Frailty has emerged as a significant predictor of health outcomes. However, multidimensional frailty among middle-aged and older patients with newly diagnosed breast cancer remains understudied. Therefore, this study aims to investigate the prevalence of preoperative multidimensional frailty and its associated factors in this population. A total of 223 middle-aged and older patients with breast cancer were recruited from the breast surgery ward of a general hospital in China from September 2023 to July 2024. Sociodemographic characteristics, clinical information, biochemical indicators, Tilburg frailty indicator scores, physical activity scale for the elderly scores, and Resnick exercise self-efficacy scale scores were collected from all patients. Chi-square tests and independent samples t-tests were used for univariate analyses, and variables with statistical significance were included in a binary logistic regression to identify factors associated with multidimensional frailty. The prevalence of preoperative multidimensional frailty was 36.3

PURPOSE:To describe an unusual case of cytomegalovirus (CMV) retinitis presenting with significant vitreous inflammation in a lymphoma patient following combined autologous transplantation and chimeric antigen receptor (CAR) T cell therapy. METHODS:This is a retrospective case report. The case was evaluated with multimodal ophthalmic imaging, and the diagnosis was established based on cytological and virological tests. RESULTS:A 54-year-old male with primary diffuse large B cell lymphoma of the cervical lymph nodes experienced monocular visual loss one month after combined autologous hematopoietic stem cell transplantation and CAR-T cell therapy. Initial examination revealed significant vitreous inflammation, mimicking intraocular lymphoma relapse. After the removal of dusty vitreous in the subsequent diagnostic vitrectomy, extensive retinal vascular occlusion emerged as the key feature with minimal retinal lesions. Cytological and virological studies of the vitreous sample excluded intraocular lymphoma and confirmed CMV retinitis. CONCLUSION:This case highlights prominent vitritis as an atypical presentation of CMV retinitis. This report broadens the recognized clinical spectrum of CMV retinitis, underscoring the necessity of considering CMV retinitis in the differential diagnosis of vitreous inflammation, particularly in lymphoma patients with complex immune statuses.

To compare outcomes of different treatment regimens for primary vitreoretinal lymphoma (PVRL) without central nervous system (CNS) involvement, specifically assessing their association with subsequent onset of central nervous system lymphoma (CNSL). This retrospective study collected data from 64 PVRL patients (118 eyes) from January 2015 to June 2023 at 4 ophthalmologic centers in China. Clinical, laboratory, and imaging data of these patients has been reviewed, focusing on the incidence of CNS manifestations during follow-up. Among the 64 patients with PVRL, 26 patients received only intravitreal injection of methotrexate (group A), and 38 patients received combined intraocular and systemic treatment (group B). The median follow-up time was 36.1 months, the median CNS progression-free survival (PFS) was 23.5 months, and the median overall survival (OS) was not-reached. CNSL developed in 44 of the 64 patients (68.8

BACKGROUND:Frailty is a potentially reversible risk factor for dementia. Whether frailty reversal actively reduces dementia risk across diverse populations, and the extent to which depressive symptoms mediate this pathway, remains unclear. METHODS:We included 59,331 adults aged ≥50 from the Health and Retirement Study (HRS), the China Health and Retirement Longitudinal Study (CHARLS), the Survey of Health, Ageing and Retirement in Europe (SHARE), and the English Longitudinal Study of Ageing (ELSA). A harmonized 25-item FI defined frailty (FI ≥ 0.25). Primary exposures were baseline frailty status and frailty transitions between the first two waves, evaluated within baseline strata as worsening versus stable non-frail status and improvement versus stable frail status. Mean FI and FI change were also examined. RESULTS:Over 7.51 ± 2.09 years, 5629 participants (9.49%) developed dementia. Baseline frailty was associated with higher risk (HRs, 1.35-2.23), as was frailty worsening (HRs, 1.43-2.53). Frailty reversal was associated with lower risk in SHARE (HR, 0.55) and CHARLS (HR, 0.70); associations in ELSA and HRS were not statistically significant. Estimated mediation proportions for depressive symptoms ranged from 29.29% to 44.78%. CLPN analyses showed cross-lagged associations in three cohorts for walking limitations, difficulty managing finances, and psychiatric problems. CONCLUSION:Frailty worsening was associated with higher dementia risk, whereas frailty improvement was associated with lower risk in some cohorts. Depressive symptoms showed indirect associations with incident dementia for both baseline frailty and frailty worsening. However, whether interventions targeting frailty and depressive symptoms can reduce dementia incidence remains to be determined in future interventional studies.

