Background Multiple Myeloma (MM) is more often characterized by clonal plasma cell proliferation restricted to the bone marrow. However, a small percentage of patients with MM develops extramedullary disease (EMD): this type of localization is found in 1.7-4.5% of the newly diagnosed MM (ND/MM) and in 3.4-10% of patients with relapsed or refractory disease (RR/MM) and seems to have a bad prognostic impact. In the present report, we describe a very rare case of splenic involvement in a patient with ND/MM. Case A 72 years old female was referred in June 2022 with asthenia and abdominal pain. At physical examination, spleen enlargement was detected, with anemia (Hb 10.5 g/dL) and thrombocythopenia (48 x 109/L). Abdominal echography confirmed spleen enlargement (20 cm of longitudinal diameter). Blood tests showed free light chain alteration with a λ/κ ratio of 800. Marrow aspiration showed 60% of λ-restricted immature plasma cells: p53 expression was present in 91% of elements. PET CT scan revealed multiple focal areas of bone increased metabolic activity and a widespread positivity of the spleen with focal areas of higher uptake. Diagnosis of MM with splenic EMD was done and Dara-VMP regimen was started. After the first cycle of therapy, a marked reduction of the spleen size was observed with increase of both Hb level and platelet count. After the 2nd cycle of therapy, however, there was evolution in plasma cells leukemia: Vd-PACE regimen was thus started, but after the 2nd cycle she died in October 2022 from septic shock and multiorgan failure. Conclusions Our very rare case of ND/MM with spleen involvement confirms the aggressive behaviour of EMD, with negative prognostic factors (p53 mutation) and failure to frontline highly effective therapy. In the other few cases of spleen involvement reported, however, there were only scarce details about response: as a consequence, collection of similar cases is warranted to fully understand clinical features and possible alternative approaches for these extremely rare patients.

Objective: To explore the application of the downward flap patch technique in single-port axillary endoscopic breast reconstruction with implants. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent single-port axillary endoscopic breast cancer radical resection with implant-based reconstruction at the Department of Oncology Surgery, Ningxia Medical University General Hospital from August 2020 to March 2023. The patients’ postoperative drainage volume, early complications, and breast reconstruction satisfaction were analyzed using the BREAST-Q questionnaire. Results: The average total drainage volume was 235 ml on the second day after surgery. A total of 8 patients (15.38%) experienced complications, including 7 cases of incision infection, 5 cases of incision dehiscence, and 2 cases of flap necrosis. There were also 2 cases of local flap ischemic necrosis. Seven patients had wound infections, including 3 cases of simple infection, 2 cases of flap necrosis, and 2 cases of combined incision dehiscence. All 52 patients completed the 3-month follow-up without any loss to follow-up. During the follow-up period, no adverse events such as recurrence, metastasis, or death occurred in any of the patients. The BREAST-Q scores of patients who experienced complications were significantly lower than those who did not. Patients with higher postoperative drainage volumes were more likely to develop wound infections. The incidence of flap necrosis and incision dehiscence was not related to postoperative compression dressing or TNM staging, while the incidence of wound infection was related to compression dressing and regional lymph node metastasis. The breast reconstruction satisfaction score was not related to TNM staging. Conclusion: Single-port axillary endoscopic breast cancer radical resection with implant-based reconstruction achieved good results in breast cancer treatment and shaping. The downward flap patch technique is simple to operate, has good implant coverage, and can achieve good breast reconstruction satisfaction.

