focalinterest.net

Tag: Cancer Care

  • Combined bone and ligament reconstruction preserved forearm mechanics after distal radius resection

    What the study found

    The study describes a feasible combined reconstruction strategy after distal radius resection: a proximal fibular autograft was paired with distal oblique bundle reconstruction to help preserve distal radioulnar joint stability and forearm rotation. In the reported case, oncologic margins were negative and early functional recovery was documented.

    Why the authors say this matters

    The authors suggest this approach may help address a difficult problem in orthopedic oncology: rebuilding the distal radius after tumor resection while preserving distal forearm mechanics. They conclude that adding ligamentous stabilization to bone reconstruction may be useful in this setting.

    What the researchers tested

    This was a technical note illustrated by a representative clinical case. The team performed segmental en bloc resection of the distal radius, reconstructed the defect with an ipsilateral, nonvascularized proximal fibular autograft including the fibular head, and reconstructed the distal oblique bundle with an autologous palmaris longus tendon graft.

    What worked and what didn't

    Histopathology confirmed negative oncologic margins. At nine months, the Musculoskeletal Tumor Society score was 80%, and forearm rotation was preserved at 68.8% pronation and 81.3% supination of normal values. Early postoperative issues included donor-site common peroneal nerve dysfunction and radiocarpal instability that needed temporary Kirschner wire stabilization.

    What to keep in mind

    The report describes a single representative case, so the findings are limited in scope. The abstract also notes that broader validation will require larger clinical series and longer follow-up.

    • A distal radius tumor resection was reconstructed using a proximal fibular autograft plus distal oblique bundle reconstruction.
    • The reported case achieved negative oncologic margins.
    • At nine months, the Musculoskeletal Tumor Society score was 80%.
    • Forearm rotation was preserved at 68.8% pronation and 81.3% supination of normal values.
    • Early complications included common peroneal nerve dysfunction at the donor site and radiocarpal instability requiring temporary Kirschner wire stabilization.

  • Pediatric maxillary mesenchymal chondrosarcoma was confirmed by HEY1::NCOA2 fusion

    What the study found

    The report describes a 13-year-old girl with a destructive right maxillary sinus mass that was ultimately confirmed as mesenchymal chondrosarcoma through detection of a HEY1::NCOA2 gene fusion. The authors present this as a rare pediatric case of maxillary mesenchymal chondrosarcoma with this fusion and sirolimus-based maintenance therapy.

    Why the authors say this matters

    The authors conclude that molecular diagnostics, especially RNA sequencing, are important for identifying mesenchymal chondrosarcoma and separating it from other high-grade pediatric sarcomas with similar appearance. They also suggest that finding the HEY1::NCOA2 fusion may support biologically targeted therapy.

    What the researchers tested

    This is a case report and literature review. The team evaluated imaging, histopathology, immunohistochemistry, comprehensive molecular analysis, and follow-up 18F-FDG PET/CT, and then used multimodal treatment including chemotherapy, radiotherapy, surgery, and maintenance sirolimus.

    What worked and what didn't

    Histopathology initially interpreted the tumor as fibrosarcoma, with diffuse vimentin positivity, a Ki-67 proliferation index of 35%–40%, and CD34 negativity. Molecular analysis confirmed a pathogenic HEY1::NCOA2 fusion and excluded ETV6::NTRK3 fusion; after VAC chemotherapy, radiotherapy, and debulking surgery, follow-up PET/CT showed a partial metabolic response, and sirolimus maintenance was started because disease persisted.

    What to keep in mind

    This is a single case report, so the findings are limited to one patient. The abstract does not provide longer-term outcomes, and it does not describe broader effectiveness of sirolimus-based maintenance therapy beyond this case.

