Patients with hematologic malignancies often receive aggressive treatment until the terminal phase and transition to end-of-life (EOL) care less frequently than those with solid tumors. A 2015 survey compared hematologists' and solid tumor-oncologists' attitudes toward EOL care, revealing differences. A decade later, no similar reports have appeared despite therapeutic advances. Therefore, we repeated the survey with additional questions to examine whether perspectives on EOL care have changed.

A 50-item questionnaire was administered to hematologists and gastroenterologists. Responses came from 121 hematologists treating hematologic cancers, 141 gastroenterologists treating gastrointestinal cancer including eight medical oncologists managing both. For analysis, hematologists were compared with 141 gastroenterologists.

In both groups, refractory to standard therapy for cancer was the leading reason for initiating EOL care, with no significant differences. However, hematologists were less likely to transition ≥ 21% of patients to EOL care (p < 0.0001), more likely to register relapsed or refractory patients in clinical trials (p < 0.0001), to administer therapy to patients with 1-month expected survival and Eastern Cooperative Oncology Group performance status of 4 (p < 0.0001), and to cite barriers such as limited transfusions and restrictions on referrals to palliative care wards (p < 0.0001).

Hematologists' continuation of therapy in terminal patients and difficulty referring to palliative wards persisted since 2015, indicating unchanged attitudes. Additional findings confirmed reliance on clinical trials, and emphasis on transfusions, which may hinder timely EOL transitions in hematologic malignancies.

Robotic and laparoscopic approaches are widely used for rectal cancer surgery. Although robotic systems provide enhanced visualization and dexterity, it remains unclear whether these advantages improve postoperative urinary and sexual function.

MEDLINE, Embase, Web of Science, and CENTRAL (2000-2025) were searched for studies comparing robotic and laparoscopic rectal cancer surgery. Outcomes included postoperative ileus, urinary retention, and urinary and sexual function. Random-effects meta-analysis was performed using RevMan. Study quality was assessed with MINORS, and certainty of evidence with GRADE. Publication bias was evaluated using funnel plots and Egger's test.

Forty-four observational studies (6,121 patients) were included. Robotic surgery was associated with lower urinary retention, though this may reflect publication bias. No significant difference was found in postoperative ileus. Subgroup analyses at 3, 6, and 12 months showed no significant differences in urinary or sexual function. Although pooled results slightly favored robotic surgery, these effects were inconsistent, not sustained, and clinically modest.

Robotic surgery may reduce urinary retention but shows no consistent functional superiority over laparoscopy. Outcomes at key follow-up points are comparable. As all studies were observational, evidence certainty is low, and findings should be interpreted cautiously.

Objective:To explore the the local tissue defects caused by the resection of nasal and facial masses, and to evaluate the effectiveness and prognosis of using different local skin flap transfers for repairing based on different defect conditions. Methods:A total of 41 patients who underwent surgical treatment in our department from April 2020 to May 2024 were collected as the research subjects. Different local skin flap transfer repair methods were used according to the location, properties, and scope of the lesions. Postoperative follow-up（12-60 months） was conducted to observe the repair effect and recurrence. Results:As a result, 41 patients（including 9 cases of squamous cell carcinoma, 20 cases of basal cell carcinoma, and 12 cases of various benign lesions） had local skin flaps that survived and achieved Grade A healing. None of the patients received adjuvant radiotherapy or other adjuvant treatments after surgery. Among them, 2 cases（5%） had recurrence and underwent secondary extensive resection surgery without using primary repair. Local tissue defects were left vacant, and local radiation therapy was supplemented. It is planned to follow up for more than 1 year without local recurrence before considering local repair and reconstruction. 95% of postoperative patients expressed satisfaction with the nasal appearance, with no obvious scars, and some patients had local skin color differences. Conclusion:The use of local skin flap transfer for repairing and reconstructing tissue defects after resection of external nasal masses has good results, fewer postoperative complications, and patients are satisfied with the recovery of nasal appearance and function. It also has the advantages of convenient local skin flap removal and minimal trauma. In summary, local skin flap transfer has high clinical application value in the treatment of external nasal masses and is worthy of clinical promotion.

