Integrating artificial intelligence into cancers of unknown primary diagnosis and treatment.

Objective: To understand the etiological diagnosis, triggers for disease recurrence and treatment status of diffuse alveolar hemorrhage (DAH) in Chinese children. Methods: A retrospective cohort study was conducted. Clinical data, including baseline information, laboratory findings, chest imaging findings and treatment regimens were collected from 567 children with DAH admitted to 21 hospitals in China from 2002 to 2021. Cases with immune-related etiologies or undetermined etiological diagnosis were included and divided into two groups based on glucocorticoids treatment duration: ≥3 months group and <3 months group. The study period from January 2002 to December 2021 was divided into two time intervals: 2002-2011 and 2012-2021. The two groups were compared in terms of etiological diagnosis rate, initial and overall immunosuppressant use rate, disease recurrence rate and mortality rate. All group comparisons were performed using the χ² test. Results: Among the 567 children with DAH, 333 were male and 234 were female. The age at onset was 4.0 (2.1, 6.5) years and the follow-up duration was 4.4 (2.4, 7.2) years. A definite etiological diagnosis was established in 107 cases (18.9%), while 460 cases (81.1%) remained without a definite etiological diagnosis. Among the 494 cases (including idiopathic pulmonary hemosiderosis and those with undetermined etiological diagnosis), 389 cases (78.7%) were initially treated with glucocorticoids alone and 45 cases (9.1%) with a combination of glucocorticoids and immunosuppressants. Throughout the treatment, immunosuppressants were used in 132 cases (26.7%). Among the 549 cases (including immune-related cases and those with undetermined etiological diagnosis), 303 cases (55.2%) experienced recurrent exacerbation of the disease. The common triggers included respiratory infection in 193 cases (35.2%), glucocorticoid dose reduction in 103 cases (18.8%) and non-adherence to medication in 66 cases (12.0%). Eight cases were lost to follow-up. The mortality rate was 8.7% (47/541), with causes of death including end-stage lung disease with severe infection in 32 cases (5.9%), severe pulmonary hemorrhage in 12 cases (2.2%) and unknown cause in 3 cases (0.5%). Among those receiving glucocorticoids therapy, 373 cases were in the ≥3 months group and 125 cases in the <3 months group. The mortality rate in the ≥3 months group was lower than that in the <3 months group (P<0.01). There were 92 cases in the 2002-2012 group and 457 cases in the 2012-2021 group. The utilization rates of immunosuppressants in both initial treatment and the entire treatment course for children with immune-related and those with undetermined etiological diagnosis were higher in the 2012-2021 group than in the 2002-2012 group (both P<0.01). Conclusions: In China, pediatric DAH has complex etiologies and a definitive etiological diagnosis remains difficult to establish in some cases. Recurrent exacerbation is common and mainly due to the respiratory infection, glucocorticoids dose reduction and non-adherence to medication. Glucocorticoids remain the primary treatment, with combined use of immunosuppressants in some cases.

We aimed to evaluate the feasibility of neuroendoscopic fenestration (NEF) for the treatment of septated chronic subdural hematoma (scSDH), in comparison with burr hole drainage (BHD) and craniotomy. A retrospective analysis of 115 scSDH surgeries conducted from 2021 to 2026 at a single institution revealed 71 BHD procedures (61.7%), 34 NEF procedures (29.6%), and 10 craniotomies (8.7%), with NEF performed as either a primary treatment for septations or as a salvage after BHD failure. Outcomes were assessed through volumetric analysis on follow-up computed tomography and recurrence leading to reoperation. Postoperative hematoma in the NEF group was significantly lower (40.59 ± 47.06 cm3) than that in the BHD (74.07 ± 58.32 cm3, P = .012). The percentage reduction in hematoma was greatest with NEF (-71.74% ± 28.57%) compared with BHD (-44.89% ± 39.66%) and craniotomy (-61.96% ± 46.00%) (P = .003). On univariable analysis, NEF was associated with a significantly lower risk of reoperation compared with BHD (odds ratio [OR], 0.261; 95% CI, 0.082-0.827; P = .022). Multivariable analysis confirmed that smaller postoperative volume (OR, 1.022; 95% CI, 1.011-1.033; P < .001) and greater percentage reduction (OR, 1.033; 95% CI, 1.017-1.050; P < .001) were independent predictors of reduced recurrence, irrespective of the surgical method. NEF demonstrated significantly lower postoperative volume and greater percentage reduction compared with BHD (P = .012 and P = .002, respectively). NEF showed better hematoma clearance and a lower recurrence rate than BHD, with a similar incision size. It is a viable primary option for scSDH and an appropriate alternative after unsuccessful BHD, without requiring a larger incision.

