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Cisplatin is a widely used chemotherapeutic agent for treating various malignancies. However, its clinical utility is often restricted by toxicities, such as nephrotoxicity, neurotoxicity and ototoxicity.1 Identifying genetic factors influencing these adverse effects is essential for developing personalised treatment strategies. This study aimed to identify genetic variants and differentially expressed genes associated with cisplatin-induced toxicity using publicly available genomic and clinical data. Clinical and genomic data from patients receiving cisplatin-based chemotherapy were retrieved from The Cancer Genome Atlas (TCGA). Patients were stratified into high-toxicity and low-toxicity groups based on the severity of adverse events.2 Differential gene expression analysis was conducted using DESeq2, and mutation frequency comparisons were performed using Fisher’s exact test. Gene set enrichment analysis (GSEA) was applied to identify biological pathways linked to toxicity. Validation was performed using data from PharmGKB. Genes associated with drug metabolism (TPMT and COMT), DNA repair (ERCC1 and XPC), and oxidative stress response (SOD2 and NQO1) showed significant differential expression between the two toxicity groups (adjusted p<0.05). Mutation analysis revealed a higher frequency of DPYD and UGT1A1 variants in the high-toxicity group.3 Pathway enrichment analysis implicated oxidative stress and mitochondrial dysfunction as key mechanisms contributing to cisplatin toxicity. These findings highlight the potential for genetic markers to predict toxicity risk and guide personalised treatment strategies.4 Table 1 outlines differentially expressed genes associated with cisplatin toxicity. Table 2 outlines mutation frequency in high- and low-toxicity groups. This study identifies potential genomic biomarkers for cisplatin-induced toxicity, providing insights into precision oncology.5 Genetic screening before cisplatin administration may help optimise dosing and minimise adverse effects. Further validation in independent cohorts is necessary to confirm these findings and facilitate their clinical implementation.

Fluoropyrimidines (FP), including 5-fluorouracil (5-FU) and capecitabine, are widely used chemotherapeutic agents. However, their toxicity varies significantly among patients, often because of genetic differences in DPYD, which encodes dihydropyrimidine dehydrogenase, an enzyme crucial for FP metabolism.1 This study examined DPYD variant frequencies across different populations to assess their impact on FP-related toxicity risk. Allele frequencies of key DPYD variants (DPYD2A, c.2846A>T, c.1236G>A, DPYD*13, and c.85T>C) were analysed using data from the 1000 Genomes Project (Phase 3) and gnomAD v2.1.1. Population groups included Indian (South Asian), East Asian (Chinese, Japanese and Korean), and African (African and African-American) cohorts.2,3 Chi-square tests and Fisher’s exact tests were used to compare allele frequencies across populations. Functional annotations were retrieved from dbSNP and ClinVar, and risk estimates were calculated using odds ratios (OR) with 95% confidence intervals (CI). Significant population differences in DPYD variant frequencies were observed1–3:•DPYD*2A (rs3918290): rare in Indian (0.05%) and East Asian populations (0%), but more frequent in African populations (0.1%);•c.2846A>T (rs67376798): absent in Indian and East Asian populations; rare in African populations;•c.1236G>A (rs56038477, HapB3): found in 1.4% of Indian populations; rare in East Asians (0%) and Africans (0.3%);•DPYD*13 (rs55886062): absent in Indian and East Asian populations; extremely rare in African populations;•c.85T>C (rs1801265): highly prevalent in Indians (24.91%), lower in East Asians (7.2%) and Africans (40.2%);•Patients carrying risk alleles had a 3.5–4.2 fold increased risk of FP-related toxicity (p < 0.05). The findings highlight higher toxicity risk in Indian and African populations resulting from distinct DPYD variant distributions. Table 1 outlines DPYD variant frequencies and Table 2 outlines risk estimates for FP-related toxicities across populations. Population-specific DPYD variant frequencies suggest the need for ethnicity-guided pharmacogenetic screening before FP chemotherapy.4 These findings support precision dosing strategies to minimise severe toxicity risks, particularly in Indian and African patients. Further prospective validation is warranted.

Cardiac myxomas are the most common primary cardiac tumors, predominantly located in the left atrium. These benign tumors can obstruct blood flow, cause embolization, or produce systemic symptoms like fever. Diagnostic tools such as echocardiography play a critical role in their identification, while surgical resection remains the primary curative treatment. Although recurrence is rare, it occurs more frequently in patients with genetic predispositions, such as the Carney complex. The risk of life-threatening complications such as embolism and sudden death necessitates prompt diagnosis and management. Despite the success of surgical treatment, recent advances have introduced minimally invasive techniques and novel molecular therapies, particularly for recurrent cases. While surgical resection remains curative in most cases, recurrence, particularly in familial syndromes, requires vigilant monitoring and innovative treatments. Emerging molecular therapies show potential in offering personalized treatment options, although they are still inchoate. Further research is needed to improve delivery systems and minimize the challenges associated with these therapies, paving the way for more effective management strategies.

Heart rate variability, the physiological variation in time intervals between successive heartbeats, is a valuable marker used to index the functionality of the cardiac Autonomic Nervous System in healthy individuals and patients with cardiovascular and non-cardiovascular disorders. In cardiac surgery, heart rate variability can be a crucial tool for the operative management of patients. This manuscript reviews the role of heart rate variability in surgery, its current applications, and emerging trends in clinical settings. Emerging trends in heart rate variability in cardiac surgery include the use of artificial intelligence for automated heart rate variability analysis, wearable biosensors for continuous monitoring, and tailored therapeutics. There are also new advances in machine-learning algorithms for heart rate variability interpretation, which are promising for enhancing ischemia detection and refining real-time decision-making during high-risk cardiac procedures. Thus, future research should focus on refining heart rate variability-based predictive models and integrating heart rate variability metrics into multimodal perioperative management strategies to improve surgical outcomes.

