Multi-instance learning for identifying high-risk subregions associated with synchronous distant metastasis in clear cell renal cell carcinoma.

BACKGROUND: Clear cell renal cell carcinoma (ccRCC) is one of the most common histological subtypes of renal tumors. PURPOSE: To identify high-risk subregions associated with synchronous distant metastasis. METHODS: This study enrolled a total of 277 patients with ccRCC. Voxel intensity and local entropy values were compiled within the region of interest for all patients. Unsupervised k-means clustering yielded three subregions per tumor. Radiomic features were extracted, and random forest-based feature selection was conducted. The selected features were used in a multi-instance support vector machine (mi-SVM) model for training, and predictions were made on the validation cohort. Model performance was evaluated using five-fold cross-validation. The subregion with the highest score for patients with synchronous distant metastasis was identified across all cohorts. RESULTS: The mi-SVM model yielded an average area under the curve (AUC) of 0.812 in the training cohort and 0.805 in the validation cohort. In the entire cohort of patients with synchronous distant metastasis, subregion 2, characterized by tumor periphery and intratumoral transitional components, accounted for the highest proportion (48.57%, 30.6/63) among all subregions. It represents a high-risk subregion for synchronous distant metastasis of clear cell renal cell carcinoma. CONCLUSION: The peripheral and intratumoral transition zones of clear cell renal cell carcinoma are high-risk subregions associated with synchronous distant metastasis.

The Prognostic Implications of Synchronous Cancers in Breast Cancer Patients.

OBJECTIVE: This study aims to examine the prognostic value of synchronous cancer diagnosis following an initial diagnosis of breast cancer, with a focus on site-specific survival rates and the correlation between primary breast cancer and secondary cancers. METHODS: We conducted a retrospective analysis of patients treated at Saint Nicholas Hospital in Pitesti, Romania, from January 2016 to January 2024. The inclusion criteria were a confirmed diagnosis of primary breast cancer and a secondary synchronous cancer diagnosed within two months. Data collection included demographic, clinical, and pathological characteristics, as well as treatment details and follow-up outcomes. Statistical analyses were performed using SPSS software version 26.0 (IBM Corp., Armonk, New York, USA), employing Kaplan-Meier survival curves, Cox regression models, and other relevant statistical tests. RESULTS: Out of 73 initially identified patients, 49 met the inclusion criteria. The mean age was 59.6 years, with most patients being postmenopausal. Synchronous cancers were primarily contralateral breast cancer (44.9%) and female genital organ cancer (12.24%). Patients with synchronous bilateral breast cancer had significantly better overall survival (33 months) compared to those with other synchronous cancers (23.5 months). Multivariate analysis indicated that synchronous non-breast cancers were associated with a higher risk of death (hazard ratio (HR)=1.6, 95% CI: 1.22-2.10, p=0.003). CONCLUSION: Synchronous cancer diagnosis following an initial breast cancer diagnosis significantly impacts prognosis, with synchronous bilateral breast cancer associated with better survival outcomes compared to other synchronous cancers. These findings underscore the importance of vigilant screening and personalized treatment strategies for patients with synchronous malignancies.

Promoting Pedagogical Resilience: Unveiling the Efficacy of Synchronous Online Lectures Compared to Traditional Methods From the Students' Vantage Point Amidst the COVID-19 Pandemic.

Introduction The COVID-19 pandemic significantly disrupted traditional educational methods, forcing medical institutes to adapt to online classes. Since online teaching was an untested approach in Indian medical education, student feedback was essential. This study compares synchronous online lectures with traditional classroom lectures from the students' perspective. Method The cross-sectional study was conducted on undergraduate medical students across India undergoing synchronous online MBBS classes during the COVID-19 pandemic. After obtaining institutional ethical clearance, five-section questionnaires via Google Forms were circulated on WhatsApp and Facebook. The generated quantitative data were analyzed using descriptive statistics and frequency analysis. Result Out of 341 responses, 64 students did not consent and were excluded, resulting in 277 responses for analysis. The total score for traditional face-to-face lectures was 11.61 out of 15, with a percentage mean score of 77%, highlighting the significant positive influence of instructor presence and a conducive learning environment. In contrast, synchronous online lectures had a total score of 16.01 out of 25, with a percentage mean score of 64.04%, reflecting mixed responses. The Student's t-test analysis underscored the significant advantages of face-to-face interactions and structured learning environments in traditional classroom settings despite the flexibility and independence offered by synchronous online lectures. Conclusion The findings of this study reveal that students have a moderate level of satisfaction with synchronous online lectures, as indicated by a mean score of 64.04%. While these lectures provide flexibility and promote independence, they require students to exhibit higher levels of self-motivation, discipline, and self-directed learning. However, the online format poses challenges for effective communication and technical issues. Addressing the challenges of technology use, teacher training, and student engagement can enhance the effectiveness of online teaching and ensure that it complements traditional teaching methods, ultimately promoting pedagogical resilience in medical education.