Background/Objectives: Our previous study showed that the dietary structure is imbalanced in a majority of colorectal cancer patients receiving chemotherapy. These patients had higher risk of developing malnutrition. In the present study, we aimed to identify factors associated with nutritional risk in this cohort of patients. Methods: We performed a secondary analysis of a dataset that was originally collected to identify the factors that are associated with an imbalanced dietary structure in patients receiving chemotherapy for colorectal cancer. Nutritional risk was evaluated by using an NRS-2002 form. Binary logistic regression was used for multivariate analysis. Results: Among the 178 CRC patients enrolled in this study, 60 (33.7%) had nutritional risk. Patients with nutritional risk exhibited lower intake of grains, potatoes, vegetables, fruits, beans, nuts, and oils compared to those without risk. Multivariate analysis showed that non-surgery (95% CI: 0.130-0.914, p = 0.032) and high dietary structure score (95% CI: 0.808-0.944, p = 0.001) are associated with lower nutritional risk in CRC patients receiving chemotherapy. Conclusions: CRC patients receiving chemotherapy have moderate risk of developing malnutrition. Dietary structure score and surgery are associated with malnutrition in CRC patients receiving chemotherapy. Education on proper dietary structure is a potential strategy to mitigate nutritional risk in CRC patients undergoing chemotherapy. These findings highlight the need for personalized nutritional support to optimize patient outcomes.

OBJECTIVE:To assess the short-term (immediately post-intervention) and long-term (post-intervention follow-up) effects of exercise-based interventions and to compare the effects of different exercise modality for improving subjective and objective cognitive function. DATA SOURCES:A comprehensive literature search was conducted in PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. STUDY SELECTION:Randomized controlled trials evaluating exercise-based interventions for cognitive outcomes in adult cancer patients were included. DATA EXTRACTION:Pairwise and network meta-analyses were conducted to estimate the standardized mean difference (SMD) with 95% confidence interval (CI). The Surface Under the Cumulative Ranking Curve (SUCRA) was used to estimate the intervention ranking probability. DATA SYNTHESIS:Twenty-seven studies (28 articles, 2,809 participants) were included. Exercise-based interventions significantly improved short- and long-term subjective cognitive function (SMD: 0.44, 95% CI: 0.27 to 0.61; SMD: 0.37, 95% CI: 0.16 to 0.57), executive function (SMD: -0.28, 95% CI: -0.43 to -0.14; SMD: -0.32, 95% CI: -0.56 to -0.08), working memory (SMD: 0.27, 95% CI: 0.14 to 0.41; SMD: 0.31, 95% CI: 0.06 to 0.55), and processing speed (SMD: -0.16, 95% CI: -0.31 to -0.01; SMD: -0.31, 95% CI: -0.55 to -0.07). In the short term, combined exercise and non-exercise intervention had the highest SUCRA ranking for subjective cognitive function (SUCRA: 93.50%), resistance exercise for executive function (SUCRA: 81.60%), multicomponent exercise for working memory (SUCRA: 77.74%), and mind-body exercise for processing speed (SUCRA: 78.39%). In the long term, aerobic exercise ranked highest for subjective cognitive function (SUCRA: 83.81%) and multicomponent exercise ranked first for executive function (SUCRA: 75.22%), working memory (SUCRA: 86.35%), and processing speed (SUCRA: 77.39%). CONCLUSION:Exercise-based interventions provide short- and long-term benefits across subjective and objective cognitive domains in cancer patients, with varying probabilistic advantages by exercise modality. No single modality demonstrated superiority across all outcomes. Further studies are warranted given the low to moderate certainty of evidence.

