Journals
2026 EN
Sohal Ambika · Freedman Jason L. · Aller Steven
+17 more
ABSTRACT In response to the evolving complexity of inpatient care, pediatric hematology/oncology (PHO) hospitalist programs have become a vital component of care delivery. To advance this emerging field, we convened a multidisciplinary collaboration from programs across the United States to define the landscape, identify challenges, and outline a path forward. This Special Report highlights the critical role of PHO hospitalists in delivering specialized, high‐acuity care, leading quality improvement and patient safety efforts, and discussing workforce challenges. It offers a collaborative framework to support sustainable growth and define the future of PHO hospitalist medicine.
Journals
2026 EN
Kessler Alexia · Wardell Alexis C. · Buddenbaum Jessica
+7 more
ABSTRACT Background Families of children with cancer and nonmalignant blood disorders frequently explore complementary medicine (CM). Despite growing evidence supporting CM for pediatric populations, physician communication about its use remains limited. This study evaluates caregiver awareness, interest, and use of CM among pediatric hematology/oncology patients. Methods A cross‐sectional survey was conducted among caregivers at the University of North Carolina Pediatric Hematology/Oncology Clinic (May–September 2024). Eligible participants spoke English or Spanish and had attended at least one clinic visit. The survey assessed awareness and use of CM, including nutrition, supplements, mind‐body practices (e.g., prayer, acupuncture, and yoga), and whole medical systems (e.g., traditional Chinese and Ayurvedic medicines)—as well as costs, motivations, and barriers. Results A total of 150 caregivers completed the survey. Only 30% of respondents were familiar with CM terminology, yet 58% reported using at least one CM form. Dietary modifications were most common (47%), followed by mind‐body practices (20%). Caregivers of cancer patients prioritized CM to reduce treatment side effects, whereas caregivers for those of patients with nonmalignant hematology conditions prioritized long‐term quality‐of‐life. Barriers included lack of awareness (61%) and cost (15%). Only 17% had discussed CM or PIM (pediatric integrative medicine) with clinicians, and in most cases (60%), caregivers initiated the conversation. Conclusions Findings highlight significant gaps in awareness, access, and clinician‐family communication regarding pediatric CM. Despite limitations such as single‐site design and modest sample size, results underscore the need for caregiver education and accessible services to better support pediatric patients and families.
Journals
2026 EN
Littooij Annemieke · Olianti Catia · Brisse Herve
+9 more
ABSTRACT Neuroblastoma is the most common extracranial solid tumor in early childhood. Its clinical behavior is highly variable, ranging from spontaneous regression to fatal outcome despite intensive treatment. The International Society of Pediatric Oncology Europe Neuroblastoma Group (SIOPEN) Radiology and Nuclear Medicine Specialty Committees developed consensus‐based imaging recommendations for high‐risk neuroblastoma at first presentation and throughout follow‐up. These expert opinions aim to improve reproducibility and enhance diagnostic performance in order to advance the current standard of care and assist in the development of future trials.
Journals
2026 EN
Xiao Heather · Schoettler Michelle L. · Huang Hui
+4 more
ABSTRACT Objective Patients with hematopoietic stem cell transplant (HCT) frequently require procedural sedation (PS) or anesthesia for diagnostic and therapeutic procedures. They often have comorbidities that may increase the risk of sedation‐related adverse events (AEs). The study objective was to compare the incidence of AEs and interventions during PS performed outside the operating room (OR) in patients pre‐ and post‐HCT. Patients and Methods Single‐center, retrospective, case‐control study of all patients with HCT who had PS outside the OR between 2015 and 2025. Results A total of 118 patients had 332 sedation encounters. The median age was 7.6 years (IQR 3.5–11.9), and 42.4% were female. Procedures included bone marrow biopsy/aspiration (66%), lumbar puncture (9%), magnetic resonance imaging (10.8%), and nuclear medicine imaging (7.8%), with 36.7% undergoing two procedures during a single sedation encounter. A combination of propofol and fentanyl was used in 75.3% of sedation encounters. Hypoxia was the most frequent low‐high‐risk AE both pre‐ and post‐HCT (11.4% and 20.5%, respectively, p < 0.021). Blow‐by oxygen was the most common intervention and was required significantly more frequently post‐HCT (10.2% vs. 25.3%, respectively, p < 0.001). Only one sedation failure was noted. There were no cardiac arrests, pulmonary aspiration events, or deaths. Conclusion PS performed outside the OR was not associated with any critical or high‐risk AEs in patients post‐HCT compared to patients pre‐HCT. Based on this largest study to date, there is an important opportunity to minimize unnecessary exposure to anesthesia and optimize resource allocation in the HCT patient population.
