Chemotherapy causes physiological, psychological, and social impairments in patients with cancer. Frailty reduces the effectiveness of chemotherapy and increases the toxicity associated with radiotherapy and chemotherapy, the possibility of chemotherapy failure, and adverse outcomes. However, factors affecting chemotherapy-related frailty in patients with cancer remain unclarified.

This systematic review aimed to identify risk factors driving frailty progression during chemotherapy in patients with cancer.

A comprehensive systematic search was conducted on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP), and SinoMed for observational studies (cohort, cross-sectional, or case-control) on factors affecting the debility-of-chemotherapy stage in patients with cancers between the inception of the database and February 2025, with an updated search executed in May 2025. Literature screening, quality evaluation using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist, and data extraction were conducted independently by 2 authors. Meta-analysis, effect size combination, sensitivity analysis, and publication bias analysis were performed using RevMan (version 5.4; The Cochrane Collaboration) and R (version 4.4.3; R Foundation).

The analysis comprised 14 studies (8 cross-sectional, 2 repeated cross-sectional, 3 cohort, and 1 mixed-design), including 3879 patients with cancer and 23 influencing factors. Methodological quality assessment using Agency for Healthcare Research and Quality (mean 8.8, SD 1.3, 95% CI 7.9-9.7; SE 0.4) and Newcastle-Ottawa Scale (mean 8.0, SD 1.0, 95% CI 6.7-9.3; SE 0.6) revealed 73% (8/11) of cross-sectional studies as high-quality. The meta-analysis showed a 35% (95% CI 22%-50%) prevalence of frailty during chemotherapy in these patients. Cancer stage (odds ratio 1.99, 95% CI 1.64-2.42), chemotherapy frequency (odds ratio 2.60, 95% CI 1.83-3.70), transfer (odds ratio 2.18, 95% CI 1.50-3.17), hemoglobin (odds ratio 0.29, 95% CI 0.18-0.47), white blood cell (odds ratio 0.37, 95% CI 0.21-0.65), comorbidity (odds ratio 1.93, 95% CI 1.30-2.86), and hypoproteinemia (odds ratio 1.74, 95% CI 1.31-2.30) were risk factors for frailty in patients at the chemotherapy stage.

Frailty during chemotherapy was strongly associated with advanced cancer stage, frequent treatment cycles, metastasis, anemia, leukopenia, comorbidities, and hypoproteinemia. Clinically actionable findings emphasized hemoglobin and albumin monitoring as preventive targets, while heterogeneity in assessment tools and population bias limited generalizability. The integration of frailty screening into chemotherapy workflows is urgent to mitigate treatment-related functional decline.

osteosarcoma is the most common malignant bone tumor, but it is rare before adolescence. The clinical behavior of the tumor that develops in pre-adolescents may differ from that seen during adolescence.

This is a retrospective study of pre-adolescents with osteosarcoma diagnosed in a tertiary-level hospital. The patients were compared with adolescents diagnosed during the same period.

we analyzed 149 patients (forty-four pre-adolescents). The diagnostic interval median was 7 weeks in pre-adolescents and 12 weeks in adolescents (p = 0.002). Forty-four patients had metastases at diagnosis (ten pre-adolescents) (p = 0.23). Limb-salvage surgery was performed on sixteen patients (two pre-adolescents). Fifty-six patients (thirteen pre-adolescents) abandoned the treatment (p = 0.18). Overall survival was 63 months in pre-adolescents and 52 months in adolescents (p = 0.301).

We only found differences in the diagnostic interval, which was shorter in pre-adolescent patients. Studies with a larger number of pre-adolescents are necessary to determine the differences in the characteristics of the disease in adolescent patients.

Despite improvements in early cancer diagnosis worldwide, morbidity and mortality in Southern Africa continue to rise owing to challenges with funding, sociocultural beliefs, and health care access. Digital health ("eHealth") has the potential to expand access to health care, particularly to remote communities. However, few studies explored the use of eHealth to support symptomatic cancer diagnosis in Southern Africa.

