This study focused on extracting and integrating expert surgeons' opinions into a quantitative decision-making model based on the best-worst method and used eight significant criteria, including postoperative complications, suturing time, and the surgeon's skill level. Experts' opinions were combined with the standard set data from CholecInstanceSeg. The model achieved an accuracy of 91.3% with a very low inconsistency ratio of 0.03, robustly outperforming the analytic hierarchy process and simple weighting methods. Moreover, model execution time improved by almost 50%. This study fills the gaps left by previous works by reducing ergonomic biases and increasing automation and overall system reliability in the decision-making process. The model provides a more efficient framework that can be further developed with artificial Intelligence (AI) for tailored surgical decision support systems, thus providing more accurate frameworks for suturing technique selection in oncological surgeries.

Patients harboring rearrangements of anaplastic lymphoma kinase (ALK) fusion may respond differently to ALK tyrosine kinase inhibitors (TKIs) depending on changes in the type of ALK rearrangements. We report the first documented case of KANK1-ALK fusion in mucinous lung adenocarcinoma, co-occurring with TP53 mutation. The patient underwent targeted therapy with loratinib and iruplinalkib, followed by alternative chemotherapy. Unfortunately, the KANK1-ALK fusion in this patient exhibited resistance to all the existing ALK-TKIs, and the patient's condition has worsened repeatedly. Uncommon ALK fusion patterns present substantial therapeutic obstacles in clinical practice. Accurate detection of ALK fusion types is of great significance in formulating precise treatment plans. An increasing number of clinical specimens have detected rare fusions, and the treatment of rare fusions may be a research direction in the future.

Peripheral blood smear (PBS) review is a test performed to evaluate a wide variety of hematologic and non-hematologic disorders. Evaluation of a peripheral smear by an expert permits assessment of blood cell morphology on a broad level. We aimed to evaluate the concordance between clinician orders and pathologist-reported findings and to assess the diagnostic, normal, and informative categories. This study was a cross-sectional analysis. Five hundred patients over a 3-month period were included. Data collection included patient age, gender, ward, along with the clinical reason for PBS and the pathologist reading of the PBS. In this study, we classified the pathology report results into diagnostic, normal, and informative categories. We then evaluated the concordance between the clinicians' orders and the pathology reports; if at least one finding in the PBS result was matched with a clinician order, it was considered as concordance between the order and the PBS result. The most common cause of PBS order was WBC abnormalities (81.0%), followed by RBC (50.4%) and platelet abnormalities (41.4%). Pathologist evaluation showed 67.2% WBC abnormalities, 53.2% RBC abnormalities, and 44.2% had platelet abnormalities. Diagnostic findings were present in 13% of cases, while 79% were informative and 8% normal PBSs. Concordance between clinician orders and pathologist reports was found in 68.2% of cases. This study highlights the essential yet selective role of PBS in modern hematology, particularly in diagnosing WBC abnormalities and hematologic malignancies. While PBS offers significant informative value, especially for non-neoplastic conditions like anemia and thrombocytopenia, its diagnostic contribution may be more limited. The concordance (68.2%) emphasizes the need for clearer criteria and targeted use to optimize resource utilization. Implementing standardized guidelines and leveraging technological advancements could enhance the efficiency and diagnostic impact of PBS in clinical practice.

This study explores the association between tumor mutation burden (TMB) and immunity, prognosis in lung adenocarcinoma (LUAD), positing TMB as a predictive biomarker for immune checkpoint inhibitor therapy. LUAD mutation and clinical data were sourced from the TCGA database, with mRNA-seq data from UCSC Xena. TMB calculation divided samples into high and low groups, analyzing survival, immune, and stromal scores via Kaplan–Meier and ESTIMATE algorithms. Weighted gene co-expression network analysis (WGCNA) identified immune-related module genes, intersecting with TMB-differentiated genes to distinguish LUAD subtypes. With an optimal TMB cutoff of 6.46, high-TMB patients demonstrated superior survival. Significant inverse relationships were found between TMB and both immune/stromal scores. WGCNA highlighted 3676 genes in 4 modules, with 80 hub genes identified. These defined two LUAD subtypes: one with worse prognosis, higher mutation rates, and advanced stage distribution. TMB significantly correlates with prognosis and immune contexture in LUAD. The identification of subtype-specific hub genes offers a nuanced understanding of LUAD heterogeneity, supporting TMB's utility in predicting immunotherapy response and stratifying patient prognosis.

To explore the effects of family-based dignity therapy on negative emotions, post-traumatic growth, family cohesion and adaptability in primary caregivers of advanced cancer patients, so as to provide the reference for clinical implementation of family-based dignity therapy. A non-synchronous controlled clinical trial design was adopted. A total of 38 pairs of advanced cancer patients and their primary caregivers who were hospitalized were conveniently selected as the control group for routine care. A total of 38 pairs of advanced cancer patients and their primary caregivers who were hospitalized from were selected as the experimental group, and family-based dignity therapy program was administered on the basis of the control group. Before intervention, 1 and 4 weeks after intervention, hospital anxiety and depression scale, post-traumatic growth inventory, family adaptability and cohesion evaluation scale-II were used to evaluate the intervention effect. At the first and fourth week after the intervention, the anxiety score of the experimental group was lower than that of the control group, the post-traumatic growth level was higher than that of the control group, and the family function at the 4th week after the intervention was better than that of the control group, with statistical significance (p < .05). The time effect, inter-group effect and interaction effect were statistically significant in the comparison of anxiety score, post-traumatic growth level and family function between the two groups at different time points (p < .05). There was no significant difference in time effect, inter-group effect and interaction effect between depression levels (p > .05). Family-based dignity therapy program can significantly alleviate the anxiety of the primary caregivers of advanced cancer patients, enhance their post-traumatic growth level, and effectively improve family function, which has certain promotion value in clinical care.