Effects of two-person synchronized cycling exercise on interpersonal cooperation: A near-infrared spectroscopy hyperscanning study.

Objective: Although psychological research indicating the synchronous activities can promote interpersonal cooperation, thus far there is no direct evidence that two-person synchronous exercise effectively enhances interpersonal cooperative behaviors in Physical exercise field. This suggests that, although synchronization phenomenon is widespread in sports and is considered a potential tool for enhancing teamwork, its specific effects and functioning mechanisms still need to be clarified by further scientific research. This study intends to use two-person synchronized cycling exercise to investigate the synchronized exercise effect on interpersonal cooperative behavior and its underlying neural mechanisms. Methods: Eighty college students without regular exercise habits will be randomly assigned to the experimental group (10 male dyads and 10 female dyads) and the control group (10 male dyads and 10 female dyads). During the experiment, dyads in the experimental group performed a 30-minute synchronized cycling exercise with synchronized pedaling movements; dyads in the control group rested sedentary in the same environment for 30 minutes. Interpersonal cooperative behavior was assessed with the Prisoner's Dilemma task, and the interpersonal neural synchronization(INS) data were collected in the prefrontal cortex using near-infrared hyperscanning. Results: This study compared behavior and brain activity before and after synchronous exercise. Behavioral results revealed that, compared to pre-exercise, dyads in the post-exercise had higher average cooperation rates, higher cooperation efficiency and shorter cooperation response times. Compared to post-sedentary, dyads in the post-exercise had shorter cooperation response times and higher cooperation efficiency. Furthermore, brain data showed that,compared to pre-exercise, dyads in the post-exercise had stronger INS in the dorsolateral prefrontal cortex(DLPFC), whereas the dyads in the post-exercise had stronge INS in the DLPFC compared to post-sedentary. After controlling for dyads' anxiety and mood states, this study also found a marginally significant negative correlation between INS differences in the left DLPFC and cooperation response time differences. Conclusions: This research confirms, from both behavioral and neuroscience perspectives, that one synchronization cycle can significantly enhance interpersonal cooperative behavior, and this positive effect is closely associated with increased INS in the left DLPFC. This study provides new insights into understanding how positive interactive exercises promote interpersonal cooperation through specific neural mechanisms.

Exploring the effects of multiple online interaction on emotions of L2 learners in synchronous online classes.

The decline in both the quantity and quality of interaction has emerged as a notable challenge in online learning. However, the definition of interaction quality remains unclear. This study clarifies it as a decrease in the breadth of interaction, which refers to interaction that can only cover a smaller number of learners. To address this, a synchronous interaction modality, termed Multiple Online Interaction (MOI), based on Zoom's interactive tools, was introduced. In a quasi-experiment involving 58 Chinese L2 learners (with 30 beginner and 28 intermediate students), emotions were assessed using the Brief Mood Introspection Scale (BMIS) while real-time emotional dynamics were revealed through the analysis of 5129 facial expression images during a 35-min synchronous class. MOI participants reported higher levels of Lively and Happy but also experienced more Nervous and less Calm. These emotional dynamics, tracked through expression recognition technology, demonstrate that MOI's impact is primarily observed during the first Grammar & Practice section of the teaching. The empirical findings of this study provide practical insights for educators aiming to conduct effective online teaching in the future.

Synchronous Pancreatic Ductal Adenocarcinoma and Nasopharyngeal Carcinoma With Associated Novel Pathogenic ATM Mutation.

