Collusion, the practice of concealing a diagnosis or prognosis from a close relative to prevent emotional distress, is a complex issue in cancer care. This study aimed to estimate the prevalence of collusion among cancer patients and identify the associated factors, including educational status, time since diagnosis, and prognosis. This 6-month cross-sectional study recruited 121 consenting cancer patients (aged >18 years) via convenient sampling at a tertiary care center in South India. Patients with psychiatric conditions or communication difficulties were excluded. The data were collected through qualitative interviews using a modified collusion questionnaire. The overall prevalence of collusion was 26.4%. Significant associations were found with educational status ( P = 0.024), with collusion being highest among those with primary education (40.7%) and lowest in postgraduates (12.2%). Collusion was also significantly associated with time since diagnosis ( P < 0.001), being 88.9% within 1 month and decreasing to 54.2% by 6 months. Caregivers frequently colluded ( P < 0.001) even when the disease was considered partly curable. Among the collusion positive cases, 96.9% of the caregivers were unwilling to discuss the diagnosis and 87.5% unwilling to inform patients about the disease's course or outcome. Collusion is prevalent in cancer patients, particularly among those with lower education levels and in the early postdiagnosis period. Caregivers often withhold comprehensive information, highlighting a need for improved communication strategies in oncology.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only potentially curative therapy for many patients with high-risk myeloid neoplasms, yet relapse and transplant-related toxicity continue to limit durable benefit. Venetoclax (VEN), a selective BCL-2 inhibitor, provides a biologically compelling strategy for conditioning augmentation through chemotherapy sensitization and potential lowering of host immune resistance to engraftment. We performed a hybrid scoping review and evidence-mapping analysis to summarize published clinical experience and the active investigational landscape of VEN-containing conditioning or sequential regimens prior to allo-HSCT. Eighteen studies (20 reports) met the inclusion criteria, including nine published cohorts comprising 238 patients and 11 ongoing clinical trials. Reported platforms were heterogeneous, spanning reduced-intensity, myeloablative, and sequential approaches. Engraftment and graft-versus-host disease outcomes were generally comparable to expected benchmarks, although available data remain preliminary and non-randomized, underscoring that the primary aim of this scoping review is to map existing evidence and ongoing trials rather than to inform clinical practice or guideline recommendations.

Extracorporeal Membrane Oxygenation (ECMO) serves as a temporary life support for critically ill patients, and with its advancing clinical application, survival rates have significantly improved. However, research focus is shifting from saving lives to improving survivors' quality of life. Currently, most studies concentrate on short-term outcomes such as in-hospital mortality, while long-term psychosocial adaptation after discharge remains understudied. Extracorporeal Membrane Oxygenation patients often face psychological distress during Intensive Care Unit stays and multiple challenges after discharge, which can profoundly affect their long-term quality of life and social reintegration. Therefore, it is necessary to conduct an in-depth study on the psychosocial adaptation of ECMO survivors and its influencing factors. To assess the long-term psychosocial adaptation status of survivors after Extracorporeal Membrane Oxygenation (ECMO) and to identify its key influencing factors. A multicentre cross-sectional study. This study utilized a convenience sampling method to recruit 205 patients discharged after Extracorporeal Membrane Oxygenation treatment from three tertiary hospitals, China. Data were collected using the Self-Report Psychosocial Adjustment to Illness Scale, general information questionnaire, the Connor-Davidson Resilience Scale and the Social Support Rating Scale. A total of 205 ECMO patients were included in this multicentre study. The psychosocial adaptation score of Extracorporeal Membrane Oxygenation patients was 48.40 ± 22.43. Multiple linear regression analysis revealed that age, income, residence, education level and time since discharge were significant influencing factors for psychosocial adaptation in these patients. The psychosocial adaptation of Extracorporeal Membrane Oxygenation patients was found to be at a moderate level, indicating a need for further improvement. Healthcare professionals should implement targeted interventions to enhance their psychosocial adaptation and promote better disease outcomes. For clinical nurses, these findings highlight the need to systematically assess not only patients' physical function but also their psychological resilience and ability to utilise social support during follow-up. Targeted interventions focusing on resilience-building and actively coaching patients on how to effectively seek and accept support should be integrated into post-ECMO care plans to improve long-term psychosocial adaptation. For patients and families, this underscores the importance of developing skills to actively engage with support networks and resources throughout the recovery journey.

Developmental trajectory of individuals with Pelizaeus-Merzbacher Disease (PMD).

LPS induces complement gene expression in absence of acute-phase proteins in the liver of Cururu toads (Rhinella diptycha).