OBJECTIVES:To evaluate the effects of a virtual reality-based cognitive behavioral therapy on sick role adaptation, psychological distress, illness perception and coping modes among young and middle-age colorectal cancer patients. METHODS:This was a single-blind, parallel-arm randomised controlled trial. A total of 84 adults aged < 60 years with colorectal cancer were randomised to either an intervention group (n = 42) receiving a 7-session self-led virtual reality-based cognitive behavioral therapy or an attention control group (n = 42) receiving regular health consultations. The sick role adaptation, illness perception, anxiety and depression, and coping modes were measured at baseline, 1-month, 2-month and 3-month post-intervention. RESULTS:Compared to the controls, the intervention group had significantly higher level of sick role adaptation, more positive illness perception, less anxiety and depression, more adaptative coping modes adopted. CONCLUSIONS:The virtual reality-based cognitive behavioral therapy enhanced adaptation to cancer in young and middle-age patients with colorectal cancer. TRIAL REGISTRATION:The study was registered on 21 June, 2023 in Chinese Clinical Trial Registry (No.: ChiCTR2300072699) at https://www.chictr.org.cn/.

BackgroundSurgical treatment of idiopathic uveal effusion syndrome (UES) is challenging with high risks. CO2 laser-assisted sclerectomy surgery (CLASS) is potentially a semiquantitative, quick and safe surgical option. This study aimed to describe the feasibility and early outcomes of CO2 laser-assisted sclerectomy surgery (CLASS) with sclerostomy for idiopathic uveal effusion syndrome (UES).MethodsThis was a prospective descriptive case series. After fully exposed, the sclera was ablated with CO2 laser beam repeatedly until a bluish hue was visible. A crescent blade was used to make scleral incision in the same plane with the floor of the scleral pool. The lamellar sclera was cut, and the scleral pool was enlarged. A 1 × 1 mm2 sclerostomy was created in each sclerectomy bed with a 15 degree stab blade.ResultsThe technique was used in three eyes of three patients with UES and exudative retinal detachment (RD). After a mean follow-up of 410 days (range, 34–825 days), all patients demonstrated sustained improvement of RD, with complete resolution in two cases. No adverse events were observed during the extended follow-up period.ConclusionCLASS with sclerostomy appears to be a feasible and durable technique for UES in this small series, though further studies are warranted.

Background Chemotherapy-induced taste alterations are prevalent and clinically significant symptoms among cancer patients. Although several non-pharmacological interventions have shown potential for alleviating these symptoms, the available evidence has not been comprehensively synthesized. Aims To evaluate the effects of non-pharmacological interventions for chemotherapy-induced taste alterations among cancer patients. Design A systematic review and meta-analysis. Methods A systematic search was conducted in five English and three Chinese electronic databases. Randomized controlled trials (RCT) that examine the effects of non-pharmacological interventions on chemotherapy-induced taste alterations among cancer patients were included. Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias in included studies. Pairwise meta-analyses were performed to estimate standardized mean differences (SMD) or risk ratios (RR) with 95% confidence intervals (CI). Results The systematic review included 13 RCTs involving 1049 participants, and 12 of these trials were included in the meta-analysis. Five types of intervention were identified, including oral cryotherapy, photobiomodulation therapy, traditional Chinese medicine- based intervention, dietary and nutritional intervention, and psycho-educational intervention. Non-pharmacological interventions significantly reduced the incidence of taste disorders (RR: 0.72; 95% CI: 0.61 to 0.86), improved perceived taste alterations (SMD: −1.21; 95% CI: −1.78 to −0.63), and enhanced objective taste function, though significant only for salty taste (SMD: 0.84; 95% CI: 0.56 to 1.12). Subgroup analysis showed that dietary and nutritional interventions conferred significant reduction in taste disorder incidence (RR: 0.54; 95% CI: 0.32 to 0.91), oral cryotherapy (SMD: −1.62; 95% CI: −3.16 to −0.07) produced a greater effect on perceived taste alterations than traditional Chinese medicine-based interventions (SMD: −0.73; 95% CI: −1.13 to −0.33), and photobiomodulation therapy significantly improved salty (SMD: 0.90; 95% CI: 0.60 to 1.20), sour (SMD: 0.69; 95% CI: 0.09 to 1.29), and sweet (SMD: 0.66; 95% CI: 0.14 to 1.18) taste function. Conclusions Non-pharmacological interventions show promise for the management of chemotherapy-induced taste alterations in patients with cancer. Further high-quality randomized controlled trials with standardized outcome assessments and diverse populations are needed to strengthen the evidence base and inform future clinical management strategies. Registration PROSPERO (ID: CRD420261348257).