Objective: To explore the relationship between tumor budding and clinical pathological characteristics and prognosis of cervical cancer; Methods: By searching Pubmed, Embase, Cochren, CNKI and CBM databases, the research studies on the relationship between tumor budding and prognosis or clinic-pathological characteristics of cervical cancer were included. The quality of researches included was evaluated according the Castle Ottawa Scale (NOS) and statistically analyzed by Stata 12.0. Result: A total of 10 studies were included, including 11 cohorts. Including 2017 patients, the NOS score of these studies is more than 6 points. Tumor budding is related to age and tumor size of cervical cancer. In part of pathological characteristics, squamous cell carcinoma, higher stage, lymph node metastasis, distant metastasis, high WHO grade, deep interstitial invasion, Lymphatic vessel vascular space invasion, nerve invasion and para uterine invasion are more likely to occur tumor budding, occurrence of tumor sprouting in C-type cervical adenocarcinoma is higher than that in A/B type; In univariate analysis, there was a significant correlation between cervical cancer tumor sprouting and disease-free survival in patients (RR=6.511,P=0.000), in multivariate analysis, there was also a significant correlation between those (HR=3.358,P=0.001); Subgroup analysis of univariate analysis showed that Asian (RR=1.879, P=0.000), sample size ≤ 300 (RR=1.875, P=0.000), inclusion of squamous cell carcinoma (RR=1.884, P=0.000), staging criteria (FIGO and TNM), and tumor staging (I-II and mixed staging) all had an impact on DFS.Conclusion: The clinical application of tumor budding as a prognostic factor of cervical cancer can be considered.

Background Due to the high mortality rate of oral squamous cell carcinoma (OSCC), early detection of the disease is critical. Despite previous research on potential diagnostic biomarkers, there is no consensus regarding the role and validity of specific biomarkers for OSCC. Aims The purpose of this study was to explore and verify diagnostic biomarkers for OSCC. Methods and Results mRNA expression data of 57 oral tissues from OSCC patients and 22 from individuals without OSCC was analyzed using a moderated t-test to determine potential biomarkers. Statistical analysis revealed 163 differentially expressed genes between OSCC and normal tissues, 68 of which were upregulated in OSCC tissue. The 11 most significantly upregulated genes were determined to be MMP1, MMP3, MMP10, CXCL10, IL8, CXCL11, MMP12, CXCL9, GBP5, RPS4Y1, and MMP13. Conclusions This study suggests that MMPs are especially promising diagnostic biomarkers and therapeutic targets for OSCC and identifies 68 upregulated genes for further research.

Colorectal cancer (CRC) ranks among the top three most prevalent and lethal cancers for men and women. The overall annual CRC incidence rate has decreased Since 1985. However, despite continued overall declines, CRC is rapidly shifting to diagnosis at a younger age. Studies suggest that there were significant differences of early-onset CRC in epidemiology, etiology, molecular features, it is a heterogeneous disease. So further characterization of early-onset CRC is required to reveal the difference in clinical and pathological characteristics as well as prognosis between the 2 groups. It may help improve the treatment strategy in the future.

Design: A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) 2020 Statement. It is registered in the Prospective Registry of International Systematic Reviews (PROSPERO) database. (Registration number: CRD42023447007).[PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, and Chinese Scientific and Technical Journal Database (VIP) were searched from the library’s construction to August 1, 2023. Methods: After literature screening, data extraction, and evaluation of literature quality were independently performed by 2 researchers trained in evidence-based care according to the inclusion and exclusion criteria, and meta-analysis was performed using RevMan 5.4. Results: A total of 6 randomized controlled trials containing 531 patients were included. Meta-analysis showed that IVR-based interventions helped to improve anxiety symptoms [SMD=-2.06,95% CI= (-2.73,-1.40), P<0.0001], depressive symptoms [SMD=-2.31,95% CI=(-4.39,0.23), P=0.03] and fatigue symptoms [SMD=-1.94,95%CI=(-3.18,-0.71), P=0.002]; the qualitative analysis results showed that IVR technology could improve the pain and the quality of life of breast cancer patients, and the difference was statistically significant (P<0.05). Conclusions: IVR technology applied to breast cancer patients can improve their anxiety, depression, pain, fatigue, and other symptoms, and improve their quality of life, and it is interesting and worth promoting. Due to the limited number of included studies and sample size, more large-sample trials are to be conducted to explore the applicability and feasibility of IVR technology in symptom management of breast cancer patients and to validate the above results.