BACKGROUND/AIM: Patients with synchronous pancreatic ductal adenocarcinoma (PDAC) and nasopharyngeal carcinoma (NPC) have not been previously reported in the English literature. We present such a unique case with both PDAC and NPC. CASE REPORT: A 72-year-old Asian-American female with a past medical history of primary biliary cholangitis presented with abdominal pain. Initial computer tomography (CT) scans demonstrated a 13 cm solid and cystic mass in the pancreatic body and tail with no mass identified in her liver. A biopsy of the pancreatic mass revealed pancreatic duct adenocarcinoma. Further evaluation with a positron emission tomography (PET) scan revealed a hypermetabolic mass (SUVmax10) in the nasopharynx. Subsequent biopsy results were consistent with nasopharyngeal carcinoma. Genetic counseling and next-generation sequencing (NGS) on her peripheral blood DNA were performed, identifying a pathogenic mutation of ATM c.8545C>T (p.Arg2849*). The patient was treated with gemcitabine-abraxane chemotherapy and FOLFIRINOX (fluorouracil, oxaliplatin, leucovorin and irinotecan) for her PDAC, while radiation therapy was proposed for her NPC. Ultimately, due to the progression of the malignancies, she entered hospice care and passed eight months after the diagnosis of PDAC. CONCLUSION: To the best of our knowledge, this is the first documented case of synchronous PDAC and NPC in a patient with novel associated pathogenic ATM c.8545C>T (p.Arg2849*) mutation and poor prognosis. More similar case reports are needed to further characterize this entity.

Synchronously Consolidating Li, Se, S, and C for Robust Li-SeS Batteries.

S-redox involving solvated polysulfides is accompanied by volumetric change and structural decay of the S-based cathodes. Here, we propose a synchronous construction strategy for consolidating Li, Se, S, and C elements within a composite cathode via a paradigm reaction of 8Li+2Se+CS2 = 2Li4SeS+C. The obtained composite features crystalline Li4SeS encapsulated in a carbon nanocage (Li4SeS@C), exhibiting ultrahigh electrical conductivity, ultralow activation barrier, and excellent structural integrity, accordingly enabling large specific capacity (615 mAh g-1) and high capacity retention (87.3% after 350 cycles) at 10 A g-1. TOF-SIMS demonstrates its superior volumetric efficiency to a similar derivative SeS@C (2Se+CS2 = 2SeS+C), and DFT reveals its lower activation barrier than Li2S@C and Li2Se@C. This consolidation design significantly improves the electrochemical performance of S-based cathodes, and the paradigm reaction guarantees structural diversity and flexibility. Moreover, employing a synchronous construction mechanism to maximize the synergistic effect between element consolidation and carbon encapsulation opens up a new approach for developing robust S or chalcogenide cathodes.

An environmentally sustainable synchronous spectrofluorimetric method coupled with second derivative signal processing for simultaneous determination of velpatasvir and simeprevir in pharmaceutical and plasma samples.

Velpatasvir and simeprevir are two direct acting antivirals that are often used in combination with sofosbuvir to treat HCV infections. Herein, an environmentally benign spectrofluorimetric method was developed for simultaneous quantification of velpatasvir and simeprevir in pharmaceutical and plasma samples. To address the issue of overlapping fluorescence spectra presented by these compounds, this method integrates synchronous fluorescence and second-derivative spectroscopy. By employing the second derivative of the synchronous fluorescence spectra measured at Δλ of 140 nm, the accurate determination of velpatasvir at 400 nm and simeprevir at 426 nm was achieved without any interference. Different experimental parameters affecting the synchronous fluorescence of the studied drugs were carefully optimized. The plots of second-derivative amplitudes against concentrations showed linearity in the range of 5-400 ng/mL for velpatasvir and 80-800 ng/mL for simeprevir. The method was very sensitive, with lower detection limits of 1.11 ng/mL and 25.40 ng/mL, and quantification limits of 3.36 ng/mL and 76.96 ng/mL for velpatasvir and simeprevir, respectively.The method was effectively used to determine velpatasvir and simeprevir simultaneously in their pure forms, pharmaceutical dosage forms, and human plasma with no interference. The suggested technique was additionally evaluated for its eco-friendliness through the utilization of the Analytical GREEnness (AGREE) and Green Analytical Procedure Index (GAPI) evaluation metrics, revealing that the method is indeed sustainable.

A randomized phase III trial of stereotactic ablative radiotherapy for patients with up to 10 oligometastases and a synchronous primary tumor (SABR-SYNC): study protocol.