Anterior communicating artery (ACoA) aneurysms are common and complex. This study investigated the effect of A1 artery variations (hypoplasia/aplasia) on treatment outcomes. We retrospectively reviewed 104 patients with ACoA aneurysms treated either microsurgically or endovascularly. Ruptured aneurysms were present in 58.7% of patients. A1 variations occurred in 45.2% of cases, more frequently in unruptured aneurysms (69.8%, p < 0.01). The neck width of ruptured aneurysms was significantly smaller than that of unruptured ones. Variations reduced the risk of rupture (odds ratio = 0.16, 95% confidence interval = 0.06-0.41; p = 0.001). Microsurgery was the primary treatment (74%), and the rate of A1 variations was significantly lower in these cases (p < 0.05). Second interventions were required in 11.5% of patients, with no significant association to variation or treatment type. Vasospasm occurred in 41% of the ruptured aneurysm cases. Functional outcomes (modified Rankin Scale) were better in patients with A1 variations (p < 0.05). Mortality was 11.5% and unrelated to A1 variation. A higher bottleneck ratio increased mortality risk, whereas a higher height/width ratio decreased it. A1 variations were more common in unruptured ACoA aneurysms. They did not significantly influence retreatment or mortality. These findings may guide management strategies as the detection of unruptured aneurysms increases.

Gestational trophoblastic neoplasia (GTN) encompasses a spectrum of pregnancy-related disorders and poses significant clinical challenges. Understanding its prevalence, clinical characteristics, and associated risk factors is essential for timely diagnosis and management. This study aimed to evaluate the prevalence, clinical and biochemical features, and associated factors of GTN patients admitted to a tertiary referral center in northwestern Iran. A cross-sectional, descriptive-analytical study was conducted on all women diagnosed with GTN at Imam Reza Hospital, Kermanshah, between 2017 and 2022. Data were collected retrospectively from both electronic and paper-based medical records using a standardized checklist. Variables included demographics, obstetric and medical history, clinical signs, biochemical markers (β-hCG), treatment modalities, and metastatic status. Descriptive statistics were analyzed using SPSS v26. Among 30,133 deliveries during the study period, 382 GTN cases were identified, yielding a prevalence of 1.27%. Complete mole was the most frequent subtype (56.8%), followed by partial mole (37.7%). Vaginal bleeding (85.6%) and uterine enlargement (74.6%) were the most common clinical presentations. Blood group A was the most prevalent (47.4%), and 15.4% of patients had a history of consanguineous marriage. Uterine evacuation was the primary treatment (85.3%), with chemotherapy and hysterectomy used as indicated. Metastatic disease was observed in 7.6% of patients, predominantly affecting the lungs. GTN represents a notable health concern in this region, with complete mole being the most common form. Age, educational level, blood group, and prior molar pregnancy were identified as relevant factors. Early recognition based on clinical and biochemical markers, alongside structured follow-up, is crucial to optimizing outcomes. These findings underscore the importance of awareness, education, and comprehensive care strategies for high-risk populations.

Treatment Strategies and Outcomes for Spinal Low-grade Gliomas: A Systematic Review of the Past Quarter Century.

The impact of COVID-19 on head and neck cancer in Northern Ireland - a population-based study.

Early oncologic and functional outcomes of partial gland high-intensity focused ultrasound (HIFU) for prostate cancer: First 110 cases at a large U.S. tertiary referral center.

Long-term trajectories of cognitive function, fatigue, and quality of life in patients after pituitary adenoma surgery: A retrospective study.

