Colorectal cancer (CRC) survivors are at increased risk of cardiovascular-kidney-metabolic (CKM) complications. Although metabolic syndrome (MetS) is a recognized precursor of cardiovascular disease (CVD) in the general population, its prognostic relevance in CRC survivors has not been well established.

We retrospectively analyzed 32,740 patients with a history of CRC who underwent health check-ups recorded in a national hospital-based database between 2005 and 2021. MetS was defined according to the Chinese Diabetes Society (2017) criteria, requiring central obesity (waist circumference ≥90 cm in men or ≥85 cm in women) and at least two of the following components: elevated blood pressure, hypertriglyceridemia, low high-density lipoprotein cholesterol, or elevated fasting glucose. Patients were grouped by MetS status at baseline and followed for composite CVD outcomes, including myocardial infarction, angina pectoris, stroke, and heart failure.

Among 32,740 CRC survivors (median age 58 years; 65.2% male), 4,970 (15.2%) met the criteria for MetS. Over a mean follow-up of 945 ± 770 days, 2,137 composite CVD events occurred. Incidence rates were significantly higher in the MetS group than the non-MetS group (368.2 vs. 200.8 per 10,000 person-years). In multivariable Cox models, MetS was independently associated with elevated CVD risk (HR = 1.36, 95% CI: 1.20-1.54). The association remained significant in male participants (HR = 1.43, 95% CI: 1.24-1.64), but not in females (HR = 1.09, 95% CI: 0.87-1.36). Subgroup analyses revealed consistent associations across strata of age, treatment status, and cancer type, with stronger effects observed in patients without obesity (P for interaction < 0.05). Among individual MetS components, elevated blood pressure and fasting glucose showed the strongest associations with CVD outcomes.

Metabolic syndrome is a significant predictor of cardiovascular events among colorectal cancer survivors in China.

Cytologically indeterminate thyroid nodules constitute 20-30% of fine-needle aspiration samples obtained from suspicious thyroid nodules. Over half of patients with indeterminate thyroid nodules undergo diagnostic surgery; however, 60-80% of excised nodules are benign. While some radiomics studies have built models to enhance the diagnostic efficacy of thyroid nodules, few have focused on indeterminate thyroid nodules with confirmed pathological results. We aimed to develop and evaluate ultrasound radiomics models to improve the diagnosis of indeterminate thyroid nodules and reduce unnecessary surgeries.

We retrospectively analyzed ultrasound images of 197 indeterminate thyroid nodules with definitive pathological results. Regions of interest were manually delineated using 3-Dimensional Slicer software, and radiomics features were extracted using Pyradiomics software. Ultrasound radiomics feature selection and dimensionality reduction were performed using univariate analysis and the least absolute shrinkage and selection operator method. Independent training (n=136) and validation (n=61) cohorts were used to develop three radiomics models. Model performance was evaluated using receiver operating characteristic analysis and compared to two existing assisted diagnostic tools and two junior radiologists.

The Radunion model achieved the highest performance, with 90.5% sensitivity, 56.8% specificity, 75.0% positive predictive value, 80.7% negative predictive value, and 76.6% accuracy. The Radsize model minimized biopsies by 21.1%, reducing the rate from 48.9% to 13.8%. These models outperformed the ITS 100 system, Thynet deep learning-based tools (p < 0.05), and junior radiologists.

Ultrasound radiomics models are promising, convenient, and accurate adjunct tools for predicting malignancy, improving junior radiologists' diagnostic performance, reducing unnecessary biopsies, and enhancing diagnostic precision in clinical practice.

Current preoperative diagnostics inadequately differentiate benign from malignant thyroid follicular neoplasms. This study evaluated the diagnostic utility of thyroid function markers and contrast-enhanced ultrasound (CEUS) features in differentiating follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC), focusing on a novel parameter: the thyroglobulin-to-tumor volume ratio (Tg/Vol ratio).

We retrospectively analyzed 432 resected thyroid follicular neoplasms. A comprehensive comparison was performed regarding baseline characteristics, thyroid function profiles, and CEUS features between FTA and FTC groups through univariate and multivariate binary logistic regression. Diagnostic performance was determined via receiver operating characteristic (ROC) curve analysis. The prevalence of FTC across serum marker subgroups was assessed, followed by the development of a multivariate diagnostic model integrating the Tg/Vol ratio with CEUS characteristics.