Purpose This study aimed to explore the correlation between morphological parameters and dosimetric parameters of the heart and spinal cord in advanced-stage esophagus cancer (EPC) to provide a reference for clinical treatment. Methods A total of 105 patients with middle- and advanced-stage EPC, who received treatment in our hospital from 2019 to 2021, were included. The morphological parameters were calculated by imaging. Intensity-modulated radiation therapy plan was executed at Raystation4.7. The prescription dose of PTV-G and PTV-C was set as 60Gy/30F and 54Gy/30F, respectively. The linear regression model was used to analyze the correlation between morphologic parameters of EPC and dosimetric parameters of the heart and spinal cord. Results In 105 cases, the total lung length was correlated with the spinal cord D2. The heart Dmean and heart V40 was correlated with PTV-G volume, PTV-G length; In middle- and upper-segment EPC cases, only the total lung volume was correlated with the spinal cord Dmean, spinal cord D2, heart Dmean, and heart V40; In middle-stage EPC cases, the heart Dmean was correlated with the PTV-G volume, PTV-G length. the total lung length was correlated with the spinal cord D2; In middle- and lower-segment EPC, only the PTV-G volume and PTV-G length were correlated with the heart Dmean. All the aforementioned values were statistically significant. Conclusions Combined with the non-segmented tumor and different locations, the organ at risk dose was comprehensively considered.

Tumor lysis syndrome (TLS) is a life-threatening condition caused by the rapid destruction of malignant cells, leading to imbalances in electrolytes and posing risks such as acute kidney injury, arrhythmia, and seizures. This retrospective study aimed to evaluate the incidence of TLS in a cohort of 94 patients with advanced-stage aggressive B-cell malignancies treated with fractionated rituximab, along with usual TLS preemptive measures such as hyperhydration and urate-lowering treatments. The study found that TLS occurred in seven patients, with one case classified as clinical TLS (cTLS) and six as laboratory TLS (lTLS). The incidence of TLS was higher in patients with Burkitt lymphoma compared to diffuse large B-cell lymphoma. TLS occurrence did not significantly influence survival outcomes in this cohort. Comparison with other datasets showed similar TLS rates in patients with high-grade B-cell lymphoma. These findings contribute to the understanding of TLS in B-cell malignancies, highlighting the potential of fractionated rituximab as a debulking approach to manage TLS risk that warrants further investigation in prospective trials.

Background and Objectives: The retroauricular hairline approach is increasingly being used for submandibular gland resections because of the excellent cosmetic results. A meta-analysis of studies compared the retroauricular hairline and conventional approaches for submandibular gland excision. Methods: A meta-analysis of studies identified from the PubMed, Embase, and China National Knowledge Infrastructure databases was performed. Postoperative nerve damage (temporary earlobe numbness and other signs of nerve damage), surgical durations, wound lengths, intraoperative bleeding volumes, postoperative drainage, and lengths of hospital stay were compared. Results: The retroauricular hairline approach led to greater risk of temporary earlobe numbness (OR: 7.28; 95% CI: 1.57–33.87; P = 0.01), but this resolved during the follow-up. There was no significant difference in the risk of other nerve injuries between the two approaches. The retroauricular hairline group had significantly longer operative times and wound lengths compared to the conventional resection group. There were no significant differences between the two approaches in intraoperative bleeding volumes, postoperative drainage, and lengths of hospital stay. Conclusions: The retroauricular hairline approach is a safe and efficient alternative to the conventional approach. It provides better cosmetic results and does not increase the risk of long-term neurological complications.

Background When unfolded proteins accumulate in the endoplasmic reticulum (ER), they cause ER stress and activate the pathways of unfolded protein response (UPR), constituted by a set of canonical ER stress transducing proteins. While the classical UPR is well-studied, the functions of non-canonical ER stress transducers are emerging. Findings The CREB3 (cyclic AMP responsive element binding protein 3) family, which contains five members including CREB3, CREB3L1, CREB3L2, CREB3L3, and CREB3L4, is the most important non-canonical ER stress response factor sensing and modulating unfolded protein homeostasis. As novel ER stress transducers, the CREB3 family plays important roles in regulating protein folding, modification, and secretion, contributing to biological events, including cell proliferation, differentiation, and migration in diverse contexts, especially in cancer. Conclusion This review summarized the roles of the CREB3 family in development and disease progression, with an aim to provide references for further research and clinical translation.