This study aimed to review the clinical presentation, types, and diagnostic methods of pediatric urogenital foreign bodies (UGFBs) and to evaluate the effectiveness and safety of endoscopic techniques as the primary treatment approach. A retrospective review was conducted of pediatric patients with UGFBs admitted to our center between August 2015 and February 2025. Clinical data-including age, sex, presenting symptoms, foreign body location, symptom duration, imaging findings, and treatment modalities-were collected and analyzed using descriptive and comparative statistics. A total of 42 pediatric patients with UGFBs were included, comprising 19 males (45.2%) and 23 females (54.8%). The patients ranged in age from 1.5 to 14 years, with a median age of 6.8 years (interquartile range [IQR], 4.7-11.6). The most common clinical manifestations included vaginal discharge (23.8%), vaginal bleeding (16.7%), genital pain (16.7%), and voiding difficulty (14.3%). Symptom duration ranged from 0.21 to 365 days, with a median of 4 days (IQR, 0.5-18.8). Ultrasound was the most commonly used imaging modality (47.6%), followed by plain X-ray (33.3%) and computed tomography (19.0%). UGFBs were located in the vagina (47.6%), urethra (31.0%), and bladder (19.0%). Common foreign body types included sewing needles, cotton fibers, magnetic beads, hair clips, and button batteries. Cystoscopic removal was the primary treatment modality, performed in 28 patients (66.7%). Open surgery was required in seven cases (16.7%), whereas a combined cystoscopic and open approach was used in two cases (4.8%). All patients were followed for 3 to 6 months postoperatively. No cases of residual UGFBs, urethrovaginal or vesicovaginal fistulas, or urethral strictures were observed. Although pediatric UGFBs are relatively uncommon, they present with varied clinical symptoms and require a high index of suspicion for timely diagnosis. Ultrasound remains a valuable first-line imaging tool, and endoscopic removal is safe and effective as the primary treatment modality in most cases.

Cerebral venous thrombosis is a rare stroke type that primarily affects younger women. Contemporary large international efforts have improved our understanding of the natural history and management of this rare disease, yet important evidence gaps persist across the disease continuum. Management of cerebral venous thrombosis can be conceptualized into multiple phases: acute management, post-acute management (including primary anticoagulation and secondary prevention), and recovery. Acute treatment centers on anticoagulation, including in the presence of intracranial hemorrhage. Endovascular therapy and decompressive craniectomy are reserved for selected severe cases. Direct oral anticoagulants appear comparable to vitamin K antagonists for most patients during primary treatment, though optimal lead-in duration and treatment length remain uncertain. Decisions regarding extended anticoagulation for secondary prevention require individualized assessment of recurrence and bleeding risk. Patients with cancer, antiphospholipid antibody syndrome, prior venous thromboembolism, and idiopathic events are at the highest thromboembolic risk. Long-term sequelae, including fatigue, headache, cognitive and mood disturbances, epilepsy, and intracranial hypertension, contribute substantially to morbidity despite high rates of functional independence. Heavy menstrual bleeding may impact young women on anticoagulation. Recognition and management of these outcomes are essential for comprehensive care.

Intractable cases of atopic dermatitis often exhibit recurrent exacerbations, with the primary treatment being topical steroids. However, prolonged use of steroids can lead to steroid addiction or iatrogenic disease. Withdrawal from steroids once the condition becomes uncontrollable is known to be challenging. Herein, we explore the strategies for overcoming steroid addiction and mitigating its adverse effects. One approach involves combining the anti-allergic drug tranilast, which inhibits mast cell degranulation, with the unique macrolide antibiotic roxithromycin, known for its T helper type 2 (Th2) suppressive effect. Moreover, we examine the methods for managing steroid-dependent atopic dermatitis, a condition that poses significant challenges in terms of withdrawal.

Tailoring radiotherapy in cT1-2N1 breast cancer to nodal response on primary chemotherapy (RAPCHEM: BOOG 2010-03): 10-year follow-up results of a Dutch, prospective, registry study.

