To investigate the efficacy and safety of MTBF as conditioning regimen for salvage allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with relapsed or refractory acute myeloid leukemia (R/R AML). We conducted a single-arm prospective clinical trial (NCT06385808). The main outcome was cumulative incidence of relapse (CIR), and the secondary outcomes were progression-free survival (PFS), overall survival (OS), engraftment time, graft-versus-host disease (GVHD), and non-hematological adverse effects. Twenty-four R/R AML patients from the First Affiliated Hospital of Xi'an Jiaotong University were enrolled, and all achieved engraftment. Mucositis was the predominant toxicity and was managed appropriately. The two-year CIR was 10%. The two-year OS and PFS were 78.9 ± 11.1% and 51.2 ± 19.3%, respectively. Two patients experienced relapse, and three patients died of infection. Subgroup analyses demonstrated that maintenance treatment post-transplantation may improve OS. The MTBF regimen for salvage allo-HSCT in R/R AML exhibited notable anti-leukemia activity and tolerable toxicity. (NCT06385808, Efficacy and Safety of MTBF Conditioning Regimen for Salvageable Allo-HSCT in the Treatment of R/R AML).

IntroductionA subgroup of pancreatic cancer with unstable genome, such as BRCA mutation, may be more sensitive to platinum-based chemotherapy. How to define the patients with homologous recombination deficiency (HRD) status other than BRCA mutation has been a clinical challenge and interest.MethodsIn this retrospective cohort study, we collected NGS data of 163 pancreatic cancer patients from July 2020 to April 2024. HRD score was calculated by 3DMed-HRD algorithm. The median of HRD score of our study population was used as potential cut-off value to determine HRD status. Cox regression was used to evaluate association of HRD status, platinum-based chemotherapy and overall survival (OS). Kaplan-Meier method with log-rank test was performed to analyze OS among different subgroups.ResultsAmong the 163 patients, the HRD score ranged from 0 to 76. The mean value was 10.48. The median was 6. With a criterion of HRD ≥6 and/or germline Homologous Recombination Repair (HRR) mutation, a total of 89 patients were considered to be HRD+. HRD+ status was associated with a poor prognosis (HR: 1.46, 95%CI:1.01-2.11, p=0.04). Platinum-based all-time usage would reduce the hazard of death by 34% (HR: 0.66, 95%CI: 0.45-0.97, p=0.03). Among the HRD+ subjects, the initiation of platinum-based chemotherapy might be associated with a longer overall survival (OS: 19.92 vs 15.38, Log-Rank test, p=0.09).ConclusionHRD score could be a potential indicator for genome unstable pancreatic cancer patients who would benefit from platinum derivatives. Future study with better design and larger population size would help to determine a proper threshold for clinical application.

This study aimed to systematically characterize the genomic alteration landscape of phosphatidylinositol 4-kinase (PI4K) and phosphatidylinositol phosphate kinase (PIPK) family genes in solid tumors, assess the correlation of these alterations with patient clinical outcomes and the tumor immune microenvironment, and explore their potential as novel biomarkers or therapeutic targets.

A retrospective analysis was conducted on whole-exome sequencing data from a cohort of 2,144 Chinese patients encompassing 18 solid tumor types. Genomic and transcriptomic data from The Cancer Genome Atlas (TCGA) pan-cancer project were integrated to perform survival analysis, correlating genomic alterations, gene expression levels, and patient overall survival. Associations between these gene alterations and tumor mutational burden (TMB), microsatellite instability (MSI), and levels of tumor-infiltrating immune cells were also evaluated.

We identified PI4K/PIPK alterations in 10.5% of 2,144 patients, with PIP4K2C amplification reaching 48%. While PI4K2B amplification and overexpression are consistently associated with poor prognosis in COAD, family-wide effects were highly heterogeneous across cancers. Alterations significantly correlated with higher TMB and MSI-H, and multi-omics analysis revealed tissue-specific immune landscapes, highlighting the family's potential for risk stratification and immunotherapy.

This study provides the first systematic delineation of the genomic alteration landscape of PI4K and PIPK families at a pan-cancer scale within a Chinese population. It identifies PI4K2B as an amplification-driven prognostic biomarker in colorectal cancer, with potential clinical value analogous to HER2. These findings illuminate the significant roles of these kinases in cancer and provide novel insights for future precision oncology strategies.