Heart diseases and oncologic diseases are more often found simultaneously worldwide. There is an increasing tendency of both diseases’ incidence due to better diagnostic approaches and increasing aging population. Patients often come to hospital to treat one disease, but during preparation to surgery are found to have another additional. The present study represents the clinical case of patients with concomitant heart and colon disease. The patient underwent simultaneous surgery: CABG and laparoscopic anterior resection. The post-operative period went well with no complications. Patient was discharged with recommendations and referred to further rehabilitation. The chosen treatment method is consistent by many studies and was the best option for our patient.

Background: Recently，epidermal growth factor receptor (EGFR) -targeting drugs have benefited thousands of patients with EGFR mutation-positive (EGFR MUT+) non-small-cell lung cancer (NSCLC). Nevertheless, nearly all patients with NSCLC who were sensitive to first- or second-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs), finally developed resistance. Therefore, numerous clinicians have focused on improving the clinical effect of first-generation EGFR-TKIs (1st-gen EGFR-TKIs). Methods: To analyze the therapeutic outcomes of individuals with progressive NSCLC, a retroactive assessment was performed on 86 patients who were medicated with only icotinib or combined with pemetrexed and platinum-based chemotherapy at The First Affiliated Hospital of Henan University of Science and Technology (HAUST). Results: Eighty-six patients with NSCLC-bearing EGFR-sensitive mutations were retroactively analyzed. The results showed statistical significance in PFS (P = 0.049) and disease control rate DCR (P = 0.031) between icotinib + chemotherapy and icotinib alone, especially in the brain metastases (P = 0.021) and L-858R mutation subgroups (P = 0.05). According to the findings of the multivariate analysis, treatment (P = 0.033) and EGFR mutation status (P = 0.019) were significant predictive variables. The OS comparison between icotinib + chemotherapy and icotinib alone were not significantly different. The study included a total of 1242 patients, of which 648 obtained combined treatment and 594 obtained first-generation EGFR-TKI monotherapy. Analyzing the relevant data from multiple studies, the results showed significant improvements in ORR (RR: 0.63, 95% CI: 0.49–0.82, P = 0.0006), PFS (RR: 0.61, 95% CI: 0.47–0.79, P = 0.0002), and OS (RR: 0.67, 95% CI: 0.51–0.88, P = 0.004) for those on combination therapy. However, there was also an increase in treatment-emergent AEs among these patients. Conclusion: In summary, administering first-generation EGFR-TKI concurrently with chemotherapy provides an edge in the therapeutic management of locally or severely advanced NSCLC that is EGFR-positive. Therefore, EGFR mutation-positive NSCLC (EGFR MUT+ NSCLC) patients in this condition may find it advantageous to consider using 1st-gen EGFR-TKIs in conjunction with chemotherapy (1st-gen EGFR-TKIs + Chemo).

Objective : To evaluate the effects of Complete Decongestive Treatment (CDT) on both cancer-related fatigue and sleep quality using validated and reliable questionnaires in cancer patients is commendable. Material and Metods: 94 patients between the ages of 18 and 75 were included in the study. The demographic characteristics of the patients were recorded. The participants’ Stages of Lymphedema , Hirai Cancer Fatigue Scale (HCFS) score, Pittsburgh Sleep Quality Index (PSQI) Global score, lymphedema-specific quality of life questionnaire (LYMQOL- ARM) score, and Global health status were recorded before and after CDT. Results : The mean age of the patients was 58.49±10.96 years. Strong correlations were found between the severity of edema and global health status . There was a significant positive relationship among the HCFS score, PSQI Global score, LYMQOL- ARM score and CDT. After decongestive physiotherapy, majority of the lymphedema stages were downstaging .(P < 0.05), respectively. There was also a trend toward improvement in general well-being (P < 0.05). Conclusion : In our study, which is the first study to investigate the HCFS score in postmastectomy patients and relationship between PSQI Global score and CDT. The findings identify the risk factors that affect these outcomes in women with lymphedema can provide valuable insights for targeted interventions and improved patient care.