BACKGROUND: Emerging randomized data, mostly from phase II trials, have suggested that patients with oligometastatic cancers may benefit from ablative treatments such as stereotactic ablative radiotherapy (SABR). However, phase III data testing this paradigm are lacking, and many studies have examined SABR in the setting of metachronous oligometastatic disease. The goal of the SABR-SYNC trial is to assess the effect of SABR in patients with oligometastatic cancers and a synchronous primary tumor. METHODS: One hundred and eighty patients will be randomized in a 1:2 ratio between standard of care (SOC) palliative-intent treatments vs. SOC + ablative therapy (SABR preferred) to all sites of known disease. Randomization will be stratified based on histology and number of metastases at enrollment. SABR may be delivered in 1-, 3- and 5-fraction regimens, with recommended doses of 20 Gy, 30 Gy, and 35 Gy, respectively. Non-SABR local modalities (e.g. surgery, thermal ablation, conventional radiation) may be used for treatment of the primary or metastases at the discretion of the treating physicians, if those modalities are clinically preferred. The primary endpoint is overall survival, and secondary endpoints include progression-free survival, time to development of new metastatic lesions, time to initiation of next systemic therapy, quality of life, and toxicity. Translational endpoints include assessment of circulating tumor DNA and immunological predictors of outcomes. DISCUSSION: SABR-SYNC will provide phase III data to assess the impact of SABR on overall survival in a population of patients with synchronous oligometastases. The translational component will attempt to identify novel prognostic and predictive biomarkers to aid in clinical decision making. TRIAL REGISTRATION: Clinicaltrials.gov NCT05717166 (registration date: Feb. 8, 2023).

Synchronous Seminoma of Testis and Renal Cell Carcinoma: A Rare Case Report.

Background and Objectives: Seminoma is the most common solid malignant tumour in young men. Clear-cell kidney carcinoma is the most common malignancy of the genitourinary tract. However, the synchronous occurrence of both of these tumours is rare. Case presentation: We present the case of a 36-year-old patient who presented to a medical facility at the end of 2019 with an enlarged right testicle. A unilateral orchofuniculectomy was performed, and a mass measuring 30 cm was removed. During histological examination, testicular seminoma pT2, R0, was diagnosed. An abdominal computed tomography (CT) scan showed a 6.4 cm × 6.8 cm × 6.7 cm tumour in the right kidney and a metastatic-like lesion in the right adrenal gland. A right nephrectomy and an adrenalectomy and paraaortic and paracaval lymphadenectomies were performed. A histological evaluation confirmed the presence of clear-cell renal carcinoma pT2aR0 G2, adrenal hyperplasia, and seminoma metastases in the removed lymph node. Chemotherapy with a Bleomycin, Etoposide, and Cisplatin (BEP) regimen was carried out. Three years after the last cycle of chemotherapy, a follow-up CT scan showed metastases in the left kidney, the right ischium, and the right lung. A well-differentiated clear-cell carcinoma G1 of the left kidney and metastasis of clear-cell carcinoma G2 in the right ischium were confirmed after the biopsy, and no tumour lesions were found in the lung tissue specimen. Treatment with targeted therapy with Sunitinib was started because the risk was favourable according to the Heng criteria. Genetic testing was performed, and the following genes were analysed: VHL, BAP1, CHEK2, FH, MET, MUTYH, APC, and STK11. The testing did not reveal any pathogenic or potentially pathogenic mutations or sequence changes of unknown clinical significance in the genes analysed. Conclusions: According to the authors, the occurrence of synchronous primary tumours is linked to one's genetic predisposition. DNA sequencing of tumour tissue could provide more information on the corresponding aetiopathogenesis.

Special Survival Strategy of First-Instar Scorpions Revealed by Synchronous Molting Behavior from Social Facilitation of Maternal Care and Reciprocal Aggregation.

