Mantle cell lymphoma (MCL) is a biologically and clinically heterogeneous B-cell malignancy with variable prognosis, ranging from indolent, asymptomatic forms to aggressive subtypes with early treatment failure. Contemporary management emphasizes risk-adapted strategies that integrate patient characteristics, clinical disease burden, and tumor biology. Prognostic tools such as the MCL International Prognostic Index (MIPI) and its biologically integrated variant (combined MIPI), alongside assessment of Ki-67 proliferation, TP53 status, and blastoid morphology, help guide treatment selection. In younger, fit patients, first-line therapy traditionally involves dose-intensified chemoimmunotherapy with high-dose cytarabine and autologous stem-cell transplantation (ASCT). The incorporation of Bruton tyrosine kinase inhibitors (BTKi), such as ibrutinib, into induction regimens has improved survival outcomes, with emerging evidence that may limit the use of ASCT to high-risk subsets. Maintenance therapy, particularly rituximab, remains crucial for durable disease control. In older or transplant-ineligible patients, bendamustine-rituximab remains a backbone therapy, with chemotherapy-free combinations incorporating BTKi, BCL2 inhibitors, and anti-CD20 antibodies offering effective, well-tolerated alternatives. High-risk patients, including those with TP53 mutations, may benefit from targeted triplet regimens or early cellular therapies. Relapsed/refractory MCL is increasingly managed with covalent and noncovalent BTKi, BCL2 inhibitors, and T-cell-redirecting therapies including chimeric antigen receptor T-cell therapy and bispecific antibodies. Ongoing trials are evaluating optimal sequencing and combination strategies to improve outcomes, particularly in high-risk and cBTKi-exposed patients. Overall, modern MCL management emphasizes individualized therapy based on biological risk, functional status, and treatment tolerability, with novel targeted and cellular approaches reshaping the frontline and relapsed treatment landscape.

Gastric and gastroesophageal junction cancers remain a major global cause of cancer-related mortality. Despite incremental advances in surgery and systemic therapy, durable survival gains have been limited, underscoring persistent unmet medical needs. However, the treatment paradigm has undergone a rapid transformation, driven by the integration of immunotherapy in curative-intent systemic treatment and the expansion of biomarker-guided systemic therapies. In the perioperative setting, immune checkpoint inhibitors combined with optimized cytotoxic chemotherapy have demonstrated encouraging efficacy, with recent phase III trials contributing to the establishment of combination of immunotherapy and chemotherapy as an emerging therapeutic platform. In advanced disease, precision oncology frameworks continue to expand beyond traditional biomarkers. Established targets such as human epidermal growth factor receptor 2 are now complemented by newly validated markers including claudin18.2, whereas additional actionable alterations-such as MET and TROP2-are actively under clinical investigation. These developments are redefining treatment algorithms and introducing new sequencing considerations, particularly in the context of tumor heterogeneity and biomarker coexpression. Concurrent advances in molecular diagnostics and next-generation sequencing are also facilitating the comprehensive identification of therapeutically relevant alterations. This review outlines the evolving therapeutic landscape of gastric and gastroesophageal junction cancers, spanning perioperative immunotherapy, newly validated molecular targets, and next-generation drug development platforms. By integrating biomarker-driven strategies with innovative modalities, such as antibody-drug conjugates, bispecific antibodies, chimeric antigen receptor-T-cell therapy, and vaccines, we highlight how precision therapeutics are reshaping treatment paradigms across resectable and advanced disease.

Uterine sarcomas are rare but aggressive tumors with high rates of recurrence and limited effective treatment options; a deeper understanding of their molecular and histologic diversity is critical to improving outcomes.

To provide a comprehensive overview of clinical management and current systemic treatment strategies for uterine sarcomas. Specific histologic subtypes and molecular features are also reviewed.

A thorough review of the literature was conducted using PubMed and clinical trial databases, with a focus on recent studies evaluating histology-specific management, molecular diagnostics, and novel systemic therapies across uterine sarcoma subtypes.

Uterine sarcomas comprise 3% to 5% of uterine malignancies and include multiple distinct subtypes such as leiomyosarcoma, low and high-grade endometrial stromal sarcoma, undifferentiated uterine sarcoma, and adenosarcoma. Each displays unique clinical behavior and molecular alterations that guide treatment. While surgery remains the foundation of management for early-stage disease, the role of adjuvant therapy is unclear and best guided by individual risk. In advanced disease, combination regimens such as doxorubicin and trabectedin have shown improved outcomes in the treatment of leiomyosarcomas. Targeted therapies, hormonal agents, and immunotherapy have variable activity across subtypes. Molecular diagnostics, including next-generation sequencing, are increasingly essential in diagnosis, prognostication, and treatment planning.

