This study investigated the impact and related mechanisms of single-nucleotide variants (SNVs) in the HBV pre-S/S region on tumor development, and evaluated the role of antiviral therapy.

A retrospective analysis was conducted in 104 patients of the gray zone. HCC-associated SNVs were analyzed in baseline samples.

HCC occurred in 15 patients (14.4%) during the median follow-up period of 10.4 years. Genotype B HBV-infected HCC patients had more T53C, A273G, and A529G SNVs and genotype C HBV-infected HCC patients had more T53C, G633A, and A3120G SNVs than HCC-free groups. Antiviral therapy reduced the risk of HCC in patients with HCC-associated SNVs in the gray zone both genotype B or C. Ectopic expression of replication-competent HBV plasmids in Huh7 cells expressing HCC-associated SNVs resulted in greater impairment of mitochondrial dynamics, increased production of reactive oxygen species (ROS), decreased mitochondrial membrane potential, lower ATP production, higher basal calcium levels, and reduced calcium buffering capacity compared to controls or wild-type HBV-expressing cells.

CHB patients in the gray zone remain at risk for HCC owing to both wild-type and HCC-associated HBV SNVs, especially the latter, inducing mitochondrial and metabolic dysfunctions. Antiviral therapy reduces the risk of HCC development in these patients.

Adenocarcinoma of the esophagogastric junction (AEG) is a common upper gastrointestinal malignancy.

This study investigates the impact of long non-coding RNA NORAD on the short-term efficacy of oxaliplatin-based neoadjuvant chemotherapy in AEG.

Patients with advanced AEG received oxaliplatin-based neoadjuvant chemotherapy. Oxaliplatin- sensitive (PDCs) and oxaliplatin-resistant (PDC-Rs) primary tumor cell lines were established, and NORAD- knockdown PDC-R cells (shNORAD PDC-R) were generated. NORAD expression in pretreatment tumor tissues was measured by qRT-PCR. The half-maximal inhibitory concentration (IC50) was determined for all cell lines.

NORAD expression correlated with Lauren classification. The low-expression group showed higher overall response rate, tumor regression grade, and pathological remission rate after chemotherapy. Pretreatment NORAD expression was an independent predictor of 3-year disease-free survival (DFS). IC50 values for PDC, PDC-R, and shNORAD PDC-R cells were 2.32, 21.41, and 3.82 μg/mL oxaliplatin, respectively.

High pretreatment NORAD expression is an independent risk factor for poor response to neoadjuvant chemotherapy. Downregulating NORAD restores oxaliplatin sensitivity in resistant cells.

Low anterior resection syndrome (LARS) is a common functional complication after sphincter-preserving surgery for rectal cancer that significantly impairs the quality of life. Current postoperative management strategies are suboptimal, and effective preventive approaches are lacking. This study aims to evaluate the impact of a mobile-based, knowledge-enhanced digital intervention for reducing the incidence of major LARS.

This is a multicentre, open-label, parallel-group, randomised controlled trial to be conducted across three academic medical centres in Korea.

A total of 300 adult patients who underwent low anterior resection or stoma reversal after rectal cancer surgery will be randomly assigned in a 1:1 ratio to the intervention group (mobile digital programme) or the control group (standard educational materials). The digital programme includes daily symptom monitoring, exercise suggestions, dietary recommendations and structured feedback from healthcare providers during clinical visits based on outcomes. The primary outcome is the incidence of major LARS (score ≥30) at 12 months postoperatively. Secondary outcomes include longitudinal changes in LARS score, quality of life (European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-Core 30 (C30), EORTC QLQ-Colorectal Cancer 29 (CR29)), European Quality of Life 5 Dimensions Level Version (EQ-5D-5L), patient satisfaction and programme adherence. Statistical analyses will include stratified chi-squared tests and mixed-effects models based on the intention-to-treat principle.

The trial received ethical approval from the Institutional Review Board of the National Cancer Centre, Korea. Written informed consent will be obtained from all participants. The findings will be disseminated through peer-reviewed publications and conference presentations.

NCT07041515.

To identify and explain the challenges of effective pain management in patients with cancer in Iran.

A convergent mixed-methods study.

Oncology departments and palliative care units across multiple healthcare institutions in Iran.

Quantitative phase: 320 healthcare providers, including anaesthesiologists, general practitioners, oncologists, nurses and pharmacists, selected via convenience sampling. Qualitative phase: 10 stakeholders, including patients, caregivers, policy makers and clinicians.

Quantitative data were collected using a psychometrically validated 23-item questionnaire assessing knowledge, attitudes and perceived barriers to cancer pain management. Qualitative data were obtained through semistructured interviews and analysed using Graneheim and Lundman's content analysis method with MaxQDA software. Integration was performed using a side-by-side approach.

Quantitative data showed that over 65% of providers did not routinely assess pain, and only 29.1% believed pharmacological treatments were effective. Qualitative analysis identified 13 barriers across three domains-professional, patient and organisational-spanning physical, psychological, social and spiritual dimensions. Integrated findings revealed consistent patterns of underassessment, legal and cultural resistance and lack of interdisciplinary collaboration. These converging challenges highlight the need for holistic, system-level reform.