Among 432 patients (352 females, 81.5%) with a median age of 47 years, multivariate logistic regression analysis revealed three independent predictors of FTC: capsular involvement (odds ratio [OR] = 9.958, 95% confidence interval [CI]: 2.453 - 40.424, p = 0.001), Tg/Vol ratio >7.412 (OR = 3.508, 95% CI: 1.388 - 8.868, p = 0.008), and male gender (OR = 3.474, CI: 1.751 - 6.891, p < 0.001). Subgroup analyses revealed higher FTC prevalence in patients with Tg > 409.18 μg/L (20.41%, p = 0.002) and Tg/Vol ratio > 20.68 (20.41%, p = 0.009). The combined diagnostic model incorporating Tg/Vol ratio and CEUS features demonstrated 69.4% sensitivity, 77.0% specificity, and the area under the curve(AUC) of 0.769.

While elevated preoperative Tg correlates with malignant potential, but the Tg/Vol ratio emerges as a more robust preoperative discriminator. The combined diagnostic model incorporating Tg/Vol ratio and CEUS features significantly improves FTC detection accuracy.

The study aimed to ascertain the appropriate surgical method for isthmic papillary thyroid carcinoma (PTC).

We reviewed the records of patients who underwent thyroid surgery for PTC in our institution from July 2018 to June 2024. The isthmus was categorized into central isthmus and paracentral isthmus. Data were compared to explore the risk factors of contralateral paratracheal lymph node metastasis (LNM) and the presence of more than 5 metastatic lymph nodes between patients with paracentral isthmic PTC and those with lobar PTC, and between patients with paracentral isthmic PTC and those with central isthmic PTC. Propensity score matching was used to identify a cohort of patients with similar baseline characteristics among patients with paracentral isthmic PTC and lobar PTC to minimize discrepancies in the number between the two groups.

Prelaryngeal and/or pretracheal LNM was confirmed to be an independent risk factor for contralateral paratracheal LNM (OR = 3.43; 95%CI 1.74 - 8.92; p = 0.013) and presence of more than 5 metastatic lymph nodes (OR = 4.55; 95%CI 1.46 - 14.15; p = 0.009) in patients with paracentral isthmic PTC and lobar PTC. While, the location in the paracentral isthmus did not exhibit a significant association with them in these patients. Conversely, being located in the central isthmus was confirmed to be a risk factor for contralateral paratracheal LNM (OR = 4.67; 95%CI 1.53 - 14.21; p = 0.007) and the presence of more than5 metastatic lymph nodes (OR = 4.55; 95%CI 1.46 - 14.15; p = 0.009) among patients with isthmic (central and paracentral) PTC.

Lobectomy with ipsilateral central lymph node dissection might be appropriate for paracentral isthmic PTC without prelaryngeal and pretracheal LNM. Total thyroidectomy with bilateral central lymph node dissection might be necessary for central isthmic PTC.

IntroductionLeft-sided breast cancer radiotherapy requires precise dose modulation to balance target coverage and organ-at-risk (OAR) sparing. This study evaluates a novel Organ and Arc-based Directional Block (OABD Block) in helical tomotherapy planning to address this challenge.MethodsIn this single-institutional retrospective study, 10 post-mastectomy patients with left-sided breast cancer receiving adjuvant radiotherapy were studied. Target volumes included chest wall, internal mammary, axillary, and supraclavicular lymph nodes, with a dose of 50 Gy over 25 fractions. Using a tomotherapy planning system, an OABD Block was configured to incorporate arc structures and protect organs-at-risk. For each patient, helical tomotherapy plans were prepared with and without the OABD Block, keeping field width, pitch, and modulation factors identical. Additionally, static intensity-modulated radiotherapy (IMRT) plans were created on a United Imaging system. Treatment plans were evaluated by dose-volume parameters, conformity and homogeneity indices, and mean doses to targets and normal tissues.ResultsHelical tomotherapy with the OABD Block provided a mean conformity Index of 0.79 for the Planning Target Volume, higher than plans without the block (0.73) but below IMRT plans (0.88). The homogeneity Index averaged 0.14 with the block, 0.18 without, and 0.11 in IMRT. For the internal mammary lymph node region, D95% reached 5007.7 cGy with the block, compared to 5001.1 cGy without and 4897.9 cGy in IMRT. The OABD Block reduced the mean heart dose to 478.7 cGy, compared to 533.5 cGy without and 638.9 cGy in IMRT. Left lung V5 was 48.0% with the block, 52.7% without, and 53.2% in IMRT; V20 was also lowest with the block (17.5%) versus without (20.3%) and IMRT (24.3%).ConclusionAdding the OABD Block to helical tomotherapy improved internal mammary lymph node dose coverage and reduced exposure to organs at risk.

