months and median PFS was 8.6 months. The ORR was 28.8% and the DCR was 61.2% in the response-evaluable population. Grade 3/4 adverse events were recorded in 11.4% of patients. In exploratory analyses, higher baseline NLR, PLR, and SII were associated with inferior survival in univariable analyses. In multivariable models, NLR and PLR remained independently associated with OS and PFS, whereas SII did not retain independent prognostic significance.

In this large multicenter real-world cohort, nivolumab monotherapy demonstrated consistent clinical activity and manageable toxicity in previously treated mRCC, with outcomes comparable to those reported in clinical trials and other European real-world studies. Baseline inflammatory indices, particularly NLR and PLR, showed potential prognostic value and warrant further investigation.

The therapeutic landscape of oncology has undergone a profound paradigm shift, transitioning from conventional cytotoxic regimens to a sophisticated era of precision immunotherapy. Despite the remarkable clinical success of immune checkpoint inhibitors, significant challenges such as primary resistance, limited T-cell infiltration in solid tumors, and severe immune-related adverse events persist. As the second volume of "The Role of Immunotherapy in Cancer Therapy and Its Challenges" Community Series, this review systematically evaluates the recent breakthroughs and persistent hurdles in CAR-T cell therapy and bispecific antibodies (BsAbs). We emphasize a critical strategic shift: transitioning these potent modalities from late-stage salvage therapies to earlier treatment lines to preserve the patient's immune repertoire and improve long-term survival. Furthermore, we dissect the molecular engineering of innovative CAR-T and BsAb constructs-such as armored CARs and multi-specific engagers-specifically designed to antagonize the immunosuppressive tumor microenvironment (TME) in solid cancers. A central focus is placed on the optimization of combination strategies, including the synergistic integration of cellular therapies with hematopoietic stem cell transplantation (HSCT) and targeted agents to eradicate minimal residual disease (MRD). By synthesizing the latest clinical data on overall survival (OS) and progression-free survival (PFS), we propose an evidence-based framework for sequential therapy and toxicity management. Ultimately, this review aims to provide a roadmap for the next generation of personalized immuno-oncology, addressing how innovative molecular design and strategic timing can overcome current resistance barriers and redefine the standard of care for refractory malignancies.

Primary intra-abdominal sarcomas in children are rare, aggressive malignancies that often present with non-specific clinical and radiological features. Differentiation from more common pediatric abdominal tumors, such as germ cell tumors, can be challenging, particularly in resource-limited settings with restricted access to advanced pathology and molecular diagnostics.

We report an 8-year-old previously healthy girl from Somaliland presenting with a 2-week history of progressive abdominal distension, weight loss, and low-grade fever. Imaging revealed a large heterogeneous abdominopelvic mass suggestive of a germ cell tumor. Due to limited access to biopsy, empiric germ cell tumor-directed chemotherapy was initiated; however, no clinical or radiological response was observed after two cycles. Exploratory laparotomy identified a large intra-peritoneal mass with omental and nodal involvement, and cytoreductive surgery was performed. Histopathology showed a high-grade malignant neoplasm with pleomorphic round-to-spindle cells and rhabdoid features. Immunohistochemistry demonstrated diffuse desmin positivity and negative myogenin expression; INI1 testing was unavailable, resulting in a diagnosis of primary high-grade intra-peritoneal sarcoma. Despite postoperative chemotherapy, the disease progressed, and the patient died approximately 3 months after treatment.

Early histopathological confirmation is essential in atypical pediatric abdominal masses. Reliance on imaging alone may lead to misdiagnosis and delayed treatment. Limited diagnostic resources remain a major barrier to optimal care in low-resource settings.

Pituitary adenomas (PAs) alter the anatomy of the pituitary gland (PG) and internal carotid arteries (ICAs), requiring accurate segmentation for surgical planning and risk assessment. Multi-sequence magnetic resonance imaging (MRI)-based automatic segmentation methods have been employed but remain limited in routine clinical practice due to protocol inconsistencies. This study aimed to evaluate the feasibility and clinical relevance of Swin-Unet and nnU-Net for automated segmentation of the PA, PG, and ICA using only contrast-enhanced T1-weighted (T1CE) coronal MRI.

A retrospective cohort of 255 patients with surgically confirmed PAs was analyzed. T1CE coronal MRI, acquired from heterogeneous scanners and protocols, was used for model development. Manual annotations of the PA, PG, and ICA by expert neurosurgeons served as ground truth. Two deep learning architectures were evaluated: 1) Swin-Unet, a transformer-based U-Net variant, and 2) nnU-Net, a self-configuring CNN framework. Models were trained using standard preprocessing and five-fold cross-validation, with ensemble predictions generated for final evaluation. Model performance was assessed using the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (HD95), true-positive rate (TPR), and false-positive rate (FPR). Additionally, slice-level presence detection and per-patient processing time were evaluated.