The convergence of quantitative and qualitative data reveals a multilayered system of barriers, professional, patient-related and organisational-rooted in physical, psychological, social and spiritual dimensions. These interlinked challenges contribute to fragmented pain management and limited interdisciplinary coordination. Addressing them requires a holistic reform strategy that integrates structural, cultural and clinical solutions.

Spiritual well-being (SpWB) is a critical yet often underexplored component of holistic care for patients with advanced cancer. This study aimed to assess the SpWB and quality of life (QOL) levels and examine their correlation among patients receiving palliative care at a tertiary cancer centre in Kerala, India.

Institution-based cross-sectional observational study among patients with advanced cancer conducted between August 2023 and December 2024.

The outpatient department of a major tertiary-level, autonomous cancer centre under the Government of Kerala, India.

398 patients with advanced cancer aged 18 and above.

SpWB and QOL were measured using validated Malayalam versions of the Functional Assessment of Chronic Illness Therapy-Spiritual well-being Expanded Version and European Organisation for Research and Treatment of Cancer, Quality of Life Core 30 questionnaires, respectively. Data collection included patient self-reports or assistance by a medical social worker.

The median (IQR) age of participants was 59 (51-65) years; most were married (94.5%) and from an upper-lower socioeconomic background (55%). Hinduism was the predominant religion (67.1%). Almost all patients (99%) were aware of their diagnosis, but only 62.3% knew their prognosis. The median (IQR) SpWB score was 67.5 (57-76), significantly higher in females (p=0.02). The median (IQR) QOL score was 50 (41.7-66.7). SpWB was positively correlated with QOL (r=0.766, p<0.01) and negatively correlated with symptoms like constipation, fatigue, nausea, pain, insomnia and appetite loss.

SpWB showed a strong positive correlation with QOL among patients with advanced cancer. Enhancing SpWB may play a pivotal role in improving overall QOL in palliative care settings.

Intraoperative neuromonitoring (IONM) has been increasingly used in thyroid surgery, yet its clinical value remains controversial.

This randomized controlled trial aimed to evaluate the efficacy and safety of IONM in thyroid cancer surgery.

The standardized four-step monitoring protocol was used in the IONM group. Primary endpoints included RLN injury rates and postoperative voice function recovery. Secondary endpoints included surgical parameters (operation time, blood loss), complication rates, and oncological outcomes. Voice function was assessed using VHI-10 scoring and maximum phonation time (MPT). Patients were followed up for a median of 6 months.

The IONM group demonstrated significantly lower rates of temporary vocal cord paralysis (2.0% vs 10.0%, P = 0.038) and higher nerve identification rates (100% vs 96.0%) compared to the control group. Voice function recovery was notably faster in the IONM group, with smaller changes in VHI-10 scores (Δ = 4.2 ± 1.5 vs 7.6 ± 2.1, P < 0.001) and shorter MPT recovery time (14.2 ± 3.5 vs 25.6 ± 5.2 days, P < 0.001). Although operation time was longer in the IONM group (125.6 ± 18.3 vs 108.4 ± 15.7 min, P < 0.001), no significant differences were found in blood loss (45.3 ± 12.6 ml vs 48.7 ± 13.2 ml, P = 0.183), complication rates, or oncological outcomes between the groups.

IONM technology greatly lowers the risk of temporary recurrent laryngeal nerve injury and speeds up voice function recovery in thyroid cancer surgery. Although operation times are slightly extended, the technique is safe and preserves oncological integrity.

DDX41-mutant myeloid neoplasia (MN) is characterized by unique clinical-molecular characteristics and prognosis. However, it is poorly understood how DDX41 mutational constellations drive MN outcomes. We leveraged collaborative resources to test the new 2022 MN diagnostic and prognostic schemes and account for the diverse mutational configurations of DDX41-mutant MN. Diagnostic re-classification from 2016 to 2022 schemes showed an overall shift of 14.9% and 29.7% for DDX41-mutant MDS and AML, respectively. Current prognostic systems (IPSS-R/M and ELN 2017/22) showed poor applicability to DDX41-mutant MN when compared to wild-type counterparts. Dissecting all possible DDX41 configurations, we assigned the greatest prognostic impact to R525H somatic and germline truncating hits. The former impacted most survival outcomes, while the latter were enriched in AML, independently predicting leukemic evolution. Such features had synergistic effects, albeit with different treatment interactions, and were included in DDX41-specific multivariable outcome models, which alleviated the shortcomings of the current prognostic MN algorithms. We here show that current prognostic tools are not able to adequately assess leukemic evolution and survival outcomes in DDX41-mutant MN. Additional risk factors inherent to this MN subentity hold a prognostic significance beyond the consideration of traditional disease-specific variables, substantiating the need for a dedicated risk scoring system.

