Negative feelings, such as anxiety and depression, are common in patients with cancer. Our aim was to investigate the prevalence of malnutrition and distress in cancer patients and to examine the relationship between them. We did a cross-sectional study in West China hospital, China, using adapted questionnaires derived from Patient-Generated Subjective Global Assessment (PG-SGA), Nutritional Risk Screening 2002 (NRS2002) and Distress Thermometer (DT). We also focused on the factors associated with distress. We found that psychological distress in cancer patients was common, with 39.5% patients suffering from distress. The mean score of PG-SGA was 3.37 (0–6), and 39.1% patients had malnutrition when using 4 as a cut-off value. Meanwhile, the mean score of NRS2002 was 1.91 (0–11), and 25.8% patients presented with malnutrition when using 3 as the cut-off value. Higher scores of nutritional risks confirmed by PG-SGA (r = 0.148, p < 0.001) and NRS2002 (r = 0.142, p < 0.001) were significantly correlated with higher levels of psychological stress. Malnutrition was correlated with psychological stress in cancer patients. Early intervention in the mental problems and nutrition was meaningful, which could improve the psychological statuses of cancer patients.

Background: Hemorrhagic stroke (HS) accounts for approximately 30% of all stroke cases and has high mortality in the intensive care unit (ICU). The blood urea nitrogen-to-creatinine ratio (BUNCR) is a potential biomarker of catabolic stress in critically ill patients. Meanwhile, its dynamic prognostic value in ICU-admitted HS patients remains unclear. This study utilized Group-based Trajectory Modeling (GBTM) to investigate associations between early BUNCR patterns and mortality. Methods: This study was conducted using data from the MIMIC-IV (v2.2) database. HS cases were identified via ICD-9/10. BUNCR trajectories were assessed by applying GBTM during the first 7 days. Outcomes were all-cause mortality (ACM) on day 28, on day 90, and at 1 year, with ICU and in-hospital mortality also evaluated. Kaplan–Meier survival curves and log-rank test compared survival across groups. Multivariable Cox proportional models adjusted for confounders and subgroup analysis assessed robustness. Results: Among 2559 patients (52.48% male), mortality was 10.16% (ICU), 14.07% (in-hospital), 17.00% (28-day), 22.43% (90-day), and 36.97% (1-year). Three BUNCR trajectories were identified: Group 1 (upward–downward, n = 655), Group 2 (stable upward, n = 1270), and Group 3 (downward–upward, n = 634). Group 2 had the highest ACM risk at 28-day, 90-day, and 1-year (p < 0.01), and was identified as a significant risk factor in multivariate Cox regression. Subgroup revealed significant interactions of BUNCR trajectories with age and sepsis. Conclusions: Distinct BUNCR trajectories were significantly associated with ACM in critically ill HS patients. Persistently increasing BUNCR predicted the poorest outcomes, underscoring its potential as a dynamic biomarker for timely risk stratification and informed ICU decisions.

Objective: Gamma knife radiosurgery (GKRS) has served as an adjunctive treatment in Cushing’s disease (CD) for decades and has become a vital part of therapy in the management of CD. Biological effective dose (BED) is a radiobiological parameter with time correction, considering the cellular deoxyribonucleic acid repairment. We aimed to investigate the safety and efficacy of GKRS for CD and evaluate the association of BED and treatment outcome. Methods: A cohort study of 31 patients with CD received GKRS in West China Hospital between June 2010 and December 2021. Endocrine remission was defined as normalization of 24 h urinary free cortisol (UFC) or serum cortisol ≤ 50 nmol/L after a 1 mg dexamethasone suppression test. Result: The mean age was 38.6 years old, and females accounted for 77.4%. GKRS was the initial treatment for 21 patients (67.7%), and 32.3% of patients underwent GKRS after surgery due to residual disease and recurrence. The mean endocrine follow-up duration was 22 months. The median marginal dose was 28.0 Gy, and the median BED was 221.5 Gy_2.47. Fourteen patients (45.1%) experienced control of hypercortisolism in the absence of pharmacological treatment, and the median duration to remission was 20.0 months. The cumulative rates of endocrine remission at 1, 2, and 3 years after GKRS were 18.9%, 55.3%, and 72.21%, respectively. The total complication rate was 25.8%, and the mean duration from GKRS to hypopituitary was 17.5 months. The new hypopituitary rate at 1, 2, and 3 years were 7.1%, 30.3%, and 48.4%, respectively. A high BED level (BED > 205 Gy_2.47) was associated with better endocrine remission than a low BED level (BED ≤ 205 Gy_2.47), while no significant differences were found between the BED level and hypopituitarism. Conclusions: GKRS was a second-line therapeutic option for CD with satisfactory safety and efficacy. BED should be considered during GKRS treatment planning, and optimization of BED is a potentially impactful avenue toward improving the efficacy of GKRS.