    • A 13-year-old girl had a destructive mass in the right maxillary sinus.
    • The tumor was initially read as fibrosarcoma on histopathology.
    • Comprehensive molecular analysis confirmed a HEY1::NCOA2 gene fusion and excluded ETV6::NTRK3 fusion.
    • Treatment included VAC chemotherapy, radiotherapy, debulking surgery, and sirolimus maintenance.
    • Follow-up 18F-FDG PET/CT showed a partial metabolic response.

  • Deep learning distinguished three fibro-osseous jaw lesions

    What the study found

    A multislide, weakly supervised deep learning model was the best-performing approach for distinguishing fibrous dysplasia, cemento-ossifying fibroma, and cemento-osseous dysplasia from histology slides. The model’s performance exceeded that of experienced oral pathologists when only histologic slides were used.

    Why the authors say this matters

    The authors say distinguishing these fibro-osseous lesions matters because they have different prognoses and require different clinical management. They conclude that the model could serve as a supportive tool alongside clinical, radiologic, and molecular data.

    What the researchers tested

    The researchers developed and validated a deep learning model using 1,218 hematoxylin and eosin whole slide images from 338 cases across 3 institutions. They compared 4 training strategies using a ResNet-50 backbone with loss functions and multiple-instance learning, including weakly and fully supervised models on single or multiple slides.

    What worked and what didn't

    In the test set, the weakly supervised multislide model performed best, with an area under the curve of 0.86 and accuracy of 0.71. The abstract says this model outperformed other models and exceeded the diagnostic accuracy of experienced oral pathologists, and heat maps suggested it identified key histomorphologic patterns relevant to the three diagnoses.

    What to keep in mind

    The authors note that the test cohort was limited in sample size and geographic diversity. They say more and more diverse cohorts would be needed to better support how generalizable the model is.

    • The model was trained on 1,218 hematoxylin and eosin whole slide images from 338 cases.
    • The best result came from a weakly supervised multislide approach.
    • That model reached an area under the curve of 0.86 and an accuracy of 0.71 in the test set.
    • The model outperformed experienced oral pathologists when only histologic slides were considered.
    • The authors describe limited sample size and limited geographic diversity in the test cohort.

  • DBSCAN estimates DNA damage yields from proton and carbon ion beams

    What the study found

    The study found that a DBSCAN (density-based spatial clustering of applications with noise) clustering approach can be used to estimate DNA damage yields and assess ion beam quality. For protons, the normalized beam-quality measure showed a strong linear relationship with double-strand break yields, and a similar relationship was seen for carbon ions up to 200 keV µm⁻¹, after which an overkill effect appeared.

    Why the authors say this matters

    The authors conclude that the normalized Quality of Beam (QoB) measure, defined as clusters per keV of deposited energy, offers a biologically meaningful alternative to conventional metrics such as linear energy transfer (LET, a measure of how much energy radiation deposits per distance). They also state that the DBSCAN framework is computationally efficient compared with full water radiolysis modeling.

    What the researchers tested

    The researchers used simulated physical track structures to model DNA damage from 0.5-200 MeV protons. They assumed that energy deposition of at least 17.5 eV caused DNA damage, that at least two damage points within a distance ε formed a cluster, that isolated points were noise, and that the cluster-to-noise ratio matched the double-strand break-to-single-strand break yield ratio. They then applied the same framework and parameters to carbon ions.

    What worked and what didn't

    For protons, normalized QoB showed a strong linear correlation with double-strand break yields, allowing direct estimation of double-strand break and single-strand break yields using a single conversion factor. For carbon ions, the same linear relationship held up to LET values of 200 keV µm⁻¹, but beyond that the overkill effect emerged. The normalized QoB also qualitatively reproduced RBE-LET trends.

    What to keep in mind

    The abstract describes a simplified framework based on simulation and specific modeling assumptions, so the results are tied to those conditions. It also notes that the carbon-ion relationship changes beyond 200 keV µm⁻¹ because of overkill, so the reported linear behavior is not universal across all LET values.