Ecdysis is a well-known developmental feature among arthropods. Because the aggregate and synchronous molting of first-instar scorpions is markedly different from the common independent molting behavior of older scorpions and most arthropods, knowledge on the biological benefits of the unusual behavior of first-instar scorpions remain limited. Before the molting of newborn scorpions, their mothers exhibited a remarkable ability to efficiently locate the fallen offspring and help them climb onto their back, which was supported by strong maternal behavior because they climbed more swiftly than the 7-day postpartum scorpions. Most newborn scorpions molted and survived on the mother's back, with a survival rate of approximately 100%, and most newborn scorpions survived via aggregate molting behavior on sand in the absence of mothers (89.83% ± 1.91%). The important role of the mother scorpion was further highlighted in mothers with one to five first-instar scorpions. While all first-instar scorpions individually or reciprocally molted and survived on the mother's back, only 52.00% ± 7.14% to 79.20% ± 4.24% of newborn scorpions isolated from the mother could individually or reciprocally molt and survive on the sand, and the aggregated states of first-instar scorpions strengthened as their numbers on sand increased before molting. These results highlight collaborative molting as an evolutionary driving force for newborn scorpions. Taken together, both maternal care and collaborative aggregate molting behavior enhanced the survival of first-instar scorpions before and after molting, and these benefits for first-instar scorpions play essential and evolutionary roles in scorpion survival.

Impact of ambient conditions on the minor nutrients content in spirulina "Arthrospira platensis" (AP) extracted from Lake Chad revealed by fluorescence spectroscopy coupled with chemometric methods.

In this study, the technique of fluorescence spectroscopy coupled with chemometric methods is used to analyse samples of Lake Chad Spirulina "Arthrospira platensis" (AP), either harvested and conditioned by using the traditional method at different seasons or industrially processed. The content of minor fluorescent nutrients is investigated. To this end, fluorescence excitation-emission matrices (EEMs) of 46 AP samples are recorded in aqueous solution. Synchronous fluorescence (SF) spectra are extracted from these EEMs and their important features are compared to those of PARAFAC methods. Synchronous fluorescence scanning allows different AP samples to be characterized in a single scan. The SF and PARAFAC methods yielded two groups of fluorescent compounds; the first group, consisting of vitamin-like molecules, shows excitation/emission (ex/em) peaks at 340/460, 390/462, 370/440 and 450/526 nm, attributed to caffeic acid, vitamin K, E and riboflavins respectively, while the second group, consisting of pigments, shows ex/em peaks at 610/654, 590/630 and 570/644 nm, attributed to phycocyanins, C-phycocyanin and allophycocyanin. Our fluorescence data showed that while both vitamins and pigments are present in AP during the rainy season, only fluorescent components of vitamin-like compounds are present during the dry season. PCA methods allowed classifying different AP samples according to their geographic origin and harvesting season. Fluorescence spectroscopy therefore appears to be a powerful technique for rapidly assessing the chemical composition of AP.

Intraoperative Doppler flowmetry evaluation of humeral head perfusion after proximal humerus fracture.

Background: Understanding vascularity and assessing the risk of post-traumatic avascular necrosis are crucial for predicting outcomes and identifying optimal treatment options in proximal humerus fractures (PHFs). Until now, Hertel et al have been the only researchers to evaluate the intraoperative perfusion of the humeral head after fracture using Doppler flowmetry in a central single drill hole within the head. This pilot study aims to standardize the evaluation of intraoperative perfusion measurements in different areas of the humeral head in patients with PHF. Methods: In this prospective pilot study, intraoperative semiquantitative Doppler perfusion measurements were conducted during plate osteosynthesis for PHF treatment in our institution between July 2021 and May 2022. The fracture morphology was classified radiologically according to Resch's criteria. Quality of reduction was determined postoperatively to be either anatomical, minor malreduced, or major malreduced according to Peters et al in conventional and computed tomography examinations. Medial hinge integrity and medial metaphyseal extension were assessed radiographically according to Hertel et al. Intraoperatively, after drilling screw holes through the plate, a Doppler probe was inserted through all nine drill holes on the humeral head and at least one on the humeral shaft to successively measure the presence of a pulse to indicate if perfusion is present. Results: A total of ten patients (mean age 59 years, range, 36-83) with a humeral head fracture (2 × 2GL, 3 × 3G, 2 × 4G, 2 × 4GL, 1 × 5aG according to Resch) were included. Nine of the ten patients showed a pulse signal on the humeral shaft. Overall, pulse-synchronous perfusion was detected using Doppler sonography in at least one hole in the humeral head of all patients. In patients with an intact medial hinge (N = 6), pulse-synchronous perfusion could be measured in almost twice as many humeral head holes on average (5.7 vs. 3.0 drill holes) compared to patients with a dislocated medial hinge (N = 4). In patients with metaphyseal extension (N = 3), pulse-synchronous perfusion was measured in an average of 6.7 humeral head holes compared to 3.7 holes in patients without metaphyseal extension (N = 7). Conclusion: Semiquantitative, intraoperative Doppler flowmetry offers a noninvasive and rapid assessment of humeral perfusion which allows an understanding of humeral head perfusion, when used in a standardized fashion to measure flow in different areas of the humeral head.