Background Bioterrorism involves the deliberate use of biological agents as weapons to cause harm or death to humans, animals, or plants. These agents are naturally found in the environment but can be modified into weapons. Identifying unusual patterns in disease outbreak, timing, or geographic location is crucial to identify potential bioterrorism events. Prompt notification of public health authorities is essential for proper investigation. This literature review aims to evaluate the potential use of oncogenic agents in bioterrorism and assess risks, preparedness, and response strategies. Methods This literature review was conducted using Google Scholar, PubMed, and World Health Organization (WHO) reports, using terms such as “bioterrorism”, “bioterror”, “biological weapons”, “oncogenic viruses”, and “oncogenic agents”. Results Biological agents pose a threat through various mechanisms such as chronic inflammation, DNA mutations, and immune evasion, which promote carcinogenesis. Namely, chemical carcinogens and radiological agents have a delayed mechanism, but have a profound impact on carcinogenesis. Advances in genetic engineering, such as Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR), have also raised concerns regarding carcinogenesis due to targeted genetic manipulation of oncogenic viruses. Conclusions Early detection, immediate mitigation measures, and long-term cancer surveillance programs are critical response strategies to bioterrorism threats. Public communication is also essential to mitigate fear and misinformation. Legal measures include victim compensation and ethical considerations, particularly regarding experimental or genetic therapies. Historically documented incidents exemplify cases that expose significant challenges in diagnosis. The potential use of biological, radiological, and chemical agents in bioterrorism highlights the need for multisectoral cooperation to develop comprehensive response strategies.

Objective Cancer is one of the leading causes of mortality in the world and also causes morbidity and deterioration in the mental health of patients and their caregivers. The most commonly reported psychological symptoms include anxiety, depression, and the fear of recurrence. The purpose of this narrative review is to elaborate and discuss the effectiveness of the different interventions employed and their utilities in clinical practice. Methods Scopus and PubMed databases were searched, with a timeframe from 2020 to 2022, to identify randomised controlled trials, meta-analyses, and reviews and reported using PRISMA guidelines. Articles were searched by the following keywords: “cancer, psychology, anxiety, and depression”. An additional search was performed with the keywords “cancer, psychology, anxiety, depression, and [intervention name]”. The most popular psychological interventions were included in these search criteria. Results A total of 4829 articles were retrieved by the first preliminary search. After reducing duplicates, 2964 articles were assessed for inclusion according to eligibility criteria. After the full-text screening, 25 final articles were chosen. To systematise psychological interventions as described in the literature, the authors have divided them into 3 broad categories, each type targeting a specific domain of mental health: cognitive-behavioural, mindfulness, and relaxation. Conclusion The most efficient psychological therapies, as well as therapies which require more extensive research, were outlined in this review. The authors discuss the necessity of primary assessment of patients and whether they require the help of a specialist. With the limitations of the potential risk of bias, an overview of different therapies and interventions targeting various psychological symptoms is outlined.

Acute radiation dermatitis is a frequent adverse effect of radiotherapy, but standardisation of care for acute radiation dermatitis is lacking. Due to the conflicting evidence and variability in current guidelines, a four-round Delphi consensus process was used to compile opinions of 42 international experts on care for people with acute radiation dermatitis on the basis of the evidence in existing medical literature. Interventions for acute radiation dermatitis prevention or management that reached at least 75% consensus were recommended for clinical use. Six interventions could be recommended for the prevention of acute radiation dermatitis: photobiomodulation therapy and Mepitel film in people with breast cancer, Hydrofilm, mometasone, betamethasone, and olive oil. Mepilex Lite dressings were recommended for the management of acute radiation dermatitis. Most interventions were not recommended due to insufficient evidence, conflicting evidence, or lack of consensus to support use, suggesting a need for further research. Clinicians can consider implementing recommended interventions in their practice to prevent and manage acute radiation dermatitis until additional evidence becomes available.

Purpose This systematic review and meta-analysis aimed to evaluate the efficacy of barrier films and dressings in preventing acute radiation dermatitis (RD). Methods OVID Medline, Embase, and Cochrane databases were searched from 1946 to September 2020 to identify randomized controlled trials on the use of barrier films or dressings to prevent RD. For comparable outcomes between studies, pooled effect sizes and 95% confidence intervals (CI) were calculated using the random effects analysis in RevMan 5.4. Results Fourteen and 11 studies were included in the qualitative and quantitative analyses, respectively. Five types of barrier films used for RD were identified: Hydrofilm, StrataXRT®, Mepitel® Film, 3 M™ Cavilon™ No-Sting Barrier Film, and silver leaf nylon dressing. Hydrofilm and Mepitel Film significantly reduced the development of RD grade ≥ 2 in breast and head and neck cancer patients (RR 0.32, 95%CI 0.19, 0.56, p < 0.0001; RR 0.21, 95%CI 0.05, 0.89, p = 0.03, resp.). Moreover, Hydrofilm had a beneficial effect on patient-reported outcomes (PROs) (SMD -0.75, 95%CI -1.2, -0.29, p = 0.001). The meta-analyses on the other barrier films did not show any significant effect. Conclusion This review and meta-analysis demonstrated that Hydrofilm and Mepitel Film could effectively reduce RD severity and improve PROs. The evidence is generally weak for all the studies on barrier films and dressings due to a limited study number, high risk of bias, small sample sizes, and minimal comparable outcome measures. It’s potential has been proven, but future research in this field is recommended to confirm the efficacy of these products and assess real-world feasibility.