Background: Ubiquitin and ubiquitin-like (UUL) modifications play pleiotropic functions and are subject to fine regulatory mechanisms frequently altered in cancer. However, the comprehensive impact of UUL modification on breast cancer remains unclear. Methods: Transcriptomic and clinical data of breast cancer were downloaded from TCGA and GEO databases. Molecular subtyping of breast cancer was conducted using the NMF and CIBERSORT algorithms. Prognostic genes were identified via univariate, lasso and multivariate Cox regression analyses. Clinical pathological features, immune cell infiltration, immune therapeutic response and chemotherapy drug sensitivity were compared between groups using the Wilcoxon test. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Results: In breast cancer, 63 UUL modification-related genes were differentially expressed, with 29 up-regulated and 34 down-regulated genes. These genes were used to generate two UUL modification patterns that exhibited significant differences in prognostic features and immune cell infiltration. The UUL modification patterns were associated with 2038 differentially expressed genes that were significantly enriched in nuclear division, chromosome segregation, neuroactive ligand-receptor interaction, cell cycle, and other biological processes. Of these genes, 425 were associated with breast cancer prognosis, which enabled the classification of breast cancer into two clusters with significantly distinct prognoses. We developed a prognostic model, UULscore, which comprised nine genes and showed a significant correlation with partial immune cell infiltration. Furthermore, UULscore demonstrated potential predictive value in breast cancer overall survival prediction, immune therapeutic response, and chemotherapy drug sensitivity. UULscore, stage, radiotherapy, and chemotherapy were identified as independent prognostic factors for breast cancer. Based on these factors, a nomogram model was constructed, which demonstrated exceptional prognostic predictive performance. Conclusion: In conclusion, we identified two UUL modification-derived molecular subtypes in breast cancer, and have successfully constructed a risk scoring model that holds potential value in prognosis, immune infiltration, immune therapeutic response, and chemotherapy sensitivity.

Background The high heterogeneity of Hepatocellular carcinoma (HCC) has led to poor clinical outcomes. The critical role of amino acid metabolic reprogramming in tumor growth is gradually emerging. However, amino acid metabolism in HCC is less studied, and the mechanisms still need to be clarified. Methods We acquired transcriptome information on HCC patients from public databases. Amino acid metabolism-related genes (ACRGs) were used as prognostic markers. We built the prognosis-related ACRG_score model using Univariate/Multivariate COX and Lasso regression analyses following stratification by consensus clustering. Furthermore, we assigned HCC patients with high ACRG expression to the high-risk category and others to the low-risk category. We compared clinical characteristics, immune cell infiltration, somatic mutations, and immune checkpoint (IC) genes among the groups. Finally, drug sensitivity and molecular docking analyses were used to identify therapeutic candidates targeting the essential ACRG target proteins. Result We constructed a six-gene ACRG_score model that better predicted the survival prognosis for liver cancer patients, and we validated it using internal and external datasets. In HCC patients, ACRG_score are associated with clinicopathological characteristics and have proven to be an independent prediction factor. Nomogram and calibration curves illustrated the model could correctly forecast patient prognosis. In addition, immune infiltration, Tumor Mutational Burden (TMB), and ACRG_score were revealed to be significantly correlated. IC genes were also present. According to immunohistochemical analysis, HCC tissues had higher EZH2, SLC2A1, and SPP1 expression levels than normal tissues. Additionally, we identified seven candidate small-molecule medications that may bind four of the ACRG essential target proteins. Conclusions: In this study, the ACRG_score model was created to analyze the prognosis, TMB, IC, and therapy responsiveness for HCC patients. This model can predict patient prognosis, guide immunotherapy, provide clinical dosing suggestions, and supply valuable tools for individualized patient treatment.