The purpose of this study was to explore the experience of treatment-related decision fatigue in patients with recurrent papillary thyroid cancer. Patients with recurrent papillary thyroid carcinoma who were followed up in thyroid surgery wards and outpatient clinics of three tertiary hospitals in Jiangsu Province were included in this study. Semi-structured interviews were conducted from January to April 2024. Inductive content analysis was used to identify themes. A total of 21 participants, aged 24-58 years, were interviewed. Two themes and six sub-themes were identified: manifestations of decision fatigue including impulsive decision making, hesitation, aggravation of negative emotions, and decision making is a burden; and consequences of decision fatigue including decision regret and delay in decision making. Our study identified the manifestations and adverse consequences of decision fatigue in patients with recurrent papillary thyroid cancer, and helped medical staff to identify and develop personalized interventions as early as possible to help patients make appropriate treatment decisions and improve the quality of decision-making and patient treatment outcomes.

Hematological cancers impair patients' quality of life (QoL) due to prolonged and complex treatments. Digital empowerment programs enhance patient engagement by supporting symptom management and psychosocial well-being.

This study was conducted to examine the effects of patient-centered digital empowerment programs on hematological cancer care.

As part of this study, a comprehensive search was conducted in nine databases and the gray literature in March 2025. The screening included randomized controlled trials without any time restrictions. This study adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Fixed-effect and random-effect models were used in the meta-analysis. Cochran's Q chi-square test and I² statistic were applied to assess heterogeneity. Data analysis was performed using the Comprehensive Meta-Analysis (CMA) 3 software.

A total of seven studies were included in this meta-analysis. Patient-centered digital empowerment programs were found to have moderate and positive effects on depression (Hedges' g = 0.27, p < 0.001), distress (Hedges' g = 0.28, p < 0.001), self-efficacy, and QoL (Hedges' g = 0.22, p < 0.001). There was no significant effect on fatigue levels in patients with hematological cancers (p = 0.27), suggesting that digital empowerment programs may not be effective in managing fatigue. The results of the sensitivity analysis support the robustness and reliability of the study findings.

Digital empowerment programs may serve as a moderately effective tool in improving depression, distress, self-efficacy, and QoL among patients with hematological cancers. However, they exhibit limited effects on physical symptoms, particularly in fatigue management. Therefore, more comprehensive and multidisciplinary interventions are needed to address the management of physical symptoms effectively. Patient-centered digital empowerment programs enable early intervention by assisting healthcare professionals in symptom tracking. Digital solutions enhance care processes by improving patient education, psychosocial support, and self-management skills.

Breast cancer, the most common type of diagnosed cancer in women worldwide, is often associated with the development of lymphedema as a treatment-related effect. Patients undergoing surgery, radiation, or chemotherapy present a higher risk for this side effect. Historically, patients are often not referred to rehabilitation for lymphedema management until the swelling is visible and has progressed, which reduces the chance of reversing the disease progression. Surveillance is key to identifying the earliest signs of breast cancer-related lymphedema, initiating treatment, reversing the disease process, and reducing the impact on function.

The primary goal of this study was to assess the feasibility of monitoring fluid levels in patients with cancer using a bioimpedance analysis home device and to detect any relevant changes that may correlate with an increased risk of developing lymphedema. Remote monitoring by a clinician has not previously been possible, and a comparable bioelectrical water analyzer device has never been available to patients within the comfort of their homes.

The study included 8 adult patients diagnosed with unilateral breast cancer who underwent unilateral lumpectomy or mastectomy, bilateral mastectomy, or reconstruction and were followed for 12 months. Patients also underwent radiation or chemotherapy as part of their treatment before the study and, in some cases, during participation in the study. Clinic visits were required every 3 months, with standard care treatment administered by the clinician, as well as daily fluid monitoring, using the extracellular to total body water (ECW/TBW) ratio obtained with the home device.