Journals
2026 EN
Olmo Marta · Ector Carolin · Herzel Hanspeter
Biological systems are fundamentally rhythmic, with oscillations emerging at multiple scales, from intracellular gene circuits to organ‐level coordination. Many of these rhythms, including the circadian clock, arise from feedback‐driven genetic networks that interact to produce coherent temporal organisation. In this review, we examine the circadian system as a model for understanding the dynamics of coupled biological oscillators. We introduce the core theoretical concepts of delayed feedback, nonlinearity and coupling, and show how these principles govern the emergence of synchronisation, entrainment, and complex dynamics across cellular populations and tissues. Drawing on tools from nonlinear dynamics, we explore how oscillator models help explain robustness, plasticity, and failure modes in circadian systems. Finally, we discuss how this theoretical framework informs experimental design and translational applications in circadian medicine, from optimising drug timing to understanding rhythm disruptions in disease.
Journals
2026 EN
Sambath Janani · George Irene A. · Manda Srikanth S.
+11 more
Cervical cancer is highly prevalent in India, with most cases being diagnosed at advanced stages. Despite the standard concurrent chemoradiotherapy (CCRT), 30–40% of patients' experience treatment failure, underscoring the need for improved therapeutic strategies. Understanding resistance mechanisms and identifying predictive biomarkers are crucial to improve treatment efficacy and enable personalized medicine. We conducted a comprehensive genomic and proteomic analysis to identify molecular signatures associated with CCRT. We identified recurrent mutations in phosphatidylinositol 4,5‐bisphosphate 3‐kinase catalytic subunit alpha isoform ( PIK3CA ) and histone‐lysine N‐methyltransferase 2D ( KMT2D ), with mutation signature analysis revealing a prevalent DNA dC‐ > dU‐editing enzyme, APOBEC mutagenesis signature. Distinct genomic alterations, including epidermal growth factor receptor ( EGFR ) amplification and serine/threonine kinase 11 ( STK11 ) deletion, were exclusively observed in the chemoradiation‐resistant cohort. Proteomic analysis identified 73 significantly dysregulated proteins, with syntaxin‐3 (STX3), SERPINB7, lipopolysaccharide‐binding protein (LBP), EMILIN2, and ribosyldihydronicotinamide dehydrogenase (quinone) (NQO2) being the top five upregulated proteins. Integrative pathway analysis highlighted an active DNA repair pathway in the resistant cohort. This study presents the first proteogenomic profiling of cervical cancer in the Indian population, linking molecular alterations to CCRT response. STK11 and STX3 emerged as predictive biomarkers for poor response, whereas EGFR presents as a promising therapeutic target in the resistant group.
Journals
2026 EN
Cuy Saqués Arnau · MartinezMendez Aracele · Crown John
+1 more
Breast cancer's global prevalence underscores a critical need for novel biomarkers to guide treatment and improve patient outcomes. Biomarker discovery historically focused on mutations in protein coding regions, comprising merely 1% of the genome. However, with advances in whole‐genome sequencing, the functional significance of the noncoding genome—comprising the remaining 99%—has become increasingly evident. Noncoding regions play a vital role in regulating gene expression, and mutations within these regions have been associated with cancer risk, progression, and treatment response. This Review compiles and synthesizes current knowledge on cis‐regulatory alterations (promoters/enhancers) and long noncoding RNAs (lncRNAs) in breast cancer. Key examples include promoter mutations [e.g., rs2279744 (Mouse double minute 2 homolog gene; MDM2 )], enhancer mutations [e.g., rs4784227 (thymocyte selection‐associated high mobility group box family member 3 gene; TOX3 )], and lncRNAs [e.g., HOX transcript antisense intergenic RNA ( HOTAIR )] linked to progression, metastasis, and poor survival. Integrating preclinical ( in vitro , in vivo ) and clinical findings, we emphasize the biomarker and therapeutic potential of these noncoding alterations. This Review also critically identifies the pressing need for more specific functional validation studies to fully elucidate their mechanistic roles. This emerging field offers promising opportunities to advance personalized medicine and refine prognostic/predictive strategies for breast cancer patients.