To compare the efficacy and safety between primary GKS and postoperative GKS for acromegaly, and to elucidate predictors associated with endocrine remission, we performed a monocenter, retrospective study. Seventy-five patients with acromegaly who had received GKS in West China Hospital between March 2010 and December 2018 were included in this study. Endocrine remission was defined as age-sex matched IGF-I normalization and either nadir level of GH 0.05). Actuarial rates of durable endocrine remission at 3, 5, 8 year were 10.60 %, 33.80 % and 70.60 % in the primary GKS group and 6.70 %, 43.40 % and 78.80 % in the postoperative GKS group(P = 0.800). Only base nadir GH after OGTT (HR = 0.637,95 % CI:0.416-0.977; P = 0.039) was found to be a predictor of duration endocrine remission. We find comparable efficacy and safety between primary GKS and postoperative GKS. Lower base nadir GH after OGTT was a positive predictor associated with endocrine remission. GKS should be considered for residual or recurrent tumor after surgery. For those who couldn't sustain surgery, GKS is an alternative treatment. Further studies are required to elucidate the efficacy and safety of GKS in acromegaly.

Backgrounds: Deep brain stimulation (DBS) is an emerging and promising therapeutic approach for treatment-refractory obsessive-compulsive disorder (OCD). The most common DBS targets include the anterior limb of internal capsule (ALIC) and nucleus accumbens (NAcc). This protocol aims to explore the efficacy and safety of the combined ALIC- and NAcc-DBS for treatment-refractory OCD. Methods: We will recruit 64 patients with refractory OCD from six centers, randomly allocate them to active and sham-stimulation groups through a three-month double-blind phase, then enter a three-month open-label phase. In the open-label stage, both groups experience real stimulation. Outcome measures: The primary outcome will be the efficacy and safety of combined ALIC- and NAcc-DBS, determined by treatment response rate between the active and sham-stimulation groups at the double-blind stage and spontaneously reported adverse events. The secondary outcomes are comparisons of change in Y–BOCS, CGI, HAMD, and HAMA scores at the third and sixth months compared to baseline between the active and sham-control groups, as well as the scores of the third month minus the sixth month between the two groups.

Background: Gamma Knife radiosurgery (GKS) is widely used for the management of intracranial disorders. Emerging evidence suggests that incorporating the biological effective dose (BED) into GKS planning may improve the prediction of treatment efficacy and toxicity. This review aims to evaluate the role of BED in GKS across multiple intracranial indications. Methods: A qualitative review of published clinical studies was performed to assess the application of BED models in GKS for pituitary adenomas, vestibular schwannomas, meningiomas, arteriovenous malformations (AVMs), trigeminal neuralgia, and other disorders. The relationships between BED, treatment outcomes, and adverse effects were compared across indications. Results: The association between BED and clinical outcomes was most consistent in AVMs, where higher BED correlated closely with obliteration rates. In other diseases, BED-based analyses showed promising but variable predictive value. Notably, BED-derived parameters demonstrated improved prediction of post-GKS hypopituitarism in pituitary adenomas and AVM obliteration compared with physical dose alone. However, most available evidence was derived from retrospective studies. Conclusions: BED may serve as a valuable complement to conventional physical dose metrics in GKS planning, but its ability to replace physical dose remains uncertain. Prospective studies and histology-specific radiobiological parameter validation are required to establish the routine clinical utility of BED.