Postoperative hypocalcemia is one of the most common complications after parathyroidectomy for Primary Hyperparathyroidism (PHPT). While early hypocalcemia is typically attributed to the sudden withdrawal of Parathyroid Hormone (PTH), late hypocalcemia often resembles Hungry Bone Syndrome (HBS) due to persistent skeletal remineralization. The mechanisms behind early and late hypocalcemia may differ, and clinical importance has been attributed to their identification. Therefore, preoperative biochemical predictors of early and late hypocalcemia post-parathyroidectomy in PHPT patients were studied.

89 patients who underwent isolated parathyroid adenoma excision at Tokat Gaziosmanpasa University Hospital between January 2015 and January 2025 were retrospectively analyzed. Patients with tertiary hyperparathyroidism, those who underwent concomitant thyroidectomy, those with chronic kidney disease, and those with missing data were excluded. Demographic and clinical features, as well as preoperative biochemical data, including corrected calcium, phosphate, alkaline phosphatase (ALP), vitamin D, and PTH, were recorded. Adenoma volume was additionally calculated to better reflect tumor burden. Early hypocalcemia was defined as corrected calcium <8.5 mg/dL within the first 3 postoperative days, while late hypocalcemia was defined as corrected calcium <8.5 mg/dL after the 4th day and postoperatively up to 3 months. Logistic regression analyses were performed to identify predictors.

Early hypocalcemia occurred in 21 patients (23.6%) and late hypocalcemia in 16 patients (18.0%). Eleven patients experienced both early and late hypocalcemia, whereas five developed late hypocalcemia without preceding early hypocalcemia. On univariate analysis, higher preoperative PTH, lower vitamin D, and higher corrected calcium were associated with early hypocalcemia, but only PTH remained significant in multivariate analysis (OR 1.004, 95% CI 1.000-1.008, p=0.047). Late hypocalcemia was associated with elevated PTH, ALP, corrected calcium, larger adenoma size, and lower vitamin D and phosphate. In multivariate models, preoperative PTH remained independently associated with late hypocalcemia, while adenoma volume provided additional prognostic information, suggesting a role of tumor burden in prolonged calcium decline.

In this study, PTH appeared to be the major determinant of early postparathyroidectomy hypocalcemia and late postparathyroidectomy hypocalcemia. However, late postparathyroidectomy hypocalcemia was also affected by adenoma burden, consistent with a clinical picture of hungry bone syndrome. Identification of these associations might enable earlier supplementation and more appropriate postoperative monitoring.

Preoperative PTH may be considered the primary risk stratification parameter in the perioperative period. In this context, it may be possible to think of adenoma burden in identifying a subgroup of patients with a risk of late postoperative hypocalcemia after parathyroidectomy for PHPT.This would probably aid a more focused approach to individualized preventative strategies and improve the management of these patients in the postoperative period.

Mature mediastinal teratomas are benign germ cell tumours that rarely present with extensive involvement of intrathoracic structures. We report the case of a patient with an 11 × 10 × 10 cm heterogeneous anterior mediastinal mature teratoma compressing the right atrium, right ventricle, superior vena cava and aorta with perforation into the right pleural cavity and associated hemidiaphragm elevation. Given the density of adhesions, a median sternotomy was indicated. Extensive intrapericardial adhesiolysis, dissection of tumour and adhesions off the right lung, hemidiaphragm and heart, as well as the great vessels was performed, along with right lung decortication . The mass was ultimately resected as completely as possible en bloc with the involved right pericardium and phrenic nerve. The resected specimen contained hair, fat and calcifications.

Korean Lung Computed Tomography Screening Reporting and Data System (Lung-RADS) category 2b was introduced to reduce false positives in a tuberculosis-endemic setting. Although its clinical validity has been partly demonstrated, interreader agreement in applying category 2b remains unclear. The aim of this study was to evaluate the diagnostic performance and interreader agreement of the modified classification.