Objective To investigate the value of quantitative computed tomography (QCT) body composition parameters in assessing the prognosis of patients with resectable rectal cancer (RC). Methods A total of 94 patients with colorectal adenocarcinoma from 2016 to 2021 were retrospectively collected. All patients underwent QCT scan before operation. Skeletal muscle cross-sectional area, total fat area, subcutaneous fat area and visceral fat area were measured, and skeletal muscle index (SMI), total fat tissue index (TATI), subcutaneous fat index (SATI) and visceral fat index (VATI) were calculated. TATI, SATI, and VATI truncation values were obtained to predict postoperative outcomes in RC patients, and sarcopenia (SA) was evaluated by SMI. Results The cut off values of TATI, SATI, and VATI were 106.39 cm 2/m 2, 47.33 cm 2/m 2, and 42.61 cm 2/m 2. The overall incidence of SA was 30.0% (28/94). Tumor N-stage, SA, and VATI were independent risk factors for postoperative outcomes in RC patients ( P < 0.05). The AUC of the nomogram model was 0.844 (95% CI: 0.755 - 0.911). Conclusion Tumor N-stage, SA, and VATI correlated with prognosis in RC patients undergoing surgery. The nomogram model established in this study has some value for evaluating the prognosis of patients with resectable RC.

Background Neuroblastoma (NB) is a childhood cancer of the sympathetic nervous system, and its prognosis is poor. NB undergoes transcription changes to use aerobic glycolysis as its primary metabolic pathway. Aerobic glycolysis provides an immediate source of ATP in metastasis proliferation, and therefore may be exploited in dietary therapies, such as the ketone diet. Procedure In this study, the expression of glycolytic and ketolytic genes in the context of MYCN oncogene amplification, tumor staging, and Kaplan-Meier survivability was investigated using the R2: Genomics analysis and visualisation platform (http://r2.amc.nl). The R2 database is a platform for gene expression and prognostic data for primary tumour samples. Six NB genomics datasets were accessed and further analysed in GraphPad Prism to investigate the relationships between glycolytic and ketolytic gene expression and prognosis. Results Glycolytic gene expression is increased in MYCN amplified, metastatic tumours, and is associated with worse event free survival. Ketolytic gene expression is lower in metastatic tumours and is associated with better event free survivability. The glycolytic gene expression profile of NB suggests that elevated levels correlate with tumorigenicity and low probability of survival. Ketolytic gene expression patterns suggest a decreased reliance for ketolytic energy, which may be exploited to slow tumorigenic growth. Conclusions This study validates the glycolytic gene expression profiles in metastatic and MYCN-amplified NB tumours and suggest the potential use of these genes in prognosis prediction. Furthermore, the study highlights the reliability and utility of the R2 database as an oncogenomic tool for NB research.

Abstract Background: The primary breast sarcoma (PBS) was described in 1887. It was a generic term given to malignant breast tumors. The presentation of a sarcoma of the breast, it is a palpable, growing rapidly mass, with or without nipple discharge, or palpable axillary lymph nodes. The PBS can form masses up to 30cm in diameter. There are many risks factors for developing sarcoma of the breast. Clinical Case: A 57-year-old female presented with a 30 x 30cm tumor of the right breast, bleeding with necrosis of two years evolution. biopsy of the lesion is taken where moderately differentiated chondrogenic sarcoma is reported. Wide resection plus chest wall reconstruction (dorsal flap rotation plus partial thickness graft) was performed. A 45 x 40 cm right chest wall tumor is observed, intraoperative without palpable lymphadenopathy. She discharged from the hospital and continues to be monitored. Conclusion: Breast chondrosarcoma is rare and only a few cases are reported in the literature. The role of adjuvant therapy in these patients is still unclear due to the unusual nature of this tumor.