Background:Behçet's disease (BD) is a chronic, relapsing, multisystem inflammatory disorder, with ocular involvement being a major cause of irreversible visual impairment. Behçet's uveitis (BU) often presents as bilateral, recurrent, non-granulomatous panuveitis with occlusive retinal vasculitis. Despite advances in immunosuppressive and biologic therapies, long-term visual outcomes remain variable, and factors associated with poor prognosis, particularly in Chinese populations, are not well defined. Methods:We conducted a retrospective cohort study of 153 Chinese patients (268 eyes) with BU at Peking Union Medical College Hospital from February 2003 to February 2023. Clinical records, ocular examinations, and systemic manifestations were reviewed. The primary endpoint was severe visual impairment (best-corrected visual acuity [BCVA] <20/200) at the final follow-up. Secondary endpoints included ocular complications and their impact on visual outcomes. Kaplan-Meier survival analysis and mixed-effects logistic regression (accounting for inter-eye correlation) were used to evaluate risk factors for poor visual prognosis. Results:Among the cohort, 77.8% were male, and bilateral involvement occurred in 84.3%. Median follow-up was 30 months. Panuveitis was the predominant form (90.3%), and cataract (64.9%) and macular edema (63.1%) were the most common complications. At final follow-up, 25.4% of eyes had BCVA <20/200. Kaplan-Meier analysis showed cumulative risk of severe visual loss of 3.5% at 1 year, 11.0% at 2 years, 19.2% at 5 years, and 41.4% at 10 years. Male patients experienced visual impairment earlier than females. Mixed-effects logistic regression identified macular damage (p=0.027, OR = 3.70) and optic nerve atrophy (p<0.001, OR = 6.47) as significant predictors of poor visual outcomes, while complete-type BD showed a trend toward association (p=0.072, OR = 2.00). Systemic disease severity was not significantly associated with visual prognosis. Conclusion:In this Chinese cohort with BU, irreversible ocular structural damage, particularly macular damage and optic nerve atrophy, was the primary determinant of long-term visual outcomes. Systemic disease severity had limited predictive value. Despite improvements compared with historical data, these findings highlight the critical importance of early recognition and effective management of posterior segment inflammation to prevent permanent visual impairment.

This case report describes a diagnosis of retinal vasculitis associated with Castleman disease in a man who presented with 6 months of progressive floaters bilaterally and no change in visual acuity.

Depressive symptoms, sleep disturbances, and frailty significantly affect older adults, representing a substantial public health issue. Although previous studies have demonstrated complex interrelationships among these factors, the underlying causal pathways and optimal intervention targets remain unclear. The study aimed to elucidate the potential causal pathways linking these factors and identify optimal intervention targets to mitigate their synergistic effects. A cross-sectional study was conducted in 2022 among 3,924 Chinese adults aged ≥ 60 years. Frailty was assessed using the FRAIL scale; sleep quality via the Brief Pittsburgh Sleep Quality Index; and depressive symptoms with the Patient Health Questionnaire-9. We employed network and Bayesian analyses to examine the interactions among these factors, focusing on identifying core and bridge symptoms and potential causal directions. Our findings indicate that illness (rs=2.30, rc=0.01, rb=24) has the greatest centrality, while fatigue (rBEI = 0.417) serves as the primary bridge symptom. Network comparison tests showed no significant differences in structure based on gender, age, or residence, suggesting uniformity across groups (p > 0.05). Sleep disturbances emerged as the most influential factor in the network, directly impacting both sleep quality and frailty. This study uncovers the complex links between depressive symptoms, sleep quality, and frailty in older adults. Illness and fatigue are key symptoms, with sleep disturbances identified as a primary predictor affecting both sleep quality and frailty. Targeting sleep disturbances may alleviate frailty and enhance overall sleep health.