Journals
2026 EN
Ringborg Ulrik · Braun Joachim · Celis Julio
+41 more
The cancer problem is expanding, particularly in low‐ and middle‐income countries (LMICs). Preventive measures can reduce the incidence by 40–50%, and cure rates have increased during the past decades in a number of cancers. However, optimizing prevention programmes and increasing cure rates of cancer remain significant research challenges. The main focus of the conference was on P4 Cancer Medicine (Predictive, Preventive, Personalized and Participatory), a comprehensive strategy encompassing Health‐Related Quality of Life (HRQoL) research, aiming to enhance the well‐being of patients and individuals at risk. Addressing the cancer problem requires two key elements: translational cancer research and the development of relevant infrastructures. A Comprehensive Cancer Centre (CCC) acts as an innovation hub by integrating high‐quality, multidisciplinary therapy and care, with healthcare‐dependent prevention, research, and education. The United States has been at the forefront, providing quality‐assured CCCs and the Cancer Moonshot for strategic cancer research. The EU has followed with the European Research Council for basic research, the European Innovation Council to boost disruptive innovation, and two EU initiatives on cancer, Europe's Beating Cancer Plan (EBCP) and the Mission on Cancer. The increasing complexity of cancer biology and technologies presents both a research challenge and a healthcare demand. For most patients, a CCC is not available. A critical discussion focused on quality assurance of healthcare outside the catchment area of a CCC and involving patients in clinical research. The strategic deployment of resources to support collective healthcare efforts and research aimed at reducing the cancer problem was discussed with representatives from the United States, EU, Africa, China, India and Taiwan. Analyses of translational cancer research have revealed important gaps in implementing innovations, assessment of clinical effectiveness, HRQoL, outcome and health economics research. The increased release of new anticancer agents over the last 25 years, accompanied by insufficient information on clinical benefits, presents both an economic and ethical problem. Direct healthcare costs have increased due to expenses for anticancer agents for the treatment of patients with incurable diseases. Evidence‐based treatment based on HRQoL research is an unmet need. Basic/preclinical research aimed at increasing the cure rate should identify new, broader targets for therapy and develop extended diagnostic technologies for stratifying patients, to inform innovative clinical trials. Present research strategies convert cancer to a chronic disease, a growing burden for the healthcare systems. The increasing complexity of cancer biology and technology, the growing need for translational cancer research, and the demand for supporting infrastructures underscore the importance of international collaborations between CCCs. However, funding for cancer research is not currently aligned to reduce the cancer problem. While public funding for cancer research doubled between 2005 and 2024, the pharmaceutical industry's spending on cancer research increased tenfold. Increasing funding by public and non‐profit funding organizations is mandatory. Education is another significant need, but it is currently fragmented and underfunded. The last session of the conference summarized the strategies in a Statement with a strong emphasis on global collaboration addressing the growing cancer burden and pronounced inequalities. Expanding partnerships and fostering innovative, multidisciplinary approaches to cancer prevention, therapeutics/care, as well as research, are not just urgent but essential steps towards reducing incidence, increasing cure rates and enhancing the well‐being of cancer patients. Data‐driven cancer medicine is currently under development, and modern communication technologies for diagnostics may facilitate interactions across geographical distances. A global cancer research agenda can become a model of solidarity, sustainability, and ethical responsibility.
Journals
2026 EN
Yadav Neha · Lei Xiaomeng · Cen Steven Y.