Optimization research on control strategies for photovoltaic energy storage systems considering multi-mode operation.

In this paper, a selective input/output strategy is proposed for improving the life of photovoltaic energy storage (PV-storage) virtual synchronous generator (VSG) caused by random load interference, which can sharply reduce costs of storage device. The strategy consists of two operating modes and a power coordination control method for the VSGs. Firstly, a selective VSG input strategy is proposed based on the magnitude of disturbances, a method of offline solving model equation is used for determine the VSG input time. An online method is used for matching the disturbance frequency variations, which enables a selective VSG startup method, allowing the grid to prioritize the utilization of the generator's physical inertia. Secondly, a dynamic VSG exit strategy is developed based on dynamic frequency characteristics to prevent secondary oscillations in the frequency recovery phase of the PV-storage VSG following grid disturbances. This strategy is crucial as grid variations may affect energy storage lifespan and reduce frequency recovery speed. Finally, the proposed approach is validated for correctness and effectiveness through computer simulations and semi-physical experiments using the NI-PXI + LabVIEW platform. Through the above optimization and research, the selective start of VSG is realized, the energy storage life is improved, the capacity of charge and discharge cycles is reduced by 37.82 % compared with the strategy without investment and withdrawal, and the life loss in the secondary charge and discharge process of PV-storage VSG is avoided, which is conducive to frequency recovery.

Eco-friendly second derivative synchronous fluorescence spectroscopic method for simultaneous determination of rosuvastatin and ezetimibe in pharmaceutical capsules.

The fixed dose combination of Rosuvastatin and ezetimibe has recently received approval from the FDA for the treatment of elevated levels of low-density lipoprotein cholesterol in adults. Herein, an eco-friendly and highly sensitive spectrofluorimetric method was developed and validated for simultaneous determination of rosuvastatin and ezetimibe in commercial capsules. The developed method involved synchronous fluorescence spectroscopy combined with second derivative spectroscopy to resolve the overlapping fluorescence spectra of rosuvastatin and ezetimibe. The studied drugs were measured in synchronous mode at Δλ of 40 and their recorded synchronous fluorescence spectra were derivatized into second-order spectra, enabling the selective quantification of rosuvastatin and ezetimibe at 370 nm and 312 nm, respectively. Optimization studies regarding to the influence of buffer pH, incorporation of surfactant, choice of diluting solvent, and synchronous Δλ were carried out. The method was validated using the validation characteristics listed in ICH Q2(R1). The calibration curves displayed satisfactory linear relationships across the calibration range of 0.1-2 µg/mL for rosuvastatin and 0.05-3 µg/mL for ezetimibe. The methodology demonstrated robustness to minor modifications in the procedural parameters and selectivity in quantifying the studied drugs in synthetic mixed solutions and commercial capsules without interference. Furthermore, the level of environmental friendliness and sustainability of the suggested spectrofluorimetric approach was assessed in relation to two previously documented methodologies utilizing the AGREE metric. The findings indicated that the suggested method demonstrated a notably superior level of sustainability in comparison to the documented methods.

Retrospective analysis of efficacy and safety of recombinant human Rh-endostatinstatin combined with concurrent radiotherapy for cervical cancer.