This retrospective study included 1,371 participants who underwent low-dose chest computed tomography (CT) scans as part of the Korean national lung cancer screening program between September 2019 and January 2024 at a single tertiary hospital. Korean Lung-RADS incorporates category 2b for nodules that are likely benign-such as tuberculous granulomas or intrapulmonary lymph nodes-even if their size corresponds to category 3 or 4. All CT scans were interpreted using Korean Lung-RADS (version 1.0 until 2021, version 1.1 from 2022 through 2023, and version 2022 implemented in 2024). To compare diagnostic performance, all category 2b nodules were reclassified into original Lung-RADS categories based on nodule size and type, and diagnostic metrics were evaluated for both systems. To assess interreader agreement, three thoracic radiologists independently reviewed nodules initially categorized as 2b to determine whether they would also assign category 2b. Diagnostic performance was compared using McNemar and Park's permutation tests, whereas interreader agreement was analyzed using the Fleiss κ statistic.

Category 2b nodules were found in 29 of the 1,371 participants (2.1%). Among them, one (3.5%) was diagnosed with lung cancer, whereas the remaining 28 (96.6%) were benign. Interreader agreement for 2b categorization was fair (Fleiss κ = 0.35; 95% confidence interval, 0.17-0.56). In terms of diagnostic performance, Korean Lung-RADS demonstrated significantly higher specificity (92.5% vs. 90.4%, P < 0.001) and comparable sensitivity (89.3% vs. 92.9%, P = 1.00) compared with the original Lung-RADS.

Korean Lung-RADS category 2b contributes to reducing false positives in lung cancer screening. However, its subjective nature results in fair interreader agreement, underscoring the need for greater standardization to improve consistency in its application.

Whether a preoperative waiting period before endoscopic resection (ER) adversely affects early gastric cancer (EGC) outcomes remains unclear. This retrospective cohort evaluated whether delays up to 180 days impair oncological and pathological outcomes.

We enrolled 1646 consecutive EGC patients who underwent curative ER between 2010 and 2023. Primary endpoints were overall survival (OS) and disease-free survival (DFS); secondary endpoints included positive resection margins, pathological upstaging, curative resection rate, and additional gastrectomy requirement. Analyses comprised Kaplan-Meier curves, multivariable Cox/logistic regression with time modeled categorically (<30 vs. ≥30 days) and continuously (per 10-day increment), plus restricted cubic spline (RCS) modeling. Sensitivity analysis was conducted after excluding high risk deep submucosal (SM2) lesions.

Median waiting time was 15 days (IQR 11-23); only 2.3% waited >90 days. Linear and RCS analyses showed no independent adverse associations between delays within 180 days and any primary or secondary endpoint (all p > 0.05). Baseline characteristics were well balanced apart from marginal discrepancies in age and family history, which were adjusted in multivariate models. Sensitivity analysis excluding SM2 lesions reproduced consistent neutral survival findings.

Preoperative waiting up to 180 days was not linked to worse EGC outcomes in this cohort. These exploratory results support reasonable 6-month deferral for preoperative assessment, but marked sample‑size imbalance among long-wait patients prevents definitive validation, requiring large prospective multicenter trials.

The polymyxins, polymyxin B and colistin, are last-line options for the treatment of infections caused by drug-resistant gram-negative organisms. The comparative neurotoxicity of these agents using contemporary dosing is poorly understood. We sought to compare the incidence of neurotoxicity among recipients of polymyxin B or colistin.

This was a single-center, retrospective cohort study of all patients who received colistin or polymyxin B for the treatment of a serious gram-negative infection between March 2016 and April 2020. The primary outcome of interest was treatment-emergent neurotoxicity, defined as new-onset perioral paresthesia, non-oral paresthesia, peripheral neuropathy, seizure, diaphragmatic paralysis, or other neurotoxicity. Bivariate analyses were performed using Fisher's exact test and the Wilcoxon rank-sum test; no multivariable analyses were performed.

A total of 82 patients receiving polymyxin B (n = 39) or colistin (n = 43) were identified. Neurotoxicity, nearly exclusively paresthesia, was more commonly seen in recipients of polymyxin B (10/39 evaluable patients, 26%) versus colistin (1/42 evaluable patients, 2%; p < 0.01). Neurotoxicity most commonly developed on the first day of therapy and resolved with discontinuation of therapy or prolongation of the infusion duration.

Polymyxin B is associated with significantly more neurotoxicity than colistin in unadjusted analyses. This potential risk should be considered when choosing between these two agents.