    • A DBSCAN clustering framework was used to estimate DNA damage yields from simulated radiation tracks.
    • For protons, normalized QoB had a strong linear correlation with double-strand break yields.
    • The same framework showed a similar linear relationship for carbon ions up to 200 keV µm⁻¹.
    • Beyond 200 keV µm⁻¹ for carbon ions, the overkill effect appeared.
    • The authors say the method is computationally efficient compared with full water radiolysis modeling.

  • Low-energy electrons selectively cleave DNA bonds in films

    What the study found

    The study found that low-energy electrons (LEEs) caused selective, energy-dependent bond cleavage in DNA films made from Tris-EDTA (TE) buffered solutions. The effects were seen in x-ray photoelectron spectroscopy (XPS), which is a technique that measures how electrons are bound in a material.

    Why the authors say this matters

    The authors conclude that the findings contribute to a deeper mechanistic understanding of LEE-induced biomolecular damage. They also say the results support the development of LEE-based cancer radiotherapy.

    What the researchers tested

    The researchers exposed DNA films to electrons with energies of 9.2, 4.2, and 0.2 eV for up to 8 hours. They then used XPS to examine changes in the C 1s, N 1s, O 1s, and P 2p spectra.

    What worked and what didn't

    At 9.2 and 4.2 eV, irradiation significantly induced cleavage of C-N bonds in N-glycosidic linkages and C-O bonds in the sugar-phosphate backbone. The selective cleavage may lead to apurinic/apyrimidinic sites and damage to the sugar-phosphate backbone and sugar moiety, while phosphate groups within the backbone remained relatively stable. At 0.2 eV, the study reports no significant spectral or compositional changes.

    What to keep in mind

    The abstract does not describe detailed experimental limitations beyond the energy range and exposure time studied. It also notes that TE components remained chemically stable during irradiation, although the results suggest they may help increase the yield of selective DNA damage.

    • Low-energy electrons caused selective bond cleavage in DNA films from Tris-EDTA buffered solution.
    • The strongest effects were reported at 9.2 eV and 4.2 eV, not at 0.2 eV.
    • C-N bonds in N-glycosidic linkages and C-O bonds in the sugar-phosphate backbone were significantly affected.
    • Phosphate groups within the DNA backbone remained relatively stable.
    • The authors say the findings may help explain LEE-induced biomolecular damage and support cancer radiotherapy development.

  • Nuclear shape changes tracked recurrent chordoma

    What the study found

    The study found that quantitative nuclear morphometry, an analysis of nuclear size and shape, aligned with immunophenotype and genomic profiling in recurrent chordoma. It also found that recurrent and metastatic cases showed longitudinal nuclear remodeling, including larger and more asymmetric nuclei, altered shape, and lower lamin A/C expression.

    Why the authors say this matters

    The authors conclude that this approach may provide a quantitative framework for future digital pathology or AI approaches, pending validation in larger cohorts. The study suggests this could help capture recurrence-associated phenotypic remodeling in chordoma.

    What the researchers tested

    The researchers studied 26 specimens from 12 adults, including 8 patients with non-recurrent tumors and 4 patients with multiple long-term recurrences and metastases over 7 to 16 years. They used whole-exome sequencing, immunohistochemistry, and nuclear morphometry to compare imaging, routine histology, nuclear features, protein expression, and tumor mutational burden.

    What worked and what didn't

    Imaging studies and routine histology did not show consistent differences between the two groups. Morphometry showed substantial variability among non-recurrent tumors and significant nuclear remodeling across recurrences, with primary tumors from patients who later recurred showing smaller, more asymmetric, and denser nuclei than non-recurrent tumors. Recurrent samples also showed higher proliferation, decreased lamin A/C expression, and a low overall tumor mutational burden that varied between patients and timepoints and tended to be higher in recurrent cases.

    What to keep in mind

    The study was based on a small sample from 12 adults, including only 4 patients with long-term recurrent and metastatic disease. The authors note that the proposed framework needs validation in larger cohorts.