Objective: Retrospective study and analysis of the safety and efficacy of Rh-Rh-endostatinstatin combined with simultaneous radiotherapy in the treatment of cervical cancer. Methods: A retrospective study was used to enroll cervical cancer patients who received Rh-endostatin combined with simultaneous radiotherapy (observation group) or radiotherapy alone (control group) from January 2019 to December 2022 in the Affiliated Hospital of Hebei University, and RECIST 1.1 criteria were used to evaluate the recent efficacy, and the WHO Adverse Reaction Scale for Anti-cancer Drugs to evaluate the toxic and side effects. Results: The difference between PR, SD, PD, ORR and DCR of the two groups was not statistically significant(P>0.05), and the CR of the observation group was significantly higher than that of the control group(P<0.05). The proportion of neutropenia, hypertension, arrhythmia, hemoglobin reduction in the observation group was significantly higher than that in the control group, and the proportion of nausea and vomiting was significantly lower than that in the control group(P<0.05), and there was no significant difference in other adverse reactions(P>0.05). After intervention, the CD3+, CD3-CD19+, CD16+CD56+, CEA, CY211 of both groups were significantly lower than before treatment(P<0.05). After treatment, CD3+, CD3-CD19+, CD16+CD56+ were significantly higher in the observation group than in the control group, and WBC and PLT were significantly lower than before treatment(P<0.05). The HPV conversion rate of the observation group was significantly higher than that of the control group(P<0.05). Conclusions: Our finding revealed that Rh-endostatinstatin combined with simultaneous radiotherapy showed better clinical outcomes and favorable toxic profile than that of radiotherapy alone in the treatment of cervical cancer.

Investigation of green synchronous spectrofluorimetric approach for facile sensitive estimation of two co-administered anti-cancer drugs; curcumin and doxorubicin in their laboratory-prepared mixtures, human plasma, and urine.

Recently, phytochemicals play an important role in cancer management. Curcumin (CUR), a natural phytochemical, has been co-administered with widespread chemotherapeutic agents such as doxorubicin (DOX) due to its excellent antitumor activity and the ability to lower the adverse reactions and drug resistance cells associated with DOX use. The present study aims to determine DOX and CUR utilizing a label-free, selective, sensitive, and precise synchronous spectrofluorimetric method. The obvious overlap between the emission spectra of DOX and CUR prevents simultaneous estimation of both analytes by conventional spectrofluorimetry. To solve such a problem, synchronous spectrofluorimetric measurements were recorded at Δλ = 20 nm, utilizing ethanol as a diluting solvent. Curcumin was recorded at 442.5 nm, whereas DOX was estimated at 571.5 nm, each at the zero-crossing point of the other one. The developed method exhibited linearity over a concentration range of 0.04-0.40 µg/mL for CUR and 0.05-0.50 µg/mL for DOX, respectively. The values of limit of detection (LOD) were 0.009 and 0.012 µg/mL, while the values of limit of quantitation (LOQ) were 0.028 and 0.037 µg/mL for CUR and DOX, respectively. The adopted approach was carefully validated according to the guidelines of ICH Q2R1. The method was utilized to estimate CUR and DOX in laboratory-prepared mixtures and human biological matrices. It showed a high percentage of recoveries with minimal RSD values. Additionally, three different tools were utilized to evaluate the greenness of the proposed approach.

Clinical, Prognosis, and Treatment Effect Features Analysis of Metachronous and Synchronous UTUC and BUC.

OBJECTIVE: To provide a comprehensive understanding of the clinical features of patients with synchronous and metachronous upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) and inform surgical and postoperative adjuvant treatment planning. PATIENTS AND METHOD: A total of 292 consecutive patients with synchronous and metachronous UTUC-BUC were retrospectively enrolled and were categorized into three groups: (1) UTUC metachronous BUC (N = 185, UTUC-mBUC), (2) BUC-metachronous UTUC (N = 43, BUC-mUTUC), (3) synchronous UTUC-BUC (N = 64, sUTUC-BUC). We compared pathological characteristics and survival data among groups with Wilcoxon's rank sum tests, Pearson's chi-squared, and the Kaplan-Meier method. RESULTS: In the sUTUC-BUC group, a higher proportion of patients exhibited UTUC tumors with grade G3 (56%, P = .001) and stage T4 (6%, P < .001) than group UTUC-mBUC (G3 = 16%, T4 = 0%). The proportion of patients with variant histology subtype in group sUTUC-BUC was higher than that of metachronous UTUC-BUC, involving squamous (P = .003), adenoid (P = .012), and sarcomatoid (P < .001) differentiation. It was also observed that the maximum diameter of the UTUC tumor of group sUTUC-BUC (median = 3.5) was significantly larger than group UTUC-mBUC (median = 2.5, P = .002) and group BUC-mUTUC (median = 2.2, P < .001). Notably, sUTUC-BUC has an increased risk of cancer-specific death compared with UTUC-mBUC (P < .001) and BUC-mUTUC (P < .001). On multivariable Cox regression, synchronous UTUC-BUC was an independent predictor of both RFS (P < .001; vs. UTUC-mBUC: HR 0.555, P = .004; vs. BUC-mUTUC: HR 0.279, P < .001) and CSS (P < .001, HR 29.737). Moreover, sUTUC-BUC showed a better response to intravesical therapy and chemotherapy with higher cancer-specific survival (P < .001) and recurrence-free survival (P = .034). CONCLUSIONS: The prognosis and pathological characteristics among different metachronous and synchronous UTUC and BUC were diverse. The synchronous UTUC-BUC group showed variant histology subtype, high-grade tumors, advanced tumors, multifocal UTUC, worse cancer-specific survival, but better response to intravesical therapy and chemotherapy.