This study explored postoperative breast cancer patients' experiences, perceptions, and barriers associated with breast cancer-related lymphedema (BCRL) screening.

A qualitative descriptive design was employed. Semi-structured interviews were conducted with 20 postoperative breast cancer patients recruited from a tertiary hospital in Suzhou, China, using purposive sampling with maximum variation. Data were analyzed using thematic analysis following the six-phase procedure outlined by Braun and Clarke. Reporting followed the COREQ guidelines.

Four themes were identified: (1) limited understanding and misinterpretation of BCRL risk; (2) motivations and barriers to screening behavior; (3) social and systemic constraints on screening; and (4) self-efficacy and health responsibility. Participants commonly lacked knowledge of BCRL, underestimated their risk, and had limited awareness of its long-term consequences. Screening participation was shaped by perceived benefits, logistical barriers, skepticism regarding effectiveness, and broader social and healthcare system constraints. Self-efficacy and an internalized sense of health responsibility promoted screening despite existing barriers.

BCRL screening behavior reflects an interaction between cognitive appraisal, contextual constraints, and health system factors. Interventions should focus on strengthening survivorship follow-up, clinician communication, and access to screening services.

Treatment-related lymphopenia is common during chemoradiotherapy for glioblastoma and has been associated with adverse outcome. Prior studies have implicated whole-brain V20Gy-V25Gy, mean brain dose, and treatment-volume reduction, but the relative contribution of target size and cerebral dose burden remains uncertain. We evaluated the relationship between brain dose-volume exposure, longitudinal lymphocyte depletion, and landmark outcome in 102 patients with IDH-wildtype glioblastoma.

This retrospective single-center cohort included 102 adults with histologically confirmed IDH-wildtype glioblastoma, paired blood counts, target-volume and brain-DVH data, and clinical follow-up. Absolute lymphocyte count (ALC) was assessed before radiotherapy and at treatment completion. Brain mean dose, V5Gy, V10Gy, V15Gy, V20Gy, V25Gy, integral dose, target volumes, corticosteroid exposure, temozolomide, and clinical-molecular variables were evaluated. V20Gy was used as the principal clinically interpretable dosimetric exposure, with the remaining dose metrics treated as correlated secondary exposures. Multivariable robust linear regression modeled log2 end-of-radiotherapy ALC after adjustment for baseline ALC and major confounders. Survival analyses were anchored at radiotherapy completion.

Median ALC decreased from 1810 to 1050 cells/µL, corresponding to a median relative decline of 42.6%. Grade ≥ 2 and grade ≥ 3 lymphopenia occurred in 33 (32.4%) and 14 (13.7%) patients, respectively. Greater cerebral dose burden was associated with lower lymphocyte preservation. In adjusted models, mean brain dose (β per 5 Gy, - 0.251; 95% CI, - 0.430 to - 0.071; p = 0.006), V15Gy (β per 10% points, - 0.198; p = 0.005), V20Gy (β, - 0.241; p = 0.003), V25Gy (β, - 0.262; p = 0.004), and integral dose (β per 5 Gy·L, - 0.197; p = 0.001) predicted lower end-of-radiotherapy ALC; V10Gy was also significant, whereas V5Gy was not. PTV was strongly correlated with V20Gy (ρ = 0.78, p < 0.001) but showed little direct association with lymphocyte preservation (ρ=-0.06, p = 0.55). Grade ≥ 2 lymphopenia was independently associated with inferior landmark overall survival (HR, 2.43; 95% CI, 1.30-4.56; p = 0.005) and progression-free survival (HR, 2.42; 95% CI, 1.37-4.29; p = 0.004).

Greater cerebral dose burden is associated with treatment-related lymphocyte depletion beyond the information conveyed by target volume alone. The most consistent associations involve mean brain dose, V15Gy-V25Gy, and integral dose, while clinically relevant grade ≥ 2 lymphopenia identifies patients with substantially inferior landmark outcome. These findings support prospective evaluation of immune-sparing radiotherapy strategies that reduce unnecessary cerebral dose exposure without compromising target coverage.

Meningiomas are the most common primary central nervous system tumors and exhibit heterogeneous biological behavior across WHO grades. Emerging evidence suggests that purinergic signaling and immune-related pathways may contribute to meningioma biology.