This study explored the barriers and facilitators to eHealth use by health care workers (HCWs) to support the management of people with symptoms of possible breast, cervical, or colorectal cancer in South Africa and Zimbabwe.

We conducted semistructured in-depth interviews with HCWs (n=56) who managed people with symptoms of possible cancer. Interviews explored the barriers and facilitators to eHealth use and attitudes toward further adoption of eHealth. Interview schedules were guided by the sociotechnical theory, a model "designed to address the socio-technical challenges involved in design, development, implementation, use, and evaluation of eHealth." The interviews were audio-recorded and transcribed. We used the framework method to analyze the data and developed themes that encompassed patterns and meaning in the data to answer the research question.

The median age of participants was 44 (IQR 34-53) years, 38 (68%) were female, and most were nurses (n=34, 61%) or doctors (n=18, 32%). Four core themes were developed: (1) "the lack of reliable infrastructure hindered eHealth use among HCWs"; (2) "the use of personal mobile devices increased eHealth access at the expense of patient privacy and personal cost"; (3) "information, workflow integration, and access"; while eHealth improved access to information, many tools were already in use, were poorly integrated into workflow, and disrupted consultations; and (4) "digital health is expanding whether we like it or not," which describes a spectrum of attitudes toward digital health, ranging from enthusiasm to resistance but willingness to adapt to those completely against its use. Themes from the workshops were concordant with the in-depth interview findings.

To capitalize on the potential benefits of eHealth use among HCWs, such as to support early cancer diagnosis, infrastructural challenges must be addressed, and tools designed to meet user needs and be integrated into clinical workflow. As in many other resource-constrained settings, significant improvements in development are required for the value of eHealth to be realized in Southern Africa. Additionally, where resources such as electricity are limited, their use for eHealth needs to be weighed against use for other priorities such as operating ventilators. Furthermore, energy production in these regions is largely reliant on burning fossil fuels, and thus, the use of eHealth tools risks contributing negatively to climate change. The findings of this study can be used to guide future eHealth design or implementation strategies that are more contextually suitable.

To evaluate the sexual function of couples after surgeries to treat penile cancer.

Patients who underwent partial penectomy or glansectomy at a cancer center, between April 2014 and January 2024, and their partners were interviewed only once, at least six months after surgery, through individually conducted interviews. We used a semi-structured questionnaire, the Six-Item Female Sexual Function Index Scoring (FSFI-6) questionnaire to assess feminine sexual function and the Erection Hardness Score (EHS) and The International Index of Erectile Function-5 (IIEF-5) questionnaire to evaluate erectile function.

Fourteen couples were included in this study. Five patients underwent glansectomy and nine underwent partial penectomy. All of male patients remained sexually active post-procedure. Of the ten who completed the IIEF-5, five (50%) experienced mild erectile dysfunction. Among partners, twelve (85.7%) continued sexual activity. Of the ten partners who completed the FSFI-6, five (50%) had sexual dysfunction. The size of the penile stump was not correlated with satisfaction of the couples. Four (28.6%) patients adopted adaptive strategies, as engaging in sexual activity in a dark environment and use of silicone penile substitutes. All participants expressed dissatisfaction with the medical information provided by their doctors regarding sexuality after penile surgery.

Many couples described sexual dysfunctions after PC surgeries. However, the majority of couples reported maintaining an active sexual life and the majority of the partners reported achieving orgasm. Unfortunately, counseling by healthcare professionals of these couples about sexual health after surgery to treat PC is inadequate.