Anterior urethral stricture disease (USD) affects 1% of at-risk men. While urethroplasty remains the gold standard, novel adjuncts, including drug-coated balloon (DCB) dilation and intralesional treatments have re-energized the field. This review summarizes the evidence base for DVIU/dilation versus urethroplasty, outlines the efficacy, safety and cost-effectiveness of DCB and intralesional treatments, and outlines where novel endoscopic treatments should sit in the current treatment pathway. The OPEN trial clarified the limitations of DVIU in recurrent USD, with patients who underwent urethroplasty having greater improvements in objective urinary function with less risk of reintervention. However, urethroplasty was associated with greater adverse events and higher costs; as a result, DVIU remains a cost-effective option. The ROBUST trials have established the efficacy and safety of DCB dilation in recurrent anterior USD, with durable improvements in IPSS and QMax. At 3 years, freedom from repeat intervention was 71.7% with DCB dilation, compared with 24% with DVIU. Economic evaluations suggest DCB dilation is likely cost-advantageous in settings where recurrent treatments are required. Intralesional mitomycin C and steroid injections have shown promising short-term results in small series but further data are required. Endoscopic therapy remains an essential component of USD management. Future research should explore DCB dilation use in primary anterior USD treatment, long-segment disease, recurrence, and posterior urethral strictures.

Cancer-associated thrombosis (CAT) is a significant cause of mortality in oncology, particularly in lung cancer. The clinical management requires a careful balance between preventing venous thromboembolism (VTE) and minimizing bleeding risks. The aim of this review is to provide the latest evidenced based-approach for primary and secondary prevention of CAT. Results from randomized clinical trials, such as TARGET-TP, CASSINI, and AVERT demonstrated that low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) reduce VTE incidence in high-risk ambulatory patients (Khorana score ≥2). Lung-cancer-specific data from FRAGMATIC showed that although VTE risk is halved, there is no overall survival benefit, and routine prophylaxis is not recommended for unselected patients, which aligns with current guidelines. For VTE treatment, randomized trials including CARAVAGGIO, SELECT-D, and ADAM VTE showed that DOACs are non-inferior to LMWH with similar major bleeding rates, although some DOACs increase non-major gastrointestinal or genitourinary bleeding. Invasive approaches such as mechanical thrombectomy and catheter-directed thrombolysis remain reserved for life-threatening presentations. Pharmacotherapy for prevention of CAT in lung cancer must be individualized. DOACs have emerged as a practical and effective alternative to LMWH for both primary and secondary VTE prophylaxis after assessing risk-benefit.

To characterize the clinical presentation, endocrine phenotype, and outcomes of pituitary metastasis in a contemporary tertiary-center cohort, with emphasis on clinically actionable diagnostic red flags. We conducted a retrospective single-center case series of 14 consecutive patients diagnosed with pituitary metastasis between 2010 and 2025. Presenting manifestations, endocrine features, radiologic findings, primary tumor origin, treatment patterns, and overall survival were assessed. In patients without histopathologic confirmation, diagnosis was established using the validated clinicoradiologic model proposed by Yuzkan et al. RESULTS: Median age was 52.5 years, and 71.4% of patients were women. Hypopituitarism (64.3%), arginine vasopressin deficiency (50.0%), and visual impairment (50.0%) were frequent at presentation. One patient presented with sudden bilateral visual loss and hemodynamic instability, mimicking an apoplexy-like sellar emergency. Breast cancer was the most common primary tumor (28.6%). Serum prolactin levels, available in 11 patients, were uniformly below the range typically expected for macroprolactinoma despite large sellar masses. Histopathologic confirmation was obtained in 35.7% of cases, whereas the remainder fulfilled high-likelihood clinicoradiologic criteria. Median overall survival after pituitary metastasis diagnosis was 6.5 months, and 92.9% of patients died during follow-up. Pituitary metastasis frequently presents with combined endocrine dysfunction and neuro-ophthalmologic compromise, occasionally as an acute sellar emergency. In oncologic patients with sellar lesions, the combination of AVP-D, visual deterioration, and non-prolactinoma-range hyperprolactinemia should raise suspicion for pituitary metastasis and prompt urgent endocrine and local evaluation.

Postoperative outcomes of Morel-Lavallee injuries and predictive factors for wound complications: A Pacific Coast Surgical Association multicenter study.

