Glioblastoma multiforme (GBM) is one of the most aggressive and lethal brain tumors, characterized by rapid growth, invasiveness, and resistance to standard therapies, including surgery, chemotherapy, and radiotherapy. Despite advances in treatment, GBM remains highly resistant due to its complex molecular mechanisms, including angiogenesis, invasion, immune modulation, and lipid metabolism dysregulation. This review explores recent breakthroughs in targeted therapies, focusing on innovative drug carriers such as nanoparticles and liposomes, and their potential to overcome GBM's chemo- and radioresistant phenotypes. We also discuss the molecular pathways involved in GBM progression and the latest therapeutic strategies, including immunotherapy and precision medicine approaches, which hold promise for improving clinical outcomes. The review highlights the importance of understanding GBM's genetic and molecular heterogeneity to develop more effective, personalized treatment protocols aimed at increasing survival rates and enhancing the quality of life for GBM patients.

Cryoablation is gaining attention as a minimally invasive treatment option for prostate cancer (PCa), offering a balance between effective oncological control and preserving genitourinary functions and quality of life. Focal cryoablation is emerging as a viable option for patients with PCa, particularly those who prioritize functional outcomes such as erectile functions and urinary continence. Whole-gland cryoablation, on the contrary, may be more appropriate for intermediate- and high-risk PCa where complete ablation of the prostate is necessary to ensure oncological control. Despite promising results, there is considerable heterogeneity in the available data regarding the long-term oncological and functional outcomes of cryoablation techniques, making it premature to issue definitive treatment recommendations. Further studies, particularly randomized controlled trials, are needed to clarify the role of cryoablation in PCa treatment. This narrative review aims to present the most relevant and up-to-date evidence on both focal and whole-gland cryoablation in PCa, providing a comprehensive overview of their current clinical applications, outcomes, and future potential.

Objectives: The impact of renal ischemia during partial nephrectomy (PN) on postoperative renal function remains controversial. On-clamp PN provides improved surgical exposure and haemostasis but induces warm ischemia, which may impair renal function. Off-clamp PN avoids ischemia-related injury and may better preserve renal function, although concerns persist regarding blood loss and oncological safety. We systematically compared perioperative and functional outcomes, as well as surgical margin status between on-clamp and off-clamp PN. Methods: We performed a systematic search of PubMed, Embase, Cochrane, Web of Science, and Scopus to identify randomized controlled trials (RCTs) and observational studies comparing on-clamp versus off-clamp PN with no publication time limitations. Outcomes included estimated glomerular filtration rate (eGFR), percentage eGFR change, estimated blood loss (EBL), transfusion rates, positive surgical margins (PSMs), operative time, and complications. Results: Thirty-nine studies (four RCTs) including 10,154 patients were analysed. Off-clamp PN was associated with a smaller decline in eGFR (mean difference [MD] −4 mL/min/1.73 m², 95% CI −5.7 to −2.8) and lower percentage eGFR loss (MD −1.7%, 95% CI −2.8 to −0.7). On-clamp PN was associated with lower EBL (MD −48 mL, 95% CI −72 to −25). Transfusion rates favored on-clamp PN but were not statistically significant (OR 0.7, 95% CI 0.5–1.0). On-clamp PN was associated with a higher risk of PSM (OR 1.3, 95% CI 1.0–1.7) and postoperative complications (OR 1.3, 95% CI 1.1–1.6). Between-study heterogeneity and predominance of observational data were key limitations. Conclusions: Off-clamp PN provides superior renal functional preservation and lower risks of PSMs and complications, at the cost of increased blood loss. These findings support individualized surgical decision-making based on patient and tumor characteristics. What does the study add?: This study provides an extensive and detailed comparison of off-clamp versus on-clamp partial nephrectomy, encompassing more than 10,000 patients from 39 studies. By integrating the available evidence up to late 2024, it delivers comprehensive estimates of the renal functional benefits associated with ischemia-free surgery. Our findings delineate the trade-offs between renal preservation, blood loss, and surgical margin status, thereby informing individualised decision-making in nephron-sparing surgery and refining current understanding of when ischemia avoidance is most clinically advantageous. Patient summary: Our study suggests that performing partial nephrectomy without temporarily clamping the kidney blood vessels may better preserve kidney function and reduce cancer-related surgical risks, but can lead to increased blood loss during surgery. These findings indicate that the choice of surgical technique should be individualised, taking into account tumour features and patient-specific factors.

Wstęp: Opioidy są podstawą w leczeniu bólu o nasileniu umiarkowanym do silnego, jednak ich stosowanie wiąże się z ryzykiem zaburzeń funkcji poznawczych. Kluczowym wyzwaniem klinicznym jest rozróżnienie jatrogennego działania opioidów od negatywnego wpływu niedostatecznie kontrolowanego bólu na funkcje poznawcze. Celem przeglądu jest synteza aktualnej wiedzy na temat mechanizmów, objawów klinicznych i strategii postępowania w przypadku ryzyka zaburzeń funkcji poznawczych podczas terapii opioidami. Materiał i metody: Przeprowadzono narracyjny przegląd literatury, korzystając z baz danych PubMed, Scopus i Google Scholar. Analiza objęła badania przedkliniczne i kliniczne (obserwacyjne i randomizowane), przeglądy systematyczne oraz metaanalizy. Dobór piśmiennictwa uwzględniał zarówno fundamentalne prace dotyczące patofizjologii, jak i najnowsze publikacje koncentrujące się na objawach klinicznych i nowoczesnych podejściach terapeutycznych. Wyniki: Zaburzenia poznawcze wywołane przez opioidy wynikają ze złożonych mechanizmów, w tym neurotoksyczności i upośledzonej plastyczności synaptycznej. Główne objawy kliniczne obejmują deficyty uwagi, pamięci i funkcji wykonawczych. Obraz kliniczny jest często komplikowany przez czynniki zakłócające, takie jak sam ból, stres emocjonalny czy polipragmazja. Do grup wysokiego ryzyka należą osoby w podeszłym wieku oraz pacjenci z niewydolnością nerek. Skuteczne strategie ograniczania ryzyka obejmują indywidualizację dawkowania, rotację opioidów oraz stosowanie leków o potencjalnie korzystniejszym profilu neurokognitywnym, takich jak tapentadol czy buprenorfina. Wnioski: Skuteczne leczenie bólu wymaga zmiany paradygmatu – od koncentracji wyłącznie na analgezji do holistycznej strategii, która aktywnie równoważy kontrolę bólu z zachowaniem funkcji poznawczych. Proaktywne monitorowanie funkcji poznawczych oraz zindywidualizowana farmakoterapia mają podstawowe znaczenie dla optymalizacji wyników leczenia i poprawy jakości życia pacjentów.

Small Intestinal Bacterial Overgrowth (SIBO) is increasingly recognized in oncology. It often complicatestreatment, reduces quality of life, and may contribute to carcinogenesis through chronic inflammation.Diagnostic breath tests, widely used for SIBO, show promise in early detection of colorectal polypsand cancer. Current therapies (antibiotics, diet, probiotics) provide partial relief, but data in oncologyremain limited. Recognizing and managing SIBO in cancer care may improve outcomes and requiresfurther research.