+3 more
Abstract Background Radiomic features derived from computed tomography (CT) are highly susceptible to variations in acquisition parameters, which can introduce confounding effects in multicenter research and reduce diagnostic accuracy. While the effects of parameters such as scanning mode and dose have been studied, the impact of gantry tilt—despite its routine clinical use—remains underexplored in radiomics literature. Purpose To systematically evaluate how scan mode (axial vs. helical), gantry tilt (0° vs. 5°), and radiation dose affect CT‐based radiomic metrics using an anthropomorphic liver phantom containing six 3D‐printed texture inserts, with special emphasis on the novel inclusion of tilt. Methods Twelve unique image acquisition configurations were scanned on a GE Revolution Apex CT scanner, with each configuration repeated once. Manual segmentation of volumes of interest (VOIs) was performed, and 93 radiomic features spanning six texture families were extracted using PyRadiomics. First‐order dispersion metrics (standard deviation, interquartile range, and coefficient of variation) were analyzed alongside higher‐order features via regression with heatmap visualization, and repeatable, robust, and calibratable features were identified. Results Helical scans without tilt generally exhibited lower first‐order dispersion than axial scans. Introducing a 5° tilt reduced dispersion in axial scans but had inconsistent effects in helical scans, with no coherent trend observed. Radiation dose demonstrated an expected inverse relationship with dispersion metrics. Intraclass correlation coefficient (ICC) analysis revealed that 34% of radiomic metrics exhibited good or excellent repeatability across all trials (ICC ≥ 0.6), but only 13% demonstrated good or excellent robustness, highlighting the sensitivity of radiomic metrics to scanning conditions. Regression analysis yielded 31 metrics (33%) that can be calibrated using their significant linear relationships with the parameters varied in this study, thereby allowing researchers to correct for variations in acquisition settings. Conclusions These findings underscore the importance of accounting for acquisition variability—including less frequently examined parameters such as tilt—when designing radiomic studies, selecting robust features, and interpreting results in clinical and multicenter studies. This approach helps distinguish meaningful biological variation from imaging artifacts, thereby improving the reliability of radiomic analysis in personalized medicine.
Journals
2026 EN
Hindmarsh Jonathan · Crowe Scott · Walsh Jemma
+4 more
Abstract Background Following the release in 2016 of the report of the American Association of Physicists in Medicine Task Group 100, there has been growing interest in the use of prospective hazard analysis in radiation therapy. System Theoretic Process Analysis (STPA) is an emerging technique in this domain that is particularly suited to processes that involve time sensitive collaboration, decision‐making and/or automation. Purpose The goal of this research was to use STPA to evaluate existing processes and procedures with an aim to identify improvements, gaps or unforeseen risks stemming from implementing real‐time adaptive treatment on a helical tomotherapy platform. Methods The Radixact treatment delivery system (Accuray Inc., Sunnyvale, CA, USA), an evolution of the Tomotherapy platform, incorporates upgrades such as the Synchrony system for real‐time motion monitoring and treatment adaptation. In collaboration with a team from the radiation oncology department of a large public hospital, a prospective hazard analysis focused on the real‐time adaptive capabilities of the Radixact Synchrony system was conducted using STPA. The system boundaries were defined and a control structure model comprising sub‐systems and control actions was developed. Unsafe control actions were identified and broad‐based causal scenarios were generated. The causal scenarios that were novel, specific to Synchrony or challenging to mitigate were selected for further analysis regarding impacts and potential causes, following which mitigation strategies were proposed, taking into consideration the hierarchy of controls. Results A control structure model encompassing the entire patient journey was developed, incorporating all the hardware and software components and human decision makers. The model consisted of 12 sub‐systems and 21 control actions, resulting in 108 unsafe control actions and 595 causal scenarios. Sixty‐one causal scenarios were selected for further analysis, for which mitigation strategies were proposed based on the hierarchy of controls. These included the development of better reference documentation, the systematic testing of the sensitivity of tracking performance to changes in tracking parameters, guidance around setting and documenting tracking parameters, and documentation review. Conclusions STPA was effectively used to assess the Radixact Synchrony system's real‐time adaptive radiation therapy capabilities, providing insight into how the system could become unsafe throughout the patient journey. While focused on Radixact Synchrony and real‐time adaptive radiation therapy, this study offers a transferable example of STPA application, from analysis initialization to mitigation, that can inform other safety assessments in radiation therapy.