Spatial transcriptomics (ST) has emerged as an efficient technology for mapping gene expression within tissue sections, offering informative spatial context for gene activities. However, most current ST techniques suffer from low spatial resolution, where each spatial location often contains cells of various types. Deconvolution methods are used to resolve the cell mixture within the spots, but conventional approaches rely on spot-by-spot analyses, which are limited by low gene expression levels and disregard spatial relationships between spots, ultimately reducing performance. Here, we introduce DECLUST, a cluster-based deconvolution method to accurately estimate the cell-type composition in ST data. The method identifies spatial clusters of spots using both gene expression and spatial coordinates, hence preserving the spatial structure of the tissue. Deconvolution is subsequently performed on the aggregated gene expression of individual clusters, mitigating the challenges associated with low expression levels in individual spots. We evaluate DECLUST on simulated ST datasets from a human breast cancer tissue and two real ST datasets from human ovarian cancer and mouse brain. We compare DECLUST to current methods including CARD, GraphST, Cell2location, and Tangram. The results indicate that DECLUST not only maintains the spatial integrity of tissues but also outperforms existing methods in terms of robustness and accuracy. In conclusion, DECLUST provides an effective and reliable approach for identifying cell-type compositions in ST data.

With or without biomarker-directed toripalimab plus chemotherapy could bring significant clinical benefit and acceptable safety profile compared with chemotherapy as first-line treatment for patients with extensive-stage small-cell lung-cancer (ES-SCLC) were demonstrated in EXTENTORCH trial. However, its cost-effective remains uncleared.

The current analysis aimed to evaluate the economic value of intratumor heterogeneity (ITH) testing directed toripalimab plus chemotherapy as first-line treatment for patients with ES-SCLC from the Chinese health-care system perspective.

A mathematical decision model-based cost-effectiveness analysis.

A pharmacoeconomic decision model was developed to simulate 3-week patients transition in 20-year time horizon to access the cost-effectiveness of three competing first-line treatments among ITH-testing directed toripalimab plus chemotherapy, toripalimab plus chemotherapy, and chemotherapy alone. Survival data were obtained from EXTENTORCH trial, cost and utility values were gathered from the dataset and published studies, annual discount rate of 5% was used for cost and utility values. Total cost, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were the model outputs. One-way and probabilistic sensitivity analyses were conducted to estimate the robustness of the model results.

In base-case analysis, compared with toripalimab plus chemotherapy and chemotherapy alone, ITH-testing directed therapy could bring additional 0.14 QALYs and 0.29 QALYs, with marginal costs of $3750.75 and $7778.18, resulting in the ICER of $27,353.27/QALY and $26,461.46/QALY, respectively, which lower than the Chinese willingness-to-pay (WTP) threshold. Sensitivity analyses demonstrated the model results were robust, probabilistic sensitivity analyses showed the probability of ITH-testing directed therapy could be considered cost-effective was 61%.

ITH-testing directed treatment was likely to be the most cost-effective first-line option compared with toripalimab plus chemotherapy and chemotherapy alone for patients with previously untreated ES-SCLC from the Chinese health-care system perspective.

This retrospective cohort study aimed to reevaluate the prognostic impact of sex and determine whether age modifies the effect of sex on cancer-specific survival (CSS) in PTC patients.

Data for PTC patients diagnosed between 2004 and 2015 were retrieved from the SEER database. The primary outcome was CSS. The effect of Sex was evaluated using both relative (hazard ratios, HRs) and absolute measures (survival differences). Additionally, the effect of sex modified by age was assessed using restricted cubic spline curves from the Cox and Poisson models, with further analysis of the interaction between sex and age.

Of 77,349 patients, 16,152 (20.9%) were male. Men exhibited older age, more aggressive clinicopathological features, and received more radioactive iodine treatment. Multivariate Cox analysis determined male sex as an independent risk factor (adjusted HR: 1.46 (1.24-1.70). The 10-year and 15-year survival differences between men and women were 0.46% (95% CI, 0.25%-0.67%) and 0.77% (95% CI, 0.31%-1.22%), respectively. Moreover, a nonlinear effect for sex across age was observed, with HRs for men plateauing below age 50 and decreasing thereafter. Importantly and conversely, before age 50, the absolute survival difference increased slightly with age, but after 50, it significantly widened. Furthermore, A significant negative multiplicative interaction between sex and age was found.

Our analyses provide robust evidence that male sex is indeed an independent risk factor for CSS in PTC patients. Although younger female patients show a relative survival advantage, this does not translate into a substantial absolute benefit, which widens with advancing age.