Using laboratory and epidemiologic data collected in 2022 and 2023 in Iraq, we aimed to evaluate the diagnostic and prognostic performance of reverse transcription PCR (RT-PCR) in Crimean-Congo hemorrhagic fever (CCHF) patients and to identify factors associated with disease outcomes. CCHF was confirmed in 955 hospitalized patients. Among those, RT-PCR analysis showed that blood specimens from deceased patients had a lower median cycle threshold (Ct) value than did those who recovered; we used those data to determine a cutoff value. Univariate and multivariate logistic regression analysis indicated that low Ct values, hemorrhagic symptoms at admission, and age >15 years were independent determinants of fatal CCHF outcome. Viral load and patient age play key roles in the outcome of CCHF in Iraq. Ct value at admission, as a proxy for viral load, serves as a practical indicator to guide clinicians in managing CCHF patients.

Epilepsy and thyroid cancer are prevalent disorders with distinct etiologies; however, emerging evidence suggests the presence of shared molecular mechanisms that remain largely unexplored. In this study, we aimed to identify and characterize common hub genes and potential diagnostic markers linking these two conditions using comprehensive in silico and in vitro approaches. Differentially expressed genes (DEGs) were analyzed from epilepsy datasets (GSE44456, GSE186334) and thyroid cancer datasets (GSE60542, GSE153659), leading to the identification of four shared hub genes: CD44, CALCOCO2, ALDH4A1, and CLEC16A. Expression validation using RT-qPCR confirmed consistent patterns, with CD44 and CLEC16A significantly upregulated and CALCOCO2 and ALDH4A1 downregulated in disease cell lines compared to controls. Receiver operating characteristic (ROC) curve analysis demonstrated strong diagnostic potential for these genes in both diseases, with area under the curve (AUC) values exceeding 0.90. Functional enrichment and pathway analyses revealed that these genes are involved in oncogenic signaling, immune regulation, and tumor progression. Genetic alteration analysis indicated frequent mutations and copy number variations, while promoter methylation profiling suggested epigenetic regulation associated with disease outcomes. Survival analysis further identified ALDH4A1 and CLEC16A as prognostic markers. Moreover, in vitro and in vivo experiments demonstrated that CD44 and CLEC16A regulate cellular proliferation, migration, and clonogenicity through extracellular matrix (ECM)-receptor interactions involving CCL5, STAT3, CXCR4, and RAC1 signaling pathways. Collectively, these findings provide new insights into the shared molecular landscape of epilepsy and thyroid cancer, highlighting potential diagnostic biomarkers and therapeutic targets.

Local cytokine modulation and parasite visceralization during murine coinfection with Leishmania amazonensis and Schistosoma mansoni.

Multiple psychological factors and related comorbidities affect children with chronic pancreatitis (CP) or acute recurrent pancreatitis (ARP). We aimed to describe the frequency of psychological symptoms/diagnoses in children with CP/ARP and predict the severity of the disease burden based on these factors. We retrospectively identified patients aged 5 years or younger with a prior history of CP/ARP who were evaluated by a pediatric psychologist as part of their evaluation for total pancreatectomy with islet autotransplantation (TPIAT) at a single center. Symptoms of psychological disorders and prior psychological diagnoses were identified. Patients and their families completed pain questionnaires as part of clinical care. Demographic and pancreatic disease data were collected from electronic medical records. Of 105 children (mean age 12.1 ± 3.5y, 54.3% females, 84.4% white), 37.1% had a psychological diagnosis [20.0% anxiety, 13.3% depression, 23.8% attention-deficit hyperactivity disorder (ADHD), 4.8% post-traumatic stress disorder (PTSD)] while 86.7% displayed symptoms based on DSM-5 criteria (75.7% anxiety, 32.3% depression, 21.1% suicidal ideation, and 40.2% panic). Regarding pain, 38.8% of patients reported daily abdominal pain, 24.3% weekly, 14.6% monthly, and 22.3% less than once per month. In the 6 months prepsychology appointment, 70.9% used opioids in the inpatient setting, 25.7% used opioids in the outpatient setting, and 45.2% were on a neuromodulator to control their pain. The median pain severity did not statistically differ by psychological diagnosis or symptoms ( P =0.16). There was a high prevalence of psychological diagnoses/symptoms in patients with ARP/CP, including suicidal ideation. This highlights the need for future prospective studies to explore the role of mental health in disease outcomes in children with CP or ARP.