Synchronous Anal Squamous Cell Carcinoma and Diffuse Large B Cell Lymphoma of Stomach: the First Report of an Odd Couple.

The unique case study presented here explores an exceptionally rare occurrence in an HIV-positive female-synchronous diagnoses of anal squamous cell carcinoma and diffuse large B cell lymphoma (DLBCL) of the stomach. With limited existing literature on such clinical scenarios, this case serves as an unprecedented insight into the complexities of managing such synchronous malignancies in HIV-positive patients. The article also examines the heightened risk of specific cancer types in individuals living with HIV compared to those without the virus, focusing on AIDS-defining cancers such as Kaposi sarcoma, various lymphomas (including Burkitt lymphoma, immunoblastic lymphoma, and primary central nervous system lymphoma), and invasive cervical cancer. Additionally, it highlights an increased incidence and severity of other cancers amongst HIV-positive individuals, including Hodgkin lymphoma, anal cancer, testicular cancer, melanoma, various skin and superficial eye cancers, and leiomyosarcoma. The article discusses the challenges in the treatment plan, the impact of HIV status on the patient's condition, and the evolving landscape of cancer risk in people living with HIV. Despite significant progress in HIV care, cancer remains a paramount health concern for this population, necessitating tailored approaches and further research to ensure improved outcomes for individuals facing this dual challenge. The case highlights the need for greater inclusivity of PLWH in cancer clinical trials and reinforces the importance of equitable cancer care for this unique patient demographic.

Detection of Contralateral Malignancies on Breast MRI.

INTRODUCTION: Women with unilateral breast cancer are at increased risk for having simultaneous cancer of the contralateral breast. Overall, earlier detection of contralateral breast cancer prevents the burden of additional surgery or chemotherapy rounds and is associated with higher overall survival. However, MRI screening for the contralateral breast is seldom done following an initial unilateral breast cancer diagnosis. The purpose of this study is to retrospectively evaluate patients with known, biopsy-proven malignancy who went on to obtain a breast MRI and were later found to have cancer of the contralateral breast.  Methods: This was a retrospective study that reviewed the charts of women aged over 18 years who were determined to have synchronous bilateral breast cancer from January 2017 to January 2022 at the University of Florida, Gainesville, FL. The study extracted data from this institution's cancer registry database, which provided information on patients with breast cancer diagnoses. The study conducted a review of mammography (MAM) and MRI imaging reports to ascertain the presence or absence of contralateral breast cancer identified by each respective imaging modality. Surgical pathology reports from the biopsy of the contralateral breast were reviewed to obtain information on the histological type of cancer and TNM (tumor, node, metastasis) staging. RESULTS: Of the 17 cases in which MAM missed contralateral cancer, follow-up MRI detected contralateral malignancy in 12 cases (70.59%) and subsequently changed management, resulting in additional imaging, biopsy, and eventual diagnosis and treatment of contralateral breast cancer. Examining the number of contralateral breast cancers detected by patients who had undergone MAM followed by MRI and those who had only undergone MAM, the study found that the detection rate of contralateral breast cancer from MAM was 45.45% (15/33). The tumor stages of the missed cancers were all T1 or Tis stage with one T1mi, and there was no nodal involvement.  Conclusion: In addition to its utility in staging breast cancers, MRI also has the superior ability to detect otherwise undetected contralateral breast malignancy. This retrospective study found that MRI imaging led to a considerable increase in the detection of contralateral cancer. The study found that these undetected contralateral breast cancers by MAM were often of lower staging with no nodal involvement, highlighting the opportunity for MRI to assist in early cancer detection while the patient's prognosis is still good. Its high cost should be balanced with staging and occult malignancy detection utility in future practice.