Peng Yan

Giant, ulcerated triple-negative breast cancer (TNBC) presents major therapeutic challenges. We report a 39-year-old woman with a 14.3 cm ulcerated TNBC (cT4bNxM0) who developed infection after intravenous chemotherapy. To achieve rapid local control, a multidisciplinary team elected to perform transarterial chemoembolization (TACE), followed by systemic chemo-immunotherapy using nab-paclitaxel and the PD-1 inhibitor Toripalimab. This multimodal approach led to marked tumor regression and improvement of skin ulceration, enabling curative surgery with modified radical mastectomy and complex reconstruction. Pathology postoperative showed a complete response (Miller-Payne grade 5, ypT0N0M0). This single case suggests that integrating TACE with multimodal neoadjuvant treatment sequences may be feasible in selected patients with extreme presentations of locally advanced TNBC, particularly in patients with extensive tumor burden or poor tolerance to systemic therapy. The approach may enhance local control and elicit synergistic immune activation, offering a potential paradigm for managing extreme TNBC presentations. Further studies are required to clarify the safety, efficacy, and potential immunomodulatory effects of this approach.

An 85-year-old woman with chronic atrial fibrillation and complete heart block received a leadless Micra pacemaker. Shortly after implantation, the device dislodged, migrating between the tricuspid valve and right ventricular apex, causing nonsustained ventricular tachycardia. Using a double-snare technique through a single 23-French delivery sheath, the pacemaker was retrieved within 40 min without complications. This case underscores the rare but serious risk of leadless pacemaker dislodgement, emphasizing the need for prompt recognition and swift intervention. The double-snare approach proved effective, minimizing procedural time and trauma, which is critical for high-risk elderly patients. As leadless pacing gains traction, expertise in emergency retrieval techniques is vital for interventional cardiology and critical care settings.

To comprehensively understand the disease burden of NASH-related liver cancer (NRLC) in China, we analyzed and evaluated the disease burden of NRLC in mainland China from 1990 to 2021 and predicted the trend in its health burden over the next 20 years. We characterized the burden of NRLC in China using the Global Burden of Disease (GBD) 2021 method and results based on incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Joinpoint and age-period-cohort (APC) analysis methods were used to interpret the epidemiological characteristics and compare them with global prevalence trends. Moreover, the Bayesian age-period-cohort model was used to predict the incidence of mortality in different age groups over the next 20 years. From 1990 to 2021, the age-standardized incidence rates of males and females in China changed from 4.75 (95% confidence interval [CI]: 3.81–5.81) to 5.42 (95% CI: 4.18–6.85), and the mortality rate changed from 5.02 (95% CI: 4.01–6.14) to 5.06 (3.88, 6.42) per 100,000 people. The age-standardized DALY rate in China has decreased from 133.91 (95% CI: 107.69–163.99) per 100,000 people in 1990 to 122.20 (95% CI: 94.14–154.42) per 100,000 people in 2021. The average annual percentage changes (AAPCs) in the age-standardized incidence, prevalence, and mortality of NRLC in China were 0.44 (95% CI: 0.34–0.54), 1.00 (95% CI: 0.75–1.25), and 0.13 (95% CI: −0.36 to 0.61), respectively. Age, period, and cohort had different effects on the incidence and mortality. Personally, middle-aged and elderly men should pay more attention to the prevention of NRLC. Given the large population, growing SDI index, and aging trend in China, multiple prevention policies and popular education programs should be considered in the near future to minimize the burden of NRLC.

Background: Tumor-associated macrophages (TAMs) play a crucial role in the tumor microenvironment (TME), and the metabolic activities of both tumor cells and TAMs have an impact on the TME. Moreover, the expression of MICA in tumor cells is closely associated with immune cells in hepatocellular carcinoma (HCC). However, it remains unclear whether MICA expression correlates with TAMs and influences the switch in macrophage phenotype by mediating metabolic alterations. Methods: Various biostatistical tools, qPCR, and IHC staining experiments were utilized to analyze data from The Cancer Genome Atlas (TCGA) and collected HCC tumor tissues. Single-cell RNA sequencing (scRNA-seq) analyses and a co-culture model of HCC cells with macrophages were performed to validate the findings from the biostatistical analyses. Results: Through the intersection of differentially expressed genes (DEGs), metabolism-related genes (MRGs), and co-expression genes (CEGs) with MICA in HCC, the EHHADH gene was identified. Gene set enrichment analyses were conducted to further confirm the role of EHHADH. EHHADH expression is decreased in HCC tumors and can serve as a prognostic biomarker for HCC. Expressions of MICA and EHHADH exhibited significant correlations with various phenotypic macrophages and exerted opposing effects on M1-like and M2-like macrophages infiltrating HCC. The underlying metabolic and molecular mechanisms revealed that MICA in tumor cells induced M2-like polarization through the PPAR/EHHADH pathway, which regulates the fatty acid oxidation (FAO) in macrophages. Conclusions: The metabolic gene EHHADH, which is associated with MICA, led to alterations in M2-like macrophages by promoting heightened fatty acid uptake and augmenting levels of FAO within macrophages.

Ventriculoperitoneal (VP) shunts are commonly used to treat hydrocephalus by diverting cerebrospinal fluid from the ventricles to the peritoneal cavity. Migration of the VP shunt into the heart and pulmonary artery is a rare complication. Herein, we described a 67-year-old man with a VP shunt catheter that migrated through the venous system into the pulmonary circulation, highlighting early diagnosis with imaging and symptoms.

Background The leadless Micra pacemaker has emerged as a safe and minimally invasive alternative for selected patients with arrhythmias. However, as the technology is still relatively new, clinical experience with urgent device retrieval—particularly in critical care settings—remains limited. Case Summary An 85-year-old female with chronic atrial fibrillation and complete heart block underwent Micra pacemaker implantation. Within minutes of tether removal, the device became dislodged and migrated between the tricuspid valve and the right ventricular apex, resulting in nonsustained ventricular tachycardia. Immediate retrieval was performed using a double-snare technique through a single 23-French delivery sheath. The pacemaker was successfully extracted within 40 minutes, with no complications. Discussion This case highlights a rare but critical complication of leadless pacemaker dislodgement, requiring urgent recognition and rapid procedural response. The double-snare technique enabled safe and efficient retrieval through a single access site, minimizing procedural time and trauma—key considerations in high-risk and elderly patients. As leadless pacing becomes more widespread, familiarity with emergency retrieval strategies and procedural adaptability will be essential, particularly in intensive care and interventional cardiology settings.