To assess the impact of psychosocial factors on hepatocellular carcinoma (HCC) treatment decisions, guideline adherence, and patient survival, and to derive empirical insights for shared decision-making (SDM) training in medical education.

In this single-center retrospective cohort study, we analyzed data from 1,928 patients with primary HCC. We collected baseline characteristics, psychosocial factors (payment method, psychological anxiety), treatment choices, and overall survival. Guideline adherence was determined based on the BCLC staging system.

Payment method and psychological anxiety were independent predictors of both treatment selection and guideline adherence (p < 0.05). Overall, only 49.95% of treatment decisions were guideline-adherent. Notably, while guideline-adherent management was associated with better overall survival (p = 0.02), a critical finding emerged in patients with intermediate-stage (BCLC-B) disease. In this subgroup, those treated contrary to guidelines demonstrated a significant survival advantage (p < 0.05).

Psychosocial factors are significant drivers of deviation from clinical guidelines in HCC care, creating a complex relationship with survival outcomes. The paradoxical survival benefit observed in non-adherent BCLC-B patients underscores the limitations of a one-size-fits-all guideline approach and highlights the necessity for individualized, patient-centered care. These findings provide a strong empirical foundation for integrating SDM and psychosocial assessment into medical curricula.

To investigate the diagnostic value of ultrasonography combined with serum parathyroid hormone (PTH) measurement in assessing the viability of autologous parathyroid grafts following endoscopic radical thyroidectomy for thyroid carcinoma.

A retrospective analysis was performed on clinical data of 38 patients who underwent endoscopic unilateral radical thyroidectomy combined with autologous parathyroid transplantation at Gansu Provincial Central Hospital from January 2023 to September 2025. During surgery, parathyroid tissue was transplanted into the brachioradialis muscle of the forearm using the homogenate injection method. Postoperatively, PTH concentration ratios in blood samples from both antecubital fossae and ultrasonographic images of the graft site were periodically evaluated to assess graft viability.

Parathyroid hormone concentration on the transplantation side increased persistently after surgery, reaching a peak at 3 months postoperatively, with a significant elevation in the PTH ratio (28.89-fold) compared to the systemic circulation. Thereafter, the ratio gradually declined but consistently remained >1.5-fold. Ultrasonography performed at 3 months postoperatively revealed hypoechoic nodules of approximately 3 mm in diameter at the graft site in some patients, with punctate blood flow signals detected by color Doppler flow imaging (CDFI).

The combination of ultrasonography and serum PTH concentration ratio provides objective imaging and biochemical evidence for parathyroid graft viability following autologous transplantation, facilitating more accurate assessment of functional recovery of the graft.

Accurately distinguishing benign from malignant indeterminate thyroid nodules is essential to avoid unnecessary diagnostic surgeries. This study aims to develop an online nomogram model that enables precise preoperative assessment of malignancy risk in indeterminate thyroid nodules (ITNs) following fine-needle aspiration, thereby helping to reduce unnecessary thyroidectomies.

Patients with thyroid nodules were recruited from five centers and divided into retrospective training, independent testing, and prospective validation cohorts. Radiomics features and deep learning features were extracted from both B-mode ultrasound (BMUS) and strain elastography ultrasound (SEUS) images for each patient. Malignancy-associated features were selected to construct BMUS and SEUS signature scores, respectively. Multivariate regression analysis was performed on all variables to develop and visualize a comprehensive model for diagnosing benign and malignant ITNs. The model was further evaluated for discrimination, calibration, and clinical usefulness.

Multimodal imaging features, genetic testing, and elastography levels were identified as key biological markers for diagnosing ITNs. The nomogram model built with these variables demonstrated strong performance. The area under the receiver operating characteristic curve was 0.907 (95% CI: 0.877-0.931) in the training set, 0.885 (95% CI: 0.821-0.932) in the external test set, and 0.860 (95% CI: 0.762-0.929) in the prospective validation set. Compared to clinical and individual scoring models, the nomogram demonstrated superior performance and calibration.

The proposed nomogram accurately diagnoses ITNs and holds promise for reducing unnecessary diagnostic thyroidectomies in clinical practice.

Primary cutaneous lymphomas comprise a diverse group of T- and B-cell-related diseases. Their heterogeneity has made diagnosis and classification challenging. Of all the existing subtypes, mycosis fungoides is the most common. We present the case of a 62-year-old Mexican man who had been treated for chronic dermatitis and subsequently underwent a skin biopsy. The biopsy revealed mycosis fungoides, and he is currently being treated with corticosteroids while awaiting re-evaluation to determine if he requires phototherapy. Mycosis fungoides presents a diagnostic and therapeutic challenge among cutaneous lymphomas, characterized by an insidious onset and a multifactorial etiopathogenesis.