Preliminary findings from the 8 cases showed that daily monitoring with the home device is possible, and may aid in the detection of fluid changes due to interventions like radiation or chemotherapy; these changes typically subside after treatment, compared to a permanent fluid increase that may indicate lymphedema. While one participant developed lymphedema, there is insufficient data to generalize the feasibility of early detection using the home device. A significant difference between ECW/TBW ratio measurements taken in the morning and evening (P values<.016) was observed for 6 participants, with morning values being higher than evening ones. Additionally, 7 participants showed a higher ECW/TBW ratio in the affected arm compared to the unaffected arm. On average, the ratio between the two values was higher than 1, approximately 75% of the time. The daily monitoring empowered patients to take charge of their health, with more than half expressing a desire to continue using the home device beyond the end of the study period.

This case report shows the feasibility of daily remote monitoring for patients at risk of developing BCRL using a home bioimpedance analysis device.

Brain tumors and craniotomy surgeries can induce both systemic and neuronal inflammation. Currently, there is a limited amount of literature addressing the influence of anesthetic agents on neuronal and systemic inflammation in neurosurgical settings and its impact on the occurrence of postoperative neurocognitive dysfunction (PND). Our primary objective is to assess the effects of propofol-based total intravenous anesthesia (TIVA) compared to sevoflurane inhalational anesthesia (INHA) with respect to the levels of perioperative inflammatory markers, specifically neuron-specific enolase (NSE) and interleukin-6 (IL-6) in patients undergoing craniotomy for supratentorial tumor surgery. Our secondary objective is to evaluate the correlation of neuronal, systemic inflammatory markers, and the incidence of PND and functional outcomes in patients receiving TIVA versus INHA for supratentorial tumor surgeries. This study protocol details the methodology of a prospective, randomized, and single-center trial approved by the Institutional Ethics Committee and registered with the Clinical Trial Registry of India. The study focuses on patients undergoing craniotomy for supratentorial glioma decompression. Assessing changes in the biomarker level is the primary objective and correlation of this change in biomarker with PND and functional outcome is our secondary objective. The sample size of 45 patients in each group was calculated using n master software by considering alpha of 5%, power of 80%, a mean difference of 79.2 between the groups, and an effect size of 0.603. We describe the study protocol of the single-center trial. The first patient was recruited on September 17, 2023, and we will complete recruitment before March 2025. Our study is expected to inform the impact of anesthesia technique on the biomarkers of the inflammation and consequently PND. Knowledge about this will help the anesthesiologist to select the appropriate anesthetic drug in their clinical practice.

Patients with cancer commonly access cannabis hoping to relieve their symptoms. This study assessed whether a 1:1 10 mg/ml THC:CBD combination oil could improve total symptom burden in patients with advanced cancer over that provided by palliative care alone.

Participants were randomised to medicinal cannabis (MC) or placebo oil; dose escalated over 14 days according to tolerance and efficacy and continued to day 28. Symptoms assessed using the Edmonton Symptom Assessment Scale (ESAS) were summated to give a total symptom distress score (TSDS). The primary outcome measure was the change from baseline in TSDS at day 14. Secondary outcomes included individual symptom scores, opioid use, participant-selected dose, QoL, psychological symptoms, global impression of change (GIC), and adverse effects.

The pre-planned sample size of 120 at day 14 was reached following the randomisation of 144 patients. Mean (SD) TSDS improved over time in both arms (- 6.30 (12.3) MC, - 6.98 (12.56) placebo, p = 0.76) to day 14 with no difference between arms. A statistically significant improvement in ESAS pain scores in the MC arm (mean (SD) - 1.42 (2.15) MC and - 0.46 (2.83) placebo, p = 0.04) was at the expense of greater psychomimetic toxicity. Improvement in general well-being was greater for the placebo. GIC and the pain component of QoL both favoured MC.

Patients can be informed that a 1:1 THC:CBD combination cannabis oil was no better than palliative care alone in palliating symptoms in patients with advanced cancer. A small benefit in pain control was associated with greater toxicity.

Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12619000037101, 14/01/2019.