Purpose To identify subgroups of psychosocial adjustment among patients with newly diagnosed colorectal cancer, and to examine the inflencing factors of different subgroups. Methods The study surveyed 490 participants in Guangzhou from July 2022 to June 2023 using face-to-face method. The scales measured psychosocial adjustment, resilience, and coping styles. Statistical analysis included latent profile analysis and multinomial logistic regression. The STROBE guidelines were followed in this study. Results Three subgroups of psychosocial adjustment were identified: the low adjustment (23.7%), the moderate adjustment (44.5%), and the high adjustment (31.8%). Factors influencing psychosocial adjustment included optimism, resignation coping style, household per capita monthly income, and tumor metastasis. Conclusions This study employed a human-centered approach to identify three types of psychosocial adjustment in newly diagnosed colorectal cancer patients. Variations were observed in optimism, resignation coping, tumor metastasis, and household income. Prompt identification of high-risk groups and tailored interventions are essential for improving psychosocial adjustment.

Objective:This study aimed to identify psychosocial distress phenotypes in postoperative patients with breast cancer and explore influencing factors. Methods:A total of 210 patients were recruited from a general hospital in Guangzhou, China, between November 2022 and July 2023. Data were collected through a general information questionnaire, the Psychosocial Distress Questionnaire-Breast Cancer, and the Connor-Davidson Resilience Scale. Latent profile analysis was conducted to identify psychosocial distress phenotypes, followed by multinomial logistic regression to determine associated factors. Results:Three distinct phenotypes were identified: "Resilient-Latent Anxious-Somatic" (Class 1, 27%), "Anxious-Somatic Dominant" (Class 2, 51%), and "Anxious-Somatic with Financial Toxicity" (Class 3, 22%). Low resilience level (odds ratio [OR] ​= ​14.230, P ​< ​0.001; OR ​= ​51.931, P ​< ​0.001) and not undergoing breast reconstruction surgery (OR ​= ​4.645, P ​= ​0.006; OR ​= ​4.175, P ​= ​0.041) were risk factors for Class 2 and Class 3. Compared with Class 1, lower income (OR ​= ​3.127, P ​= ​0.009) and urban residence (OR ​= ​3.162, P ​= ​0.025) were risk factors for Class 2. Factors significantly associated with membership in Class 3 included older age (OR ​= ​0.923, P ​= ​0.008), unemployment (OR ​= ​3.181, P ​= ​0.047), being married (OR ​= ​16.993, P ​= ​0.010), and living with others (OR ​= ​0.071, P ​= ​0.033). Conclusions:Psychosocial distress among postoperative patients with breast cancer is heterogeneous, manifesting in three phenotypes shaped by diverse factors. Early identification of patients by phenotype and implementation of group-level interventions tailored to phenotype-specific characteristics are essential for mitigating psychosocial distress.