This study aimed to evaluate the diagnostic value of serum matrix metalloproteinase-9 (MMP-9) and nuclear matrix protein 22 (NMP22) in patients with bladder cancer.

Patients pathologically diagnosed with bladder cancer between January 2023 and January 2024 were included as the experimental group, while healthy individuals undergoing routine physical examinations during the same period comprised the control group. Serum MMP-9 and NMP22 levels were measured via enzyme-linked immunosorbent assay. Diagnostic performance was assessed using receiver operating characteristic curves, and multivariate logistic regression was performed to determine their ability to independently predict tumor-node-metastasis (TNM) stage.

Serum MMP-9 and NMP22 levels were significantly higher in bladder cancer patients compared to healthy controls (p < 0.001). Patients at the T stage showed significantly elevated levels compared to those at the N and M stages (p < 0.001). The areas under the curves for MMP-9, NMP22, and their combination were 0.786 (95% confidence interval (CI): 0.714-0.857), 0.785 (95% CI: 0.714-0.857), and 0.793 (95% CI: 0.725-0.862), respectively, with corresponding sensitivities of 70.00%, 72.00%, and 75.00%, and specificities of 80.00%, 78.00%, and 85.00%. Hematuria (odds ratio (OR): 3.42, 95% CI: 1.89-6.18), frequent urination (OR: 2.44, 95% CI: 1.41-4.22), urinary urgency (OR: 2.18, 95% CI: 1.19-3.99), MMP-9 (OR: 1.01, 95% CI: 1.004-1.016), and NMP22 (OR: 0.98, 95% CI: 0.97-0.99) were identified as independent predictors of TNM stage (p < 0.05). The Cancer Genome Atlas (TCGA) data further confirmed elevated MMP-9 messenger RNA (mRNA) expression in tumor tissues versus adjacent normal tissues (p < 0.001).

Serum MMP-9 and NMP22 levels are significantly elevated in bladder cancer and correlate with TNM stage. Combined detection may improve diagnostic accuracy and clinical utility in bladder cancer diagnosis.

Prostate adenocarcinoma (PRAD) is the most prevalent malignancy in men and frequently evades early detection. However, the role of genes containing adenylate uridylate- (AU-) rich elements (AREGs) in PRAD remains largely uncharacterized.

Publicly available PRAD datasets were analyzed through weighted gene co-expression network analysis (WGCNA) to identify co-expressed gene modules. Unsupervised clustering defined AREG-associated molecular subtypes. Prognostic genes were selected via univariate/multivariate Cox proportional hazards regression (Cox) regression and least absolute shrinkage and selection operator (LASSO) regularization. Tumor immune infiltration was profiled using CIBERSORT and other bioinformatic tools, with functional enrichment revealing associated mechanisms. Single-cell transcriptomics (TISCH2) and drug sensitivity predictions (CellMiner) were integrated. Finally, quantitative reverse transcription polymerase chain reaction (qRT-PCR) validated hub gene expression in PRAD.

We identified three AU-rich element-related prognostic genes: ACSM3, ACTG2, and DES. The low-risk group exhibited enhanced immune pathway activity and elevated tumor-infiltrating immune cell levels compared to high-risk patients. Functional analyses linked high-risk scores to pathways such as glycosylation and proteasome regulation. Single-cell transcriptomics revealed widespread expression of ACSM3, while ACTG2 and DES were fibroblast-enriched. Drug sensitivity predictions suggested Docetaxel as a potential therapeutic agent for high-risk PRAD patients.

In this study, we propose that an AREG-based signature comprising ACSM3, ACTG2, and DES effectively predicts prognosis and reflects immune microenvironment characteristics in PRAD. Through systematic analysis, we established a prognostic model utilizing these three AREGs, which demonstrates strong potential as a clinical predictor for PRAD patient outcomes.

Acute airway obstruction in patients with head and neck conditions often results in a 'can't intubate, can't oxygenate' (CICO) situation, which requires a different management approach than the airway emergency guidelines in the context of anaesthesiology. This systematic review and meta-analysis synthesized and analysed the patient demographics, causes, presentations, complications, operators, and outcomes of emergent surgical airways performed in patients with head and neck conditions, and proposed a targeted management pathway. A total of 1011 emergent surgical airways reported in 14 studies were identified, including 961 tracheostomies and 50 cricothyrotomies. The analysis of patient demographics showed that 79% of the patients were male (95% confidence interval (CI) 73.3-84.1%), and mean age was 56.0 years (95% CI 51.5-60.5 years). The most common underlying cause was neoplasm (56.0%, 95% CI 37.4-73.7%). The most common preceding symptom was dyspnoea (66.6%, 95% CI 44.3-85.7%). The pooled mean complication rate was 16.8% (95% CI 8.8-26.6%). The airway-related mortality rate was 0.2% (95% CI 0.0-0.8%). The odds of successful decannulation were significantly increased in non-malignant tumour cases compared to malignant cases. The odds of complications were significantly increased for emergent surgical airways performed in locations other than the operating room.