Hepatocellular carcinoma (HCC) continues to pose a significant threat to global health, contributing substantially to worldwide cancer-related mortality, particularly in high-incidence regions such as Asia, where current treatment strategies are often limited by poor drug delivery efficiency, systemic toxicity, and drug resistance.

To address these critical challenges, we developed an innovative dual-targeted nanoplatform (Exo-SPIONs-SRF/CGA) that synergistically combines the natural tumour-homing capability of HCC-derived exosomes with the magnetic guidance of superparamagnetic iron oxide nanoparticles (SPIONs) for precision drug targeting. This nanoplatform co-encapsulates SRF and CGA to improve the therapeutic index by enhancing desired responses and minimizing undesired side effects.

The exosome component provides inherent biological targeting to HCC cells. At the same time, the incorporated SPIONs enable external magnetic field-guided spatial control, collectively ensuring superior tumour accumulation compared to conventional delivery systems. Furthermore, the platform's tumour microenvironment-responsive release characteristics ensure localized drug activation, maximizing the therapeutic index through spatial and temporal control of drug availability. In vitro and in vivo evaluations demonstrated that this nanoplatform significantly enhances tumour suppression and drug retention while reducing systemic side effects compared to monotherapies or single-modality nanocarriers.

The Exo-SPIONs-SRF/CGA platform represents a promising strategy in HCC treatment, addressing fundamental limitations of current therapies by simultaneously overcoming biological barriers to drug delivery, enhancing therapeutic efficacy through synergistic drug combinations, and minimizing collateral damage to healthy tissues, thereby advancing the frontier of precision oncology toward more effective and safer HCC management.

Undifferentiated pleomorphic sarcoma (UPS) is a high-grade sarcoma typically seen in older adults; its occurrence in young adults is rare and poses significant diagnostic challenges. We report the case of a 21-year-old female who initially presented with a presumed infectious lesion that proved refractory to standard antibiotic therapy and incision and drainage. Progressive enlargement prompted surgical excision, with pathology demonstrating FNCLCC grade 3 UPS. Histopathologic evaluation revealed a pleomorphic high-grade neoplasm with extensive necrosis and high mitotic activity, while immunohistochemical and molecular studies, including negative MDM2 amplification, supported the diagnosis of UPS. Staging studies demonstrated no evidence of metastatic disease. The patient subsequently underwent wide local re-excision with negative margins, and postoperative MRI demonstrated no residual enhancing mass. During subsequent follow-up, the patient continued oncologic care at Memorial Sloan Kettering Cancer Center. Documentation from December 2025 reported multiple pulmonary lesions identified on surveillance CT imaging. Subsequent biopsy confirmed metastatic sarcoma involving the lungs. The patient was subsequently enrolled in an immunotherapy-based clinical trial at the outside institution. The patient also continued routine follow-up at our institution every six months. Local examination of the right posterior thigh surgical site demonstrated no evidence of local recurrence. At the most recent documented follow-up in March 2026, the patient remained under active multidisciplinary oncologic management with ongoing surveillance. This case highlights the importance of considering soft tissue sarcoma in atypical or nonresolving soft tissue lesions to avoid delays in diagnosis and management.

Osteochondroma, also termed osteocartilaginous exostosis, is the most common benign bone tumour of all benign osseous neoplasms. These lesions typically arise from the metaphyseal region and project away from the adjacent joint. However, intracapsular or intra-articular osteochondromas are rare, especially in the proximal humerus. Here, we report 2 cases of intracapsular osteochondroma of the proximal humerus in a 49-year-old woman and a 14-year-old boy, both with shoulder pain and restricted joint movements. The anteroposterior X-ray and magnetic resonance imaging of the shoulder joint demonstrated a bony lesion with medullary continuity with the parent bone and delineated a thin cartilaginous cap. MRI further enabled precise assessment of the lesion's intra-articular location and cartilage thickness. These cases highlight the emphasis on considering the possibility of intracapsular osteochondroma in the differential diagnosis of unexplained shoulder pain and restricted range of motion. A thorough imaging evaluation, particularly with MRI, is essential for accurate diagnosis, differentiation from other intra-articular pathologies, and appropriate management planning.