Objective:To investigate the audiological characteristics of unilateral vestibular schwannoma（VS） and their correlations with disease duration and tumor size, and to evaluate the clinical value of pure-tone audiometry（PTA）, speech discrimination score（SDS）, and auditory brainstem response（ABR） in screening and prognostic assessment. Methods:A retrospective analysis was performed on 93 patients with unilateral VS confirmed by surgery and pathology in our hospital from May 2008 to March 2025. PTA, SDS, ABR, and tumor size were analyzed. Correlation analysis and group comparisons were conducted to explore the relationships between audiological parameters, disease duration, and tumor size. Results:The mean age was（47.1±11.3） years. Hearing loss occurred in 97.8% of patients, tinnitus in 63.4%, and vertigo in 37.6%. PTA showed normal hearing in 2 cases and varying degrees of loss in 91 cases, with descending（33.3%） and flat（29.0%） curves being most common. Hearing loss duration was positively correlated with PTA average（r=0.52, P<0.001）, and flat curves were more frequent in longer disease courses. SDS was significantly negatively correlated with PTA average（P=-0.81） and tumor size（P=-0.61）, with a faster decline than PTA. ABR abnormalities were detected in 82.0%-89.5% of cases, with prolonged wave Ⅲ latency, wave Ⅴ latency, Ⅰ-Ⅴ interpeak interval, and interaural Ⅴ wave interval difference being most frequent. The mean tumor size was （20.5±10.6） mm, with stage Ⅲ being most common（46.2%）. Tumor diameter was positively correlated with hearing loss severity（r=0.37, P=0.001）, and Ⅲ-Ⅴ interpeak interval abnormalities were significantly more frequent in tumors>15 mm（P=0.042）. Conclusion:Hearing curve patterns in VS patients are closely related to hearing loss severity, disease duration, and tumor size. ABR demonstrates high diagnostic sensitivity for VS, particularly when tumor diameter exceeds 15 mm, as indicated by increased Ⅲ-Ⅴ interpeak interval abnormalities. Multidimensional audiological assessment can assist in early detection and prognostic evaluation. ABR screening combined with MRI is recommended for patients with unilateral hearing loss.

Objective:To investigate the clinical and imaging characteristics of intralabyrinthine and internal auditory canal（IAC） lipomas so as to improve diagnostic accuracy. Methods:A retrospective analysis was conducted on the clinical follow-up data of 8 patients diagnosed with intralabyrinthine or IAC lipomas at our hospital from January 2017 to September 2024. The diagnostic key points and diagnosis and treatment strategies were discussed with reference to the literature. Results:The cohort comprised 4 males and 4 females, all with unilateral involvement（left: 3; right: 5）, aged 7-61 years. The predominant symptoms were unilateral sensorineural hearing loss（SNHL） with tinnitus（progressive in 5 cases, sudden in 3）. Two patients experienced vertigo. Imaging features: Temporal bone HRCT revealed fat-density lesions（HU: -30 to -100）; MRI demonstrated T1WI hyperintensity, T2WI heterogeneous signals, no contrast enhancement, and signal attenuation on fat-suppressed sequences. Lesion size ranged from 2 to 8 mm. All cases were confirmed by imaging and without surgical intervention. Follow-up duration spanned 6 months to 9 years（mean: 59.3 months）. No tumor growth was observed during follow-up; one patient exhibited worsened hearing loss and tinnitus, while the other 7 had stable symptoms. Conclusion:Imaging is definitive for diagnosing intralabyrinthine and IAC lipomas. These lipomas exhibit indolent growth, making follow-up observation the optimal clinical strategy.