    • Quantitative nuclear morphometry matched immunophenotype and genomic profiling in chordoma.
    • Recurrent and metastatic samples showed larger, more asymmetric nuclei and altered nuclear shape.
    • Primary tumors from patients who later recurred had smaller, more asymmetric, and denser nuclei.
    • Recurrent samples showed higher proliferation and decreased lamin A/C expression.
    • Tumor mutational burden was low overall and tended to be higher in recurrent cases.

  • Belgian adaptation of nurse-led eHealth monitoring required local changes

    What the study found

    The SMILe integrated care model, which combines a patient app for home symptom registration with advanced practice nurse-led monitoring, self-management support, and care coordination, needed local adaptation for use in Belgian daily care. The authors report that several changes were required to fit existing technical, legal, and resource conditions.

    Why the authors say this matters

    The authors conclude that real-world adaptation must balance an intervention's core components with the local technical, regulatory, and resource constraints. They also state that structured adaptation and strategic implementation planning were essential to support long-term sustainability.

    What the researchers tested

    The researchers adapted the SMILe integrated care model to their local setting after a prior context analysis. They followed the ADAPT guidelines, involved patients, informal caregivers, and local clinical, IT, and legal teams, documented adaptations with the Framework for Reporting Adaptations and Modifications-Expanded (FRAME), and selected implementation strategies using the Expert Recommendations for Implementing Change (ERIC) taxonomy.

    What worked and what didn't

    Key adaptations included using the local electronic eHealth platform to improve usability and allow multiple providers to access patient-documented data. The team also reduced advanced practice nurse intervention sessions from 12 to six during the first year after allogeneic stem cell transplantation because of financial constraints. Minor adaptations included revising content and simplifying language, and 20 tailored implementation strategies were selected for context understanding, stakeholder involvement, pilot preparation, and training.

    What to keep in mind

    The abstract describes an adaptation project, not an evaluation of patient outcomes or effectiveness. It does not provide results from the planned pilot trial, and it does not report limitations beyond the stated technical, regulatory, and financial constraints.

    • The SMILe integrated care model combines a patient app with nurse-led monitoring, self-management support, and care coordination.
    • The Belgian team adapted the model for a local setting with existing eHealth infrastructure and advanced practice nurse support.
    • Major changes included switching to the local eHealth platform and reducing nurse sessions from 12 to six in the first year.
    • The researchers used ADAPT, FRAME, and ERIC to guide and document adaptations and implementation strategies.
    • The authors say balancing core components with local constraints is important for long-term sustainability.

  • Craniofacial fibrous dysplasia osteoblasts show altered bone homeostasis

    What the study found

    The study found that osteoblasts from craniofacial fibrous dysplasia lesions showed higher intracellular cyclic adenosine monophosphate (cAMP), increased proliferation, reduced osteoblastic differentiation, and no mineralization ability. The authors also reported a decreased osteoclastogenic potential, meaning a reduced ability to promote osteoclast formation, in these cells.

    Why the authors say this matters

    The authors suggest that comparing craniofacial and appendicular fibrous dysplasia, that is, lesions in the skull-face region versus the limbs, could help explain why these sites behave differently. They conclude that further study of craniofacial fibrous dysplasia pathogenesis is needed.

    What the researchers tested

    The researchers studied osteoblasts from craniofacial fibrous dysplasia lesions in vitro, meaning in laboratory cell cultures. They examined histology, intracellular cAMP levels, cell proliferation, osteoblastic differentiation, mineralization, and the ability of conditioned medium from these cells to support osteoclast formation.

    What worked and what didn't

    Typical histological features described as an "alphabet soup" appearance were observed in craniofacial fibrous dysplasia lesions. The cells showed increased proliferation, but osteoblastic differentiation and mineralization were decreased or absent. The conditioned medium also showed impaired osteoclast formation, indicating reduced osteoclastogenic potential.