SCD is a prevalent genetic disorder marked by chronic complications that impact quality of life and survival. Affecting approximately 100 000 individuals in the United States and millions globally, SCD results from a mutation in the β-globin gene, leading to sickle-shaped red blood cells and subsequent vaso-occlusive episodes, hemolysis, and multiorgan damage. Despite advancements such as newborn screening and disease-modifying therapies, individuals with SCD continue to face significant long-term challenges. This review focuses on the major long-term complications of SCD, including chronic pain, mental health diagnoses, neurological deficits, infection, alloimmunization, cardiopulmonary complications, and reproductive health concerns. Pain, often a hallmark of SCD, significantly affects quality of life and requires an individualized approach to management. Depression and anxiety are prevalent and impact both psychosocial well-being and disease outcomes. Neurological complications, including stroke and cognitive deficits, pose substantial risks and require ongoing monitoring. Reproductive health concerns, such as fertility and pregnancy complications, demand careful management. Alloimmunization, a potential consequence of transfusion exposure transfusion exposure, complicates future transfusion therapy and increases the risk of delayed hemolytic transfusion reactions. Cardiopulmonary complications, including pulmonary hypertension and restrictive lung disease secondary to recurrent acute chest syndrome, are associated with increased morbidity and warrant early recognition and monitoring. This review aims to bridge the knowledge gap for general pediatricians by providing comprehensive insights into these long-term complications and offering strategies for effective management. Understanding these aspects is essential for improving patient outcomes and ensuring that pediatricians can provide informed, empathetic, and proactive care for children with SCD.

Metal-phenolic nanoparticles with ROS/pH dual-responsiveness for liver fibrosis therapy via synergistic microenvironment remodeling and metabolic reprogramming.

ASO Visual Abstract: Association Between Clinical Tumor Stage and Response to Total Neoadjuvant Therapy in Rectal Cancer: Outcomes in cT3 Versus cT4 Disease.

Lung Transplant Outcomes for MDA5-Associated Interstitial Lung Disease: A Single Center Case Series

Desmoplastic small round cell tumor (DSRCT) is an ultra-rare, fusion-driven sarcoma with a dismal prognosis despite multimodal therapy. Most patients present with advanced intra-abdominal and/or metastatic disease at diagnosis, and long-term survival remains uncommon. This review summarizes recent advances in the molecular and biological understanding of DSRCT. It highlights current diagnostic and therapeutic standards, and discusses emerging targeted and immunotherapeutic strategies with translational relevance. DSRCT is defined by the pathognomonic EWSR1::WT1 fusion, which acts as an aberrant transcription factor driving oncogenesis. Although there is no consensus standard of care, multimodal strategies combining dose-intense chemotherapy, complete cytoreductive surgery, and whole abdominopelvic radiotherapy remain the cornerstone of management when feasible. However, outcomes remain poor, particularly in patients with extra-peritoneal disease. Recent genomic studies have identified actionable vulnerabilities, including dysregulation of the angiogenic pathways, and IGF axis. In parallel, innovative immunotherapeutic approaches - particularly antibody-drug conjugates targeting HER2 and B7-H3 - have shown encouraging early signals of activity. Despite multimodal treatment, DSRCT remains a highly lethal malignancy. Advances in molecular characterization are reshaping the therapeutic landscape and supporting the development of targeted strategies, especially antibody-drug conjugates. Enrollment in prospective clinical trials and international collaborative efforts are essential to improve outcomes in this orphan disease.

Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). However, risk stratification and prognostic prediction remain limited. To assess the incremental prognostic value of combined left atrial (LA) and left ventricular (LV) strain in predicting MACE among ESRD patients receiving renal replacement therapy. Prospective. Three hundred thirteen ESRD patients (mean age: 53.8 ± 14.0 years; 202 males) undergoing maintenance dialysis. Balanced steady-state free precession (bSSFP) cine sequence at 3.0 T. Myocardial strain was analyzed from bSSFP cine images using feature-tracking software (CVI42). LA strain components were reservoir (LARS), conduit (LAScd), and contractile (LASct) strain, and LV strain included global longitudinal (GLS), radial (GRS), and circumferential (GCS) strain. Patients were followed up via clinical records and MACE were documented. Prognostic models were constructed using multivariable Cox proportional hazards regression. The baseline prediction model of conventional cardiovascular risk factors was then compared with models incorporating LARS and GLS to assess incremental prognostic value. Cox proportional hazards regression identified predictors of MACE, and model performance was evaluated using C-index, Akaike and Bayesian information criteria (AIC/BIC), and Kaplan-Meier analysis. p < 0.05 was considered significant. During a median follow-up of 16.93 months, 61 patients developed MACE. LARS (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.87-0.94) and LV GLS (HR 1.21, 95% CI 1.08-1.36) were independent predictors. The Cox model incorporating both LARS and LV GLS showed improved discrimination compared with the clinical risk factor model (C-index 0.79 vs. 0.70). Stratification by both LA and LV strain markers significantly improved MACE prediction (log-rank: p < 0.001). The integration of LA and LV strain offered superior prognostic value for MACE prediction in ESRD patients, enabling refined risk stratification beyond traditional measures. 2. Stage 3.