This study evaluated the expression and activity of CD39/ENTPD1 and CD73/NT5E, the expression of PD-L1/CD274, and the systemic inflammatory profile in patients undergoing surgical resection of meningiomas.

Forty patients were included, with specific subgroups available for molecular, immunohistochemical, enzymatic, and cytokine analyses. Molecular comparisons were restricted to WHO grade 1 and grade 2 tumors. NT5E/CD73 expression was higher in WHO grade 2 tumors at both mRNA and protein levels, whereas CD274/PD-L1 expression was lower. Peripheral CD39/CD73 enzymatic activity also differed between study groups, while plasma cytokines showed non-significant trends toward higher concentrations in patients with WHO grade 2 tumors.

Given the cross-sectional design, small sample sizes for specific analyses, and the absence of direct measurements of adenosine signaling or longitudinal clinical outcomes, these findings should be interpreted as exploratory patterns associated with tumor grade rather than evidence of tumor progression or a causal mechanism of immune evasion. Overall, the results identify CD73 as a candidate biomarker associated with WHO grade, warranting validation in larger, longitudinal, and mechanistic studies.

Following cancer diagnosis, patients regularly request further information regarding alternative complementary therapies besides conventional treatments to better manage treatment-related side effects, improve their quality of life and prolong survival. Many patients turn to integrative medicine approaches and lifestyle changes. A more transparent framework would be required to provide appropriate management, ensure quality control, and limit potential abuses. This study reported real-life data collected during integrative oncology (IO) consultation implemented in a comprehensive cancer center.

This observational, descriptive study used prospective data collected using clinician-rated assessments during IO consultation at inclusion (T0), 3 months (T1), and 6 months (T2) after inclusion.

Among the 50 patients attending an IO consultation at the Léon Bérard Cancer Center, majority were women (n = 45; 90%) with breast cancer (n = 28; 56%), mainly from the wealthy metropolitan areas (n = 22; 44%). Most of them had a first IO consultation duration lasting 60 min (n = 40; 82%), including aromatherapy prescription (n = 35; 74%) and an orientation to supportive care (i.e., psychological support (n = 24; 69%), adapted physical activities (n = 22; 63%). Patients mostly expressed a request for a comprehensive support (n = 37; 74%), improvement in their well-being (n = 34; 68%), or reduction in treatment side effects (n = 33; 66%). At 3 and 6 months, almost all patients were satisfied with the IO consultation (respectively, n = 27/29; 93%, n = 11/11; 100%).

Patients who attended an IO consultation had specific sociodemographic characteristics. The IO consultation contributed to identify supportive care needs and to guide referral to qualified professionals. Referral to complementary therapy (CTh) depended on institutional resources and on the city-hospital network.

Traditional two-dimensional (2D) cell culture systems are inadequate for maintaining numerous intrinsic cellular characteristics inherent to the native three-dimensional (3D) in vivo environment, which can result in misleading experimental outcomes. Hence, there is an urgent demand for innovative 3D tumor models that can be reliably employed in preclinical investigations. As an additive manufacturing technique, 3D bioprinting enables the fabrication of biomimetic 3D structures using a variety of materials, cells, and other small-molecule substances. This capability enables the fabrication of complex biomimetic tissue-like architectures. In this study, we developed an advanced 3D tumor model using 3D bioprinting technology to investigate the phenotypic and molecular expression profiles of gastrointestinal stromal tumor (GIST) cells within this engineered microenvironment. Our findings show that cells within the bioprinted constructs maintained high viability over an extended period following printing. In comparison to conventional 2D monolayer cultures, GIST cells cultured in the 3D bioprinted system exhibited significantly enhanced metabolic activity and improved long-term cell survival. Furthermore, the 3D bioprinted environment promoted cell proliferation and upregulated the expression of key tumor-associated genes. In vivo transplantation experiments revealed markedly higher tumorigenic potential in the 3D bioprinted group relative to the 2D control group. Overall, our 3D bioprinting model effectively recapitulates critical aspects of clinical tumor behavior and disease-relevant phenotypes of GIST. This platform holds strong potential as a highly predictive preclinical tool for drug screening and translational research of GIST, offering a promising alternative to animal testing.