To investigate the prevalence of vitamin D deficiency and its relationship with all-cause and cause-specific mortality among middle-aged and elderly populations in the U.S.

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. A total of 22,130 participants aged 40-70 years were included. Serum 25-hydroxy vitamin D [25(OH)D] concentrations were measured and categorized. The primary outcome was all-cause mortality, and secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Multivariable-adjusted models and various statistical analyses were employed.

The prevalence of vitamin D deficiency (≤50.00 nmol/L) was 33.59%, and insufficiency (≤75.00 nmol/L) was 71.74%. For all-cause mortality, the multivariate adjusted hazard ratios (HRs) across different 25(OH)D levels (< 25.00, 25.00-49.99, 50.00-74.99, and ≥ 75.00 nmol/L) were 1.00, 0.78 (0.65, 0.93) p = 0.0069, 0.59 (0.49,0.72) p < 0.0001, and 0.54 (0.44, 0.66) p < 0.0001 respectively. Similar patterns were observed for CVD mortality. There was no significant difference in cancer mortality between the moderately deficient and severely deficient groups, but lower mortality was found in the insufficient and sufficient groups compared to the severely deficient group. An L-shaped association between serum vitamin D levels and mortality was identified. Subgroup analyses were consistent with the main findings.

This study found that higher serum 25-hydroxyvitamin D concentrations are linked to lower all-cause, cardiovascular, and cancer mortality. The relationship is nonlinear: increases in concentration reduce death risk below a certain threshold, but above it, the association weakens. Further research is needed to understand causal mechanisms.

Uterine fibroids (UFs) are still mysterious lesions, they are influenced by hormonal imbalances and chronic inflammation, with recent emerging evidence suggesting a role for microbiota. While gastrointestinal and vaginal microbiota in UF patients have been moderately explored, this study uniquely examines endometrial microbiota in women with UFs. Aim of this study was to investigate the microbiota composition in the uterine cavity, cervix and stool using 16S rRNA bacterial gene sequencing, alongside the concentration of bacterial metabolites in stool samples, comparing women with UFs to a control group. Results revealed no statistically significant differences in α- and β-diversity in cervical swab and endometrial tissue samples between patients with UFs and controls. However, detailed analyses highlighted the overrepresentation of Lactobacillus iners in cervical samples of patients with UFs, a species often associated with vaginal dysbiosis. Gut microbiota analysis demonstrated increased Shannon index measured α-diversity in patients with UFs, yet no differences in richness or β-diversity. While short-chain fatty acids (SCFAs) modulate inflammation and immunity, this study found no significant differences in SCFA or amino acid levels, though trends warrant further investigation. The small sample size and microbiota variability limited statistical significance, emphasizing the need for larger studies to unravel microbiota's complex role in UF pathogenesis. In conclusion, the study underscores microbiota's potential impact on gynecological health and highlights avenues for future research, including microbiome-targeted therapies for UFs and related disorders.

This meta-analysis aims to evaluate the efficacy of daratumumab (DAR) in combination with standard therapy for the treatment of high-risk multiple myeloma (HRMM), offering evidence-based insights to guide clinical decision-making.

A comprehensive search was conducted across literature databases to identify studies investigating the use of DAR in HRMM. After removing duplicates, titles, abstracts, and full texts were screened. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). Studies with high risk of bias were excluded. Data on authors, publication dates, study populations, objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events were analyzed using RevMan 5.3 software.

11 studies were included, comprising 2330 patients in the control group (standard therapy) and 2663 patients in the experimental group (DAR plus standard therapy). All studies were rated as having a low to moderate risk of bias. Meta-analysis showed that ORR, PFS, and OS were significantly higher in the experimental group (P < 0.05). The incidence of anemia was lower in the DAR group, while thrombocytopenia and neutropenia were more frequent (P < 0.05). Funnel plot analysis suggested minimal publication bias.

The combination of DAR with standard therapy significantly enhances clinical outcomes in HRMM patients, resulting in prolonged PFS and OS, with manageable adverse effects.