The cGAS/STING pathway enables cells to sense cytosolic DNA and mount rapid innate immune responses to infection, cellular stress, and tissue damage. While essential for host defense and immune surveillance, inappropriate or sustained activation of this pathway can drive chronic inflammation, autoimmunity, and disease-associated immune dysfunction, which can promote cancer growth. Effective immunity therefore depends on precise regulatory control that restrains cGAS/STING activity under homeostatic conditions while preserving the capacity for swift and robust responses to diverse danger signals. In this Review, we synthesize emerging principles that regulate cGAS/STING signaling across cellular contexts to control signal initiation, amplification, and termination. We discuss how disruption, persistence, or pathological rewiring of these regulatory processes contributes to immune imbalance across health and disease, promoting chronic inflammation, immunosuppression, and tissue pathology, with particular relevance to tumor progression and therapeutic resistance. Finally, we consider how restoring appropriate cGAS/STING regulation, rather than simply enhancing or inhibiting pathway activity, may reestablish immune homeostasis and improve therapeutic outcomes in cancer and other inflammatory diseases, framing the pathway as a dynamic regulatory circuit rather than a simple linear signaling cascade.

Systematic Evaluation of Plasma and Urine Metabolites to Predict the Risk of Adverse Kidney-related Outcomes in Chronic Kidney Disease: The GCKD Study∗.

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin malignancy frequently associated with Merkel cell polyomavirus (MCPyV) or ultraviolet (UV) mutagenesis. While immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 axis achieve response rates of 50-60%, primary and acquired resistance remain significant challenges. This review aims to synthesize current evidence on the determinants of ICI resistance in MCC to improve patient stratification and therapeutic strategies. A comprehensive narrative review of scholarly literature was performed using SciSpace, Google Scholar, and PubMed databases. Studies focused on MCC pathogenesis, immunotherapy clinical trials, tumor microenvironment (TME) profiling, and molecular mechanisms of ICI resistance were analyzed. A total of 29 peer-reviewed sources were integrated to provide a multi-layered perspective on resistance. Resistance to ICIs in MCC is multifactorial, driven by TME heterogeneity, MHC-I down-regulation, T-cell exhaustion, and viral status-dependent immune recognition. "Cold" tumors lacking preexisting tissue-resident CD8+ and γδ T-cell circuits are predisposed to failure. Furthermore, tumor cell plasticity - shifting between neuroepithelial and mesenchymal-like states - actively shapes immune evasion. Emerging biomarkers such as circulating tumor DNA (ctDNA) and composite gene expression signatures show promise but require prospective validation. Understanding the interplay between viral status, genomic burden, and the immune landscape is essential for overcoming ICI resistance. Rational combination strategies, particularly ICI plus radiation or epigenetic modulators to restore MHC-I expression, offer pathways to improve outcomes in resistant disease.

This study investigated the effectiveness of COVID-19 vaccination in decompensated cirrhosis. This study comprised a population-based cohort of 1 583 777 patients with chronic liver disease (CLD), including decompensated cirrhosis, from the National Health Insurance Service data in South Korea. The primary outcome was the risk of COVID-19 within 6 months after vaccination between 26 February 2021 and 31 December 2021. Hospitalisation and all-cause mortality rates were also investigated. Target trial specifications with propensity score matching were used to minimise the bias between the unvaccinated and vaccinated groups. The mean age of patients was 54.2 years, and 54.5% were men. In total, 61 765 patients (3.9%) had decompensated cirrhosis. Compared to the unvaccinated group, the vaccinated group exhibited a lower risk of COVID-19 (hazard ratio [HR] = 0.94; 95% confidence interval [CI] = 0.91-0.97), hospitalisation (HR = 0.86; 95% CI = 0.83-0.89), and all-cause mortality (HR = 0.27; 95% CI = 0.20-0.36) in CLD. However, there was no statistical difference in the clinical outcomes among patients with decompensated cirrhosis with respect to COVID-19 vaccination. The multivariable analysis determined that COVID-19 vaccination reduced all-cause mortality in CLD (HR = 0.39; 95% CI = 0.32-0.49) and decompensated cirrhosis increased all-cause mortality in patients with COVID-19 (HR = 2.94; 95% CI = 2.15-4.02). These results were consistent during the pre-Delta and Delta-variant periods. COVID-19 vaccination reduced the risk of COVID-19, hospitalisation, and mortality in CLD. However, patients with decompensated cirrhosis had a poor prognosis independently of COVID-19 vaccination.

Longitudinal trajectory of thoracic CTA-derived sarcopenia stratifies mortality risk in transcatheter aortic valve replacement.