    What to keep in mind

    The abstract does not describe sample size, study duration, or detailed experimental controls. It also does not provide clinical outcome data, so the findings are limited to laboratory observations from craniofacial fibrous dysplasia cells.

    • Craniofacial fibrous dysplasia osteoblasts had higher intracellular cAMP.
    • These cells showed increased proliferation but reduced differentiation and mineralization.
    • Conditioned medium from the cells had impaired osteoclast formation.
    • The study reports typical histological "alphabet soup" features in craniofacial lesions.
    • The authors note shared features with appendicular fibrous dysplasia, but differences in osteoclastic potential.

  • Surgical resection controlled a chemoresistant pediatric mandibular rhabdomyosarcoma

    What the study found

    The report describes an 11-year-old boy with a rare FUS::TFCP2 fusion-positive rhabdomyosarcoma of the mandible. The authors report that surgery after ineffective chemotherapy was followed by 18 months of disease-free status.

    Why the authors say this matters

    The authors conclude that early pathological diagnosis and prompt surgical intervention are crucial for FUS::TFCP2 fusion-positive rhabdomyosarcoma because of its chemoresistance. They also note that optimal treatment strategies have not been established.

    What the researchers tested

    This is a case report of one pediatric patient with mandibular rhabdomyosarcoma and a FUS::TFCP2 fusion gene. The patient first received standard induction chemotherapy for rhabdomyosarcoma, and then underwent radical resection with segmental mandibulectomy and reconstruction using a rectus abdominis free flap.

    What worked and what didn't

    Standard induction chemotherapy was ineffective. Histological examination of the surgical specimen showed a viable tumor with minimal response to chemotherapy, while the patient remained disease-free for 18 months after surgery.

    What to keep in mind

    The report describes a single patient, so the findings are limited to one case. The abstract does not describe broader follow-up beyond 18 months or provide a comparative treatment study.

    • The article reports a rare FUS::TFCP2 fusion-positive rhabdomyosarcoma in an 11-year-old boy.
    • Standard induction chemotherapy for rhabdomyosarcoma was ineffective in this case.
    • Radical surgery included segmental mandibulectomy and reconstruction with a rectus abdominis free flap.
    • The surgical specimen showed a viable tumor with minimal response to chemotherapy.
    • The patient remained disease-free for 18 months after surgery.

  • Older Iranian adults with colorectal cancer reported existential distress

    What the study found

    The study found that older Iranian adults with colorectal cancer experienced existential distress, meaning deep psychological suffering related to meaning, identity, and purpose. Their accounts centered on diminished self-worth, uncertainty and fear of death, and strained relationships.

    Why the authors say this matters

    The authors conclude that the findings support supportive cancer care that addresses existential and spiritual needs as well as physical care. The study suggests that psychosocial dimensions should be considered in culturally informed interventions.

    What the researchers tested

    The researchers used a qualitative descriptive phenomenological design to explore the lived experience of existential distress. They interviewed 17 adults aged 65 years or older with confirmed colorectal cancer at a cancer center in northern Iran and analyzed the interviews using Colaizzi’s seven-step method.

    What worked and what didn't

    Three themes emerged: Inadequate Self-Realization, Confronting Uncertainty and Death, and Disruption of Meaningful Relationships. Participants described diminished inner value and guilt about being a family burden, feeling lost and fearful of the unknown, and experiencing stigma, social humiliation, and self-isolation.

    What to keep in mind

    The study is based on 17 participants from one cancer center in northern Iran, so the findings reflect this specific group and setting. The abstract does not describe additional limitations.

    • Seventeen adults age 65 and older with confirmed colorectal cancer were interviewed.
    • Participants described existential distress as suffering tied to meaning, identity, and purpose.
    • Three themes were identified: inadequate self-realization, confronting uncertainty and death, and disruption of meaningful relationships.
    • Reported experiences included guilt about family burden, fear of the unknown, stigma, and self-imposed isolation.
    • The authors say supportive care should address existential and spiritual needs alongside physical care.