For patients with early-stage low-risk uterine cervical cancer ≤2cm, simple hysterectomy is recommended, and this can now be considered the new standard of care.1 However, for patients with cervical cancer >2cm with "non-SHAPE" criteria, radical hysterectomy is still recommended as the standard primary treatment.2. Nerve-sparing radical hysterectomy requires deep knowledge of pelvic neurovascular anatomy. Lack of proper anatomical knowledge and adequate surgical skills are associated with not only the risk of hypogastric nerve injury but also unnecessary bleeding during surgery, which may lead to unintentionally less radical surgery. We performed nerve-sparing radical hysterectomy (Querleu-Morrow classification: type C13) using the following eight steps (Video). In Japan, total laparoscopic radical hysterectomy is performed under the public health insurance system. Step 1: Development of the lateral pararectal space and the paravesical space. Step 2: Isolation of the ureter and separation of the hypogastric nerve. Step 3: Development of the rectovaginal space. Step 4: Dissection of the anterior leaf of the vesicouterine ligament. Step 5: Development of the paravaginal space and dissection of the posterior leaf of the vesicouterine ligament Fig. 1). Step 6: Separation of the cut end of the deep uterine vein from the pelvic splanchnic nerve (Fig. 2). Step 7: Transection of the uterine branch from the inferior hypogastric plexus and ligation of the paracolpium. Step 8: Vaginal cuff creation and transection of the vaginal wall. Surgeons should recognize the importance of developing a retroperitoneal avascular space based on precise anatomical landmarks, and each surgical step must be reproducible. Fig. 1 Anatomical relationships between the posterior leaf of the vesicouterine ligament and the paravaginal space (Left side). (A) and (B) The surgical forceps can easily penetrate the paravesical space. This space is known as the "paravaginal space." (C) After development of the paravaginal space, the posterior leaf of the vesicouterine ligament can be dissected. Fig. 2 Anatomical relationships between deep uterine vein, hypogastric nerve and bladder branch (right side). (A) The bladder branch from the inferior hypogastric plexus can be identified when the cut end of the deep uterine vein is cranially retracted. (B) Dot line: dissection line.

Collecting data is essential to analyse demographic and clinical trends, measure the effectiveness of ptosis correction caused by lesions and determine the possibility of the progression of the disease. From 2015 to 2020, a prospective observational study was conducted in tertiary eye care in Bangladesh. The study included all patients who received surgical correction for mechanical ptosis caused by neurofibromatosis. The primary treatment approach was to remove the lesion through excision or debulking, followed by ptosis correction, either FBS (Frontalis Brow Suspension) or LPS (Levator Palpebrae superioris) reattachment. The results were assessed based on the extent of lesion reduction, the correction of ptosis and the likelihood of recurrence. The grading system ranged from a low score (poor) to an average score (fair) to a satisfactory score. A thorough examination was conducted on 48 cases, with an average age of 19.21. It was discovered that 29.0% of the cases presented mild ptosis accompanied by s-shaped PN (Palpebral neurofibromatosis). About 31.0% of individuals experience moderate ptosis, defined by OPN (Orbits-palpebral neurofibromatosis). In 40.0% of severe ptosis cases, OPN and TOPN (Temporo-orbital-palpebral neurofibromatosis) are present. The average MRD1 (Margin-reflex distance 1) measurement before surgery was -0.819 mm for patients who had ptosis surgery with LPS resection (75.0% of cases). In comparison, patients who had undergone FBS had an average preoperative MRD1 of -0.929 mm (25.0% of cases). Following a six-month surgical procedure, the average MRD1 measurements were +1.208 mm for LPS resection cases and +0.750 mm for FBS cases. The outcome was better in LPS resection than in FBS. Progression of the disease is common in severe cases of plexiform neurofibromatosis among young individuals. An optimal surgical solution for achieving satisfactory results and enhanced appearance demands a careful evaluation of the affected area, followed by removing the lesion through excision or debulking surgery and correcting any ptosis in a single procedure. This approach can undoubtedly provide exceptional cosmetic results.

CatSeg: A holistic cataract surgical scene segmentation model