Objective:To investigate the clinical value of thoracoscopic partial parathyroidectomy via the subclavian approach for the treatment of parathyroid adenoma with primary hyperparathyroidism. Methods:A retrospective analysis was conducted on 26 patients with parathyroid adenoma and primary hyperparathyroidism treated between September 2023 and April 2024. Patients were divided into two groups based on surgical approach: the thoracoscopic subclavian approach group and the median anterior cervical open approach group. Multiple indicators, including perioperative parameters, postoperative complications, postoperative pain, and incision cosmetic satisfaction, were compared and analyzed. The clinical efficacy of thoracoscopic partial parathyroidectomy via the subclavian approach was evaluated. Results:All surgeries were completed successfully. There were significant differences between the two groups in terms of operative time and intraoperative blood loss（P=0.001,<0.001）, while there were no statistically significant differences in age, lesion size, preoperative/postoperative serum parathyroid hormone（PTH）, preoperative/postoperative serum calcium, postoperative drainage volume, drainage tube placement time, length of hospital stay, and cost（all P>0.05）. At 24 hours postoperative serum PTH and calcium concentrations were significantly decreased compared to preoperative levels（P=0.012,<0.001; P=0.018,<0.001）. There was no statistically significant difference in the incidence of postoperative complications between the endoscopic and open surgery groups（P>0.05）. At 24 hours postoperatively, the visual analogue scale（VAS） pain scores were comparable between the two groups（P>0.05）. In contrast, cosmetic satisfaction scores were significantly higher in the endoscopic cohort compared to the open surgery group（P=0.003）. Conclusion:Subclavicular approach endoscopic parathyroidectomy is an ideal treatment option compared to the median approach, effectively reducing serum PTH and calcium levels without increasing the risk of postoperative complications, while also satisfying patients' aesthetic needs. The surgery is safe and feasible, and has high clinical application value.

Clonal hematopoiesis of indeterminate potential (CHIP)-associated somatic mutations are associated with increased cardiovascular and cerebrovascular risk in the general population; whether mutations detected at myeloid neoplasm (MN) diagnosis predict incident cardiovascular and cerebrovascular events (CCVEs) is unclear.

We retrospectively studied 203 adults with newly diagnosed myelodysplastic neoplasms, myelodysplastic/myeloproliferative neoplasms, or acute myeloid leukemia unfit for intensive chemotherapy (2016-2023) who underwent pretreatment next-generation sequencing. Cause-specific hazard models adjusted for cardiovascular risk factors assessed associations between CHIP-associated gene mutations and incident CCVEs, including age-stratified and age-by-mutation interaction analyses.

Median age was 68 years (IQR, 61-75); 127 (62.6%) were male; 141 (69.5%) carried ≥1 CHIP-associated gene mutation, most commonly ASXL1, TET2, TP53, or DNMT3A. Over median 12-month follow-up, 74 (36.5%) experienced a first CCVE. Any CHIP-associated gene mutation was associated with CCVE risk in univariable analysis; this association was not significant after multivariable adjustment (adjusted hazard ratio [aHR], 1.58; 95% CI, 0.87-2.88; p=0.13). In joint age-mutation analyses, mutation-positive patients aged ≥70 years had the highest CCVE risk (aHR, 2.77; 95% CI, 1.17-6.56), whereas younger mutation-positive patients showed a nonsignificant trend (aHR, 2.16; 95% CI, 0.90-5.20; p=0.085); interaction was not significant (p=0.29). In multivariable models, CHIP-associated gene mutations, higher-risk MN, and incident CCVEs were each associated with higher all-cause mortality.

CHIP-associated gene mutations at MN diagnosis were not independently associated with incident CCVEs. Older mutation-positive patients had higher observed CCVE risk, predominantly heart failure, with limited precision. These exploratory findings warrant prospective multicenter validation.

The primary goal of the study was to develop folic acid-conjugated eugenol-loaded PLGA nanoparticles for the treatment of breast cancer. Eugenol is reported to have potent anticancer activity. Entrapment of eugenol in folic acid-conjugated polymeric nanoparticles is expected to enhance its availability at the cancer site and improve overall efficacy in breast cancer treatment.