Immune checkpoint V-domain Ig suppressor of T-cell activation (VISTA) exhibits distinct expression patterns and non-redundant immunoregulatory mechanisms in different autoimmune diseases. This study aims to investigate the expression of VISTA in patients with autoimmune uveitis and experimental autoimmune uveitis (EAU) mice, and explore its clinical significance and preliminary mechanisms in disease development. We found that VISTA expression on 12 subsets of peripheral blood immune cells was lower in autoimmune uveitis patients than in healthy volunteers, especially on neutrophils. The expression of neutrophil VISTA in active uveitis patients markedly increased when intraocular inflammation was ameliorated, indicating a significant correlation with disease activity. In vitro treatment of neutrophils from autoimmune uveitis patients with a VISTA antagonist markedly aggravated cell activation and neutrophil extracellular traps formation, whereas a VISTA agonist produced the opposite effect. Moreover, VISTA was constitutively expressed in the outer segments of retina in healthy mice, and decreased in EAU mice, reaching the lowest level of expression when the disease was at a peak stage. Taken together, this study investigates the relationship between neutrophil VISTA and the development of autoimmune uveitis, and provides new insights into the mechanisms and therapeutic roles of VISTA in autoimmune diseases.

Vitreoretinal lymphoma (VRL) is often a diffuse large B-cell lymphoma in nature, and patients may have or eventually develop central nervous system lymphoma, which frequently leads to a poor prognosis. Currently, there are no international or domestic clinical guidelines specifically for the diagnosis and treatment of VRL, and no standardized diagnostic procedures or treatment evaluation systems for this disease. VRL is clinically characterized by prominent vitreous opacities, multiple lesions beneath the retinal pigment epithelium or subretinal, and intraretinal infiltration, making it one of the most common masquerade syndromes in ophthalmology. To promote early diagnosis and standardized treatment of VRL, the Ocular Immunology Group of the Chinese Medical Association Ophthalmology Branch has developed "Clinical Guidelines for the Diagnosis and Treatment of Vitreoretinal Lymphoma in Chinese Patients (2024)", based on extensive references to diagnosis, treatment experiences and relevant clinical recommendations. The working group systematically reviewed and comprehensively summarized the latest research evidence from both domestic and international sources. Using the Oxford Evidence Level System, we assessed the quality of evidence and the strength of recommendations. This guideline provides crucial academic references and clinical practice guidance for the diagnosis and treatment of VRL patients. This guideline, including VRL diagnostic methods, processes, and treatment recommendations is suitable for clinical practice in China and is intended to assist ophthalmologists in clinical diagnosis and treatment of VRL.

AIMS:To investigate the status of social isolation among middle-aged and elderly breast cancer patients and identify its influencing factors. Additionally, to explore the mediating role of self-perception of aging between frailty and social isolation, as well as the moderating effect of menopausal symptoms. DESIGN:A cross-sectional study guided by the Strengthening the Reporting of Observational Studies in Epidemiology. METHODS:This study was conducted on middle-aged and elderly breast cancer patients from September 2022 to February 2023 in Guangzhou, China. Related data were assessed by structural questionnaires. Correlation analysis and regression analysis were performed by SPSS 26.0 while PROCESS macro v4.0 was used to test the moderated mediation model. RESULTS:Breast cancer patients aged 45-82 years experienced moderate social isolation. It was influenced by educational level, residence, menopause symptoms, self-perception of aging, and frailty. The moderated mediation model involving self-perception of aging and menopausal symptoms for explaining how frailty causes social isolation was supported. The mediating role of self-perception of aging gradually strengthens as menopausal symptoms become severe. CONCLUSION:Social isolation resulting from frailty in middle-aged and elderly breast cancer patients is mediated by self-perception of aging, with menopausal symptoms amplifying this effect. Interventions focused on improving self-perception of aging and managing menopausal symptoms may help reduce social isolation by mitigating the impact of frailty. IMPACT:This study highlights the importance of addressing frailty, self-perception of aging, and menopausal symptoms in clinical nursing practice, which may help reduce social isolation among breast cancer patients. PATIENT OR PUBLIC CONTRIBUTION:Patients contributed by completing the questionnaire, ensuring the accuracy and completeness of the information with assistance from the research team.

