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Molecular characterization of tumors has shifted cancer treatment strategies away from nonspecific cytotoxic treatment of histology-specific tumors toward targeting of actionable mutations that can be found across multiple cancer types. The development of high-throughput technologies such as next-generation sequencing, combined with decision support applications and availability of patient databases, has provided tools that optimize disease management. Precision oncology has proven success in improving outcomes and quality of life, as well as identifying and overcoming mechanisms of drug resistance and relapse. Addressing challenges that impede its use will improve matching of therapies to patients. Here we review the current status of precision oncology medicine, emphasizing its impact on patients - what they understand about precision oncology medicine and their hopes for the future.Background Poorly differentiated thyroid carcinoma is rare and patients are typically euthyroid. We report a novel rare case of poorly differentiated thyroid carcinoma with triiodothyronine (T3) thyrotoxicosis. Patient's Findings A 77-year-old man presented to Kuma Hospital due to a neck tumor. A thyroid ultrasonography revealed a 220-mL mass in the right lobe. Laboratory data showed low serum thyrotropin (TSH), low free thyroxine (fT4), and high free T3 (fT3) levels. Anti-TSH receptor antibodies and thyroid-stimulating antibodies were positive. ALK inhibitor 131I scintigraphy showed diffuse uptake only in the left thyroid lobe. The patient underwent a total thyroidectomy and histological examination identified as poorly differentiated thyroid carcinoma. He was diagnosed with poorly differentiated thyroid carcinoma coexisting with Graves' disease. The tumor showed elevated type 1 iodothyronine deiodinases (D1) and type 2 iodothyronine deiodinases (D2) activities compared with that of the left thyroid lobe. Summary and Conclusions Increased D1 and D2 activities in poorly differentiated carcinoma resulted in T3 toxicosis with a high serum fT3/fT4 ratio.The objective of the current research was to explore the potential prognostic value of readily available clinical and pathologic variables in bladder cancer. The novel association found between cholesterol levels and prognosis may provide the rationale for exploring novel treatments. Patients included had histologically confirmed urothelial bladder cancer and were treated with at least 3 cycles of cisplatin-based neoadjuvant chemotherapy before radical cystectomy with lymphadenectomy. A total of 245 patients at low, intermediate and high risk, presenting with 0-1, 2 or 3-4 risk factors, including positive lymph nodes, Hb less then 12.8, NLR ≥2.7 and cholesterol levels ≥199, were included. Five-year cancer-specific survival rate was 0.67, 0.78 and 0.94 at high, intermediate and low risk, respectively. Total cholesterol levels at the time of cystectomy may represent a commonly assessable prognostic factor and may be incorporated in a clinically meaningful risk-group classification model.The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients.Level of evidence IV.This study investigates the impact of Colles versus scaphoid casts on hand function in modern day activities using the Jebsen Hand Function Test with additional modified subtests including texting on a mobile phone, using a computer mouse and typing on a computer keyboard. Twenty healthy volunteers were recruited for the study. Study participants performed worse in a scaphoid cast compared to a Colles cast; most evident in tasks involving fine motor movements such as writing, picking up small objects and stacking checkers (mean time difference 2.3 seconds, 1.5 seconds and 1.2 seconds, respectively) and tasks involving forearm rotation such as card turning and picking up large light objects (mean time difference 1.6 seconds and 1.1 seconds, respectively). This study highlights the importance of careful consideration when assessing the need for thumb immobilization, due to its impact on hand function when performing both traditional and modern-day activities of daily living.

Flexible ureteroscopy (fURS) is a one-person surgical technique, limiting trainees' ability to practice intra-operatively. Although well-suited for simulation training, few existing fURS simulators reproduce accurate, complex renal collecting system anatomies. We developed an anatomically accurate fURS simulator using 3D reconstructions of CT urograms and 3D printing technology to address this need.

Patient-specific CT urograms were used to create 3D reconstructions of the renal collecting system using SlicerTM. 3D models were modified using BlenderTM. Hollow elastomer kidney models were created using an Objet 3DTM printer. To test and evaluate the new fURS simulator, 25 volunteers were recruited (5 novices, 13 residents, 7 urologists). Participants were asked to explore the model with fURS and were evaluated on their ability to deduce its 3D anatomy, their ability to navigate to prespecified calyces, and their time to task completion. Furthermore, participants were asked to compare the anatomical model tce. Preliminary testing revealed that trainees will benefit from this simulator particularly with respect to learning how to navigate challenging collecting systems.