Both models demonstrated comparable voxel-wise performance, with mean DSC = 0.70 (95% CI: 0.66-0.74) for Swin-Unet and 0.69 (95% CI: 0.65-0.73) for nnU-Net. Segmentation accuracy was lower for the PG compared to the PA and ICA. Boundary-based evaluation showed a mean HD95 of 5.21 mm (95% CI: 4.40-6.03) for Swin-Unet and 5.30 mm (95% CI: 4.44-6.16) for nnU-Net. Slice-level recognition yielded a mean F1-score of 0.89 ± 0.09 for Swin-Unet and 0.87 ± 0.08 for nnU-Net across the PA, PG, and ICA, respectively. The mean computation time was 78.4 seconds per patient (95% CI: 61.5-95.5), and the segmentation outputs facilitated approximate 3D reconstructions for qualitative assessment.

Our findings demonstrate the feasibility of automated segmentation of the PA, PG, and ICA using single-sequence T1CE coronal MRI. While voxel-level accuracy was modest, the combination of reliable slice-level recognition, rapid processing, and 3D visualization suggests potential utility as an adjunct tool for radiologic assessment and surgical planning.

Hyperleukocytosis in acute myeloid leukemia (AML) could cause life-threatening complications, including leukostasis and tumor lysis syndrome (TLS). While leukocytapheresis and continuous renal replacement therapy (CRRT) are typically performed independently to maintain hemodynamic stability and manage anticoagulation, their simultaneous application is rarely reported. We report a case of a deteriorating patient with secondary AML treated with simultaneous leukocytapheresis and CRRT. For the CRRT circuit, two separate hemodialysis catheters were placed in the femoral vein (access) and internal jugular vein (return). The leukocytapheresis circuit was then connected to the CRRT return line. The procedure was completed without immediate bleeding or thrombotic complications. Reductions in white blood cell counts, ammonia, and lactic acid levels were observed, along with improved oxygenation. Simultaneous leukocytapheresis and CRRT can be a safe and effective modality for the urgent management of hyperleukocytosis and TLS in critically ill patients.

Cancer-related fatigue (CRF) is highly prevalent and often insufficiently addressed in routine survivorship care. This study examined whether patient activation and patient-physician communication quality in early survivorship are associated with subsequent CRF among cancer survivors.

The observational German LIFT study enrolled 1175 adult survivors of various cancer types. CRF was assessed 4-6, 9, 12, and 24 months post-diagnosis using the EORTC QLQ-FA12. Patient activation was assessed with the German Patient Activation Measure (PAM-13-D (PAM)) and communication quality with an exploratory five-item scale (ComQ) 9 months after diagnosis. Multiple linear regression models examined associations of PAM and ComQ with physical and total CRF 12 months (n = 1132) and 24 months (n = 1067) after diagnosis, adjusting for sociodemographic and clinical covariates. Sensitivity analyses additionally adjusted for previous CRF 4-6 months after diagnosis. Missing data among alive participants were multiply imputed.

PAM at 9 months was negatively associated with physical and total CRF at both 12 and 24 months after diagnosis, whereas ComQ at 9 months was negatively associated with physical and total CRF at 12 months only. After additional adjustment for previous CRF at 4-6 months, negative associations for PAM with physical and total CRF persisted at 12 months but were attenuated.

Higher patient activation and better perceived patient-physician communication were associated with lower subsequent CRF, particularly within the first year after diagnosis. Activation-oriented and communication-focused strategies may complement existing CRF interventions and warrant further evaluation in pragmatic trials across different survivor groups and settings.

SMARCA4-deficient pulmonary neoplasms have emerged as a major focus of lung cancer research in recent years. This subtype is characterized by aggressive behavior and poor prognosis. However, radiotherapy-related studies in this population remain scarce, and evidence is lacking regarding the optimal selection of radiotherapy parameters and the sequencing of combination with immunotherapy. The present study aimed to evaluate the efficacy of radiotherapy in these tumors and to explore the prognostic value of radiotherapy parameters.

Clinical data of 88 patients with SMARCA4-deficient pulmonary neoplasms were retrospectively analyzed. Patients were divided into a radiotherapy group (n=20) and a non-radiotherapy group (n=68). Overall survival (OS) was compared between groups using the Kaplan-Meier method. Subgroup analyses were performed for radiotherapy site, biological equivalent dose (BED), fractionation mode, and the timing of radiotherapy combined with immunotherapy.

The radiotherapy group had a lower proportion of patients aged ≥60 years (25.0% vs 66.2%, P<0.001) and a higher proportion receiving immunotherapy (65.0% vs 33.8%, P=0.013) compared with the non-radiotherapy group. The median OS was not reached in the radiotherapy group, which was significantly superior to that in the non-radiotherapy group (22.9 mon, P=0.048). Among patients receiving radiotherapy, those who also received immunotherapy had a significantly longer median OS than those receiving radiotherapy alone. No statistically significant differences in OS were observed among subgroups stratified by radiotherapy site, BED, fractionation schedule or timing.

Radiotherapy effectively improves OS in SMARCA4-deficient lung tumors, with synergistic potential when combined with immunotherapy. The lack of prognostic impact of radiotherapy parameters supports regimen simplification, while the timing of combined therapy needs refinement. These exploratory results lay a critical foundation for future large‑sample confirmatory studies.