ObjectiveTo evaluate the association between serum adalimumab (ADA) concentrations, antibodies against adalimumab (AAAs), tumor necrosis factor α (TNFα) levels, and clinical response in patients with noninfectious uveitis (NIU), as well as changes in TNFα after administration of ADA, to explore the role of therapeutic drug monitoring in these patients.MethodsThis retrospective study included NIU patients treated with ADA at Peking Union Medical College Hospital between June 2024 and April 2025, who underwent testing for serum ADA and AAA levels. Most patients also had serum TNFα measured concurrently. Clinical data collected included concomitant medications, ADA dosing frequency, and ocular inflammation status, etc. High-performance size-exclusion chromatography was used to characterize forms of TNFα in serum samples of patients. THP-1 cells were stimulated with free TNFα or TNFα-ADA complexes to compare their pro-inflammatory activity.ResultsAmong 164 test results from 147 patients included (aged 5~56 years), median ADA level was significantly lower in AAA-positive patients than in AAA-negative patients (1.9 vs. 6.4 μg/mL; P<0.001), and lower in those with active inflammation than in those with quiescent inflammation (2.2 vs. 6.0 μg/mL; P<0.001). An ADA level below 4.1 μg/mL was associated with poor clinical response. Concomitant antimetabolite use was linked to a lower proportion of detectable AAAs compared with ADA monotherapy (34.3% vs. 54.5%; P = 0.036). Median ADA level was significantly higher when testing occurred ≤14 days after the last dose of ADA (P<0.001), though many patients maintained therapeutic levels even with extended dosing intervals. TNFα levels increased in most patients after ADA therapy, predominantly in the form of TNFα-ADA complexes, which exhibited significantly weaker pro-inflammatory effects than free TNFα.ConclusionThe presence of AAAs was associated with reduced ADA levels and an increased risk of treatment failure. Despite the limitations of a retrospective design, these findings suggest that therapeutic drug monitoring may help identify causes of treatment failure and optimize regimens in stable patients.

The definitive therapeutic paradigm for primary vitreoretinal lymphoma (PVRL) remains controversial, with ongoing debates surrounding the comparative efficacy of localized ocular therapy, high-dose systemic chemotherapy, and combined-modality approaches. The benefit of systemic administration of methotrexate is unambiguous and severe adverse events related to intense chemotherapy are reported. Immunomodulators such as lenalidomide and Bruton’s tyrosine kinase (BTK) inhibitors, like zanubrutinib, have not been explored for their safety and efficacy as first-line treatments for PVRL. This study aimed to analyze the safety and efficacy of chemo-free combination regimens in newly diagnosed PVRL patients. In our study, systemic chemo-free regimens were administrated as induction therapy, including the ZR regimen (zanubrutinib and rituximab), and the R2 regimen (lenalidomide and rituximab). Of the 44 patients, 41 (93.2

OBJECTIVE:To evaluate the literature to clarify the concept of psychosocial distress and to conceptualize it in cancer patients. METHODS:The Walker and Avant concept analysis approach was applied for this review. A comprehensive search of studies published from inception to March 2024 was searched in PubMed, EMBASE, Cochrane Library, Web of Science, and PsycINFO, utilizing the PRISMA 2020 reporting checklist. Additional studies were included by manually reviewing the reference lists from relevant research. A total of 5,941 studies were identified in the initial search, and 36 articles were ultimately included for further analysis and synthesis. RESULTS:Four attributes of psychosocial distress in terms of cancer were identified: role dysfunction, negative self-perception, disrupted daily life, and unpleasant emotion. Antecedents of psychosocial distress were cancer-related stress and the inability to cope. The consequences were identified as negative health-related behaviors and unhealthy outcomes. CONCLUSIONS:The four identified attributes of psychosocial distress in cancer patients provide healthcare providers with a more comprehensive framework for assessment and recognition than existing instruments, which often focus only on anxiety and depression. It will aid researchers and healthcare providers in understanding the concept, guiding the development of suitable assessment instruments and the design of targeted psychosocial interventions. IMPLICATIONS FOR NURSING PRACTICE:Through clarifying the concept, this study may enhance health professional's understanding of the nature of psychosocial distress and improve their awareness of periodically assessing and managing individuals' psychosocial distress.