Sarcoidosis is a systemic disease that causes noncaseating granulomas in multiple organs, primarily affecting the respiratory tract, eyes, skin, and heart. Although it also occurs in the liver, it is difficult to distinguish it from well-differentiated hepatocellular carcinoma based on imaging diagnosis alone. Here, we report a case in which it was difficult to distinguish it from well-differentiated hepatocellular carcinoma, but the diagnosis was made after surgical resection.

The middle meningeal artery (MMA) has emerged as an endovascular route for treating chronic subdural hematoma (CSDH), meningioma, and refractory headaches. The third ARISE roundtable convened experts from neurology, neurosurgery, neuroradiology, industry, and regulatory agencies to develop consensus guidance on current evidence for MMA-based therapies METHODS: Over 50 experts participated in a multi-stakeholder discussion. Evidence from randomized and observational studies, early-phase interventional series, and preclinical work was reviewed. Breakout groups focused on four domains: (1) MMA embolization (MMAE) for CSDH, (2) preoperative embolization of meningiomas, (3) MMA-targeted therapies for headache, and (4) transvascular access for endovascular drainage of subdural hematomas. Consensus recommendations were developed by a writing committee RESULTS: Randomized trials support MMAE as an adjunct to surgery or medical management for selected patients with non-acute, symptomatic CSDH to reduce recurrence, progression, and reoperation. Evidence remains insufficient to support MMAE for acute or asymptomatic subdural hematomas. For meningioma, observational data suggest that preoperative embolization in experienced centers can reduce blood loss and operative time and may delay recurrence in large, hypervascular tumors with predominant dural or external carotid supply; primary embolization and intra-arterial oncologic therapies remain investigational. Early series of MMA-directed lidocaine infusion for refractory migraine, status migrainosus, and post-subarachnoid hemorrhage headache show short-term benefit, highlighting the need for controlled trials. Preclinical and first-in-human studies of combined MMAE and transvascular drainage for CSDH demonstrate high technical success, rapid radiographic and clinical improvement, and no early recurrences CONCLUSION: The MMA represents a vascular pathway for an expanding spectrum of neurointerventional therapies.

Hypocellular bone marrow failure (BMF) may be acquired due to immune-mediated disease, the prototype being immune aplastic anemia (IAA), or inherited, due to germline defects in genes important for hematopoietic stem cells' function and maintenance (inherited bone marrow failure syndromes [IBMFS]). Proper diagnosis of the underlying etiology of hypocellular bone marrow failure, particularly distinguishing immune AA, myelodysplastic syndrome (MDS) (most relevant in this setting, hypoplastic MDS [MDS-h]), and the IBMFS, is important given the differences in clinical management. Clonal hematopoiesis (CH), in this context comprising somatic mutations or chromosomal abnormalities, is incorporated into standard algorithms for classification, risk stratification, and treatment decisions for hematologic malignancies, but the clinical significance in BMF is not well established. Disease-specific clonal signatures have been reported across the BMF spectrum, and here we show how distinct patterns of CH can aid in distinguishing different etiologies of hypocellular BMF. Additionally, detection of somatic alterations in many BMF disorders can estimate risk for secondary myeloid neoplasms, guide surveillance and, in some instances, allow for early therapeutic intervention.

Right ventricular (RV) myxomas account for < 5% of cardiac myxomas and are often asymptomatic, easily overlooked. We report a 13-year-old female with a giant RV myxoma (70 × 35 × 49 mm) extending to the main pulmonary trunk, detected via routine adolescent health screening. Multimodal imaging (TTE, CT, MRI) facilitated diagnosis, and complete surgical resection was performed. Postoperative histopathology confirmed the diagnosis, with favorable short-term outcomes. This case highlights that proactive TTE-based screening, multimodal imaging evaluation, and early surgical intervention are crucial for improving the prognosis of patients with right ventricular myxoma. This case highlights that proactive TTE-based screening, multimodal imaging evaluation, and early surgical intervention are crucial for improving the prognosis of patients with right ventricular myxoma.

The human thymus plays a key role in the development of the adaptive immune system. Its development and pathologic aberrations with missing involution occupy the scientific world for years. Here, we present a comprehensive single-cell RNA sequencing (scRNA-seq) analysis of 453,727 cells across 53 datasets derived from healthy prenatal, pediatric, and adult thymic tissues, as well as six pathological conditions, including thymic hyperplasia and thymic epithelial tumors (types A, AB, B, C, and micronodular thymoma). We created a high-resolution cellular atlas revealing disease-specific cellular populations and transcriptional programs, particularly within fibroblast subsets and thymic epithelial cells. Comparative analysis uncovers distinct intercellular communication patterns and identifies transcriptional alterations associated with thymic pathology. Integration with published bulk RNA-seq datasets supports the robustness and translational relevance of our findings. This study provides a foundational resource for understanding the cellular and molecular landscape of thymic development and disease, offering avenues for diagnostic and therapeutic innovations.

A 69-year-old woman with a recurrent skull-base meningioma developed recurrent hypothermia during rehabilitation, initially misattributed to infection. Episodes followed a circadian pattern and were associated with delirium, pancytopenia, and signs of central endocrine dysfunction. MRI showed a large meningioma compressing the hypothalamus with an intact corpus callosum. Infection and adrenal insufficiency were excluded. Hypothermia resolved with external warming, and pancytopenia normalized spontaneously. Subclinical hypothyroidism and central hypogonadism were noted, consistent with hypothalamic-pituitary axis involvement. These findings supported a diagnosis of acquired spontaneous periodic hypothermia (SPH) due to hypothalamic compression. This case illustrates that early recognition of SPH in patients with skull-base tumors can prevent misdiagnosis and guide appropriate supportive care and monitoring.