Eugenol was isolated by the column chromatography technique. The isolated bioactive fraction was characterized by IR and NMR analyses. Polymeric NPs were prepared by the solvent emulsification-diffusion method and conjugated with FA by the EDC coupling method. The in vitro release profile for FA-conjugated eugenol-loaded PLGA NPs was evaluated by the dialysis membrane technique. Further in vitro anti-inflammatory activity, in vitro antioxidant assays, and cytotoxicity studies were carried out.

NPs exhibiting particle size ranging from 444.2 to 928.3 nm, zeta potential ranging from -32.0 to -37.7 mV, entrapment efficiency ranging from 76.97% to 87.51%, and percent conjugation were found to be 72.59%-79.68%. The in vitro drug release profiles of the formulations were most effectively described by the Higuchi kinetic model, indicating that the mechanism governing drug release is primarily attributed to diffusion. The FTIR study indicated that there is no chemical modification of the drug, confirming its compatibility with other excipients. The morphology of the NPs was analyzed by FESEM analysis. The particulate nature of NPs showed homogenous, spherical shapes of NPs. The cell cytotoxicity studies on MDA-MB-231 cell lines exhibited enhanced cytotoxicity of the NPs.

In conclusion, it was found that FA-conjugated PLGA NPs can be a suitable platform for the targeted administration of eugenol for BC treatment.

Large-scale studies of germline variants in hereditary cancer susceptibility genes among Chinese epithelial ovarian cancer (EOC) patients remain limited. This study assessed the prevalence and clinical significance of germline variants in 21 genes relevant to hereditary breast and ovarian cancer.

In this multicenter prospective cohort (February 2017-December 2018), 961 unselected EOC patients underwent germline testing for 21 genes. Variant frequencies were compared with international data, and associations with clinicopathologic characteristics and survival outcomes were evaluated.

Pathogenic or likely pathogenic (P/LP) variants were identified in BRCA1 (17.79%), BRCA2 (6.35%), and other homologous recombination (HR)-related genes (2.71%). P/LP variants in non-HR-related genes were rare (0.1%). BRCA1 and BRCA1/2 P/LP variant carriers were more likely to respond to platinum-based chemotherapy (p = .002 and p < .001). Variants of uncertain significance or higher (VUS+) in HR-related genes were associated with better overall survival (hazard ratio, 0.57; p = 0.004) and progression-free survival (hazard ratio, 0.75; p = 0.02), with a trend more pronounced than that observed for BRCA1/2 VUS + carriers.

Over 25% of Chinese EOC patients carry germline HR-related gene variants, which are associated with better treatment response and survival. Broad genetic testing is critical, and the prognostic value of VUS warrants further investigation.

Endoscopic endonasal transsphenoidal surgery has become a cornerstone of minimally invasive skull base surgery, particularly for pituitary neuroendocrine tumors. Advances in endoscopic visualization, navigation systems, and surgical instruments have enabled safe and effective use of a direct transnasal corridor to the sella and adjacent skull base structures. However, successful execution of this approach requires a precise understanding of nasal and paranasal sinus anatomy, as well as meticulous surgical technique during the nasal and sphenoid phases of the procedure. This chapter describes the basic concepts and step-by-step techniques of the endoscopic endonasal transsphenoidal approach, with a special emphasis on nasal cavity expansion, sphenoid sinus access, and sellar floor opening. Key anatomical landmarks, including the lamellar concept of the ethmoid sinus, the sphenoid sinus natural ostium, and the relationship between the internal carotid artery and surrounding structures, are highlighted to enhance intraoperative orientation and safety. Practical guidance on mucosal incision, septal cartilage preservation, bone removal, and reconstruction strategies to prevent cerebrospinal fluid leakage is also provided. This chapter aims to establish a practical foundation for novice and intermediate surgeons, facilitating a safe transition to more advanced endoscopic skull base procedures through systematic anatomical understanding and standardized surgical techniques.