Over the past decade, clonal hematopoiesis (CH) has gained substantial attention as a prevalent, age-associated phenomenon with major implications for hematologic malignancy, cardiovascular disease, and mortality. CH arises from the clonal expansion of hematopoietic stem cells and progenitor cells harboring somatic mutations, most commonly in genes implicated in leukemia. Beyond chronological aging, CH evolution is shaped by lifelong exposure to inflammatory, metabolic, and environmental stressors, such as smoking and obesity. More recently, cancer therapies-particularly cytotoxic treatments-have been shown to significantly increase the risk of CH. Therapy-related CH, however, exhibits a distinct mutational spectrum, frequently involving genes in the DNA damage response pathway, reflecting the selective pressure exerted by cytotoxic exposure. Current evidence largely supports that cytotoxic therapies primarily drive the expansion of preexisting mutant clones rather than inducing de novo mutations. The increased recognition of therapy-related CH has prompted growing interest in its prognostic and therapeutic implications in patients with cancer. To date, data regarding the prognostic impact of CH in cancer are conflicting, but the presence of CH generally portends worse overall survival, especially among patients with hematologic malignancies. Moreover, cancer survivors with CH appear to be at a heightened risk of cardiovascular disease, which may be further exacerbated by exposure to cardiotoxic cancer therapies. Collectively, these findings underscore the growing clinical relevance of CH and highlight its potential implications for precision medicine and survivorship care in oncology.

Esophageal squamous cell carcinoma (ESCC) is characterized by intrinsic radioresistance, primarily mediated by hyperactivation of DNA damage response (DDR) pathways. This repair capacity significantly diminishes radiotherapy efficacy, contributing to poor patient outcomes. Targeting DNA-dependent protein kinase catalytic subunit (DNA-PKcs), a master regulator of non-homologous end joining (NHEJ), represents a promising strategy to overcome radioresistance. Immunohistochemistry (IHC) was performed on paired biopsy specimens from esophageal squamous cell carcinoma (ESCC) patients (n = 20) collected before neoadjuvant radiotherapy and after surgical resection. In vitro, ESCC cell lines (TE13 and Eca9706) were co-treated with DNA-dependent protein kinase catalytic subunit (DNA-PKcs) inhibitors (AZD7648 or NU7741) or PRKDC-targeting siRNA plus irradiation. Subsequent functional assays were conducted to assess cell viability, apoptosis, cell cycle distribution, and underlying molecular mechanisms. In vivo, the combined efficacy of AZD7648 and irradiation was evaluated in xenograft tumor models. Phosphorylated DNA-PKcs (Ser2056) in ESCC tissues was significantly elevated following irradiation. Inhibition of DNA-PKcs markedly enhanced radiosensitivity in both ESCC cell lines and xenograft models, correlating with prolonged G2/M arrest and increased apoptosis. Mechanistically, the combined therapy activated the ATM (Ser1981)-Chk2 (Thr68) axis and concurrently enhanced phosphorylation of Chk1 at Ser345, reinforcing G2/M arrest through Wee1 kinase-mediated inhibitory phosphorylation of CDC2 at Tyr15. Consequently, irreparable DNA double-strand breaks (DSBs) accumulated, triggering Caspase-3-dependent cleavage of PARP and execution of the intrinsic apoptosis pathway. Our study reveals a novel mechanism by which DNA-PKcs inhibition augments radiosensitivity in ESCC. Targeting DNA-PKcs could represent a promising strategy to improve the efficacy of radiotherapy in ESCC, offering a potential therapeutic approach to overcome radioresistance.

To explore the intervention effect of preoperative visit nursing based on the Health Belief Model (HBM) on the perception of preoperative anxiety and pain-related stress in patients with lung cancer (LC). This retrospective study included 110 LC patients who underwent surgery at our hospital from June 2022 to June 2024. Based on the preoperative nursing protocol received, patients were assigned to a control group (routine preoperative care, n = 55) or a study group (HBM-based preoperative visit nursing, n = 55). Primary outcomes were preoperative anxiety (Amsterdam Anxiety and Information Scale [APAIS]; higher scores indicate greater anxiety), pain sensitivity (Pain Sensitivity Questionnaire [PSQ]; higher scores indicate greater sensitivity), perceived stress (Perceived Stress Scale [PSS]; higher scores indicate greater stress), and postoperative pain (Visual Analogue Scale [VAS]; higher scores indicate greater pain). Secondary outcomes included preoperative physiological parameters (systolic/diastolic blood pressure, heart rate), sleep quality (Pittsburgh Sleep Quality Index [PSQI]; higher scores indicate poorer sleep), and postoperative complications.No significant baseline differences existed between groups (P > 0.05). Between-group comparisons used independent t-tests or chi-square tests; repeated-measures ANOVA was used for longitudinal data. After intervention, APAIS, PSQ, and PSS scores decreased in both groups, with significantly lower scores in the study group (P < 0.05). Except at 6 h postoperatively, VAS scores at 12 h, 24 h, and 48 h were significantly lower in the study group (P < 0.05). Preoperative physiological parameters increased less in the study group (P < 0.05); PSQI scores decreased more in the study group (P < 0.05). The study group had a lower postoperative complication rate (3.64% vs. 16.36%, P < 0.05). HBM-based preoperative visit nursing may alleviate preoperative anxiety, pain sensitivity, and stress perception, reduce postoperative pain and physiological stress, improve sleep quality, and lower postoperative complications in LC patients.