The landscape of uterine sarcoma treatment is rapidly evolving due to advances in molecular biology and emerging systemic therapies. Personalized management based on histology and molecular profiling, along with the development of subtype-specific clinical trials, will be essential in improving survival. Centralized, multidisciplinary care remains a cornerstone for patients with these rare tumors.

Preeclampsia before 20 weeks of gestation is an unusual clinical entity that suggests an underlying etiology, such as gestational trophoblastic disease (GTD). Among its forms, complete hydatidiform mole may evolve into gestational trophoblastic neoplasia with metastatic potential. The objective was to present the case of an adolescent patient with early-onset preeclampsia as the initial manifestation of a complete hydatidiform mole with pulmonary metastasis.

A 15-year-old patient without prenatal care was admitted due to vaginal bleeding, persistent nausea, and clinical signs of preeclampsia. A complete hydatidiform mole associated with grade IV hypovolemic shock was diagnosed. Patient underwent urgent uterine evacuation, intensive care for uterine atony, and received EMA-CO chemotherapy after pulmonary metastases were identified. 3 months after completing treatment, a viable intrauterine pregnancy was confirmed, with no evidence of tumor recurrence.

The onset of preeclampsia before 20 weeks should raise suspicion of GTD. Timely, multidisciplinary management can achieve full disease resolution, preserve fertility, and avoid long-term sequelae, even in advanced clinical scenarios.

Acquired radioresistance remains a major obstacle to effective radiotherapy for cervical cancer, often driven by epithelial-mesenchymal transition (EMT). This study reveals TSPAN8 as a novel regulator of EMT-mediated radioresistance, offering new insights for overcoming treatment failure. Radioresistant subclones of HeLa-R25 and SiHa-R25 cells were established by repeated 2 Gy fractions. Radioresistance, apoptosis, EMT, and stemness were assessed by clonogenic survival, flow cytometry, immunoblotting, and immunofluorescence. Differentially expressed genes were identified by microarray, validated by protein-protein interaction analysis and co-immunoprecipitation, and functionally examined via TSPAN8 overexpression/knockdown, xenograft models, and immunohistochemistry of primary, metastatic, and recurrent post-radiotherapy specimens. Prognostic relevance was analyzed in the TCGA-CESC cohort. Fractionated irradiation induced EMT and radioresistance, with significantly higher clonogenic survival in R25 cells (P < 0.05), characterized by E-cadherin loss, N-cadherin/Vimentin upregulation, and increased CD44/Oct4. TSPAN8 was the most upregulated gene and directly interacted with E-cadherin. Overexpression enhanced EMT, invasion, and resistance to apoptosis, while knockdown reversed these effects and restored radiosensitivity in vivo. TSPAN8 knockdown in radioresistant xenografts significantly suppressed tumor growth (P < 0.05), and combined knockdown with irradiation further reduced tumor volume (P < 0.05). In patient samples, post-radiotherapy recurrences and metastases exhibited high TSPAN8 and vimentin with reduced E-cadherin. TCGA data confirmed that elevated TSPAN8 was associated with worse outcomes, including shorter disease-specific survival (HR = 2.02, 95% CI 1.01-3.71, P = 0.02) and progression-free survival (HR = 3.09, 95% CI 1.80-5.30, P < 0.001). These data suggest that TSPAN8 drives EMT-mediated radioresistance in cervical cancer, is associated with recurrence and poor survival, and represents a potential biomarker and therapeutic target. Targeting TSPAN8 may enhance radiosensitivity and improve personalized radiotherapy outcomes.

A close relationship exists between inflammation and cancer. Recent studies have highlighted inflammation as a significant contributor to the progression of bladder cancer. However, the role of alkyladenine DNA glycosylase homolog 2 (AlkBH2), an enzyme involved in DNA repair and a member of the AlkB family, in the context of bladder cancer inflammation remains largely unexplored. Our findings demonstrate that AlkBH2 promotes the proliferation, colony formation, migration, and invasion of bladder cancer cells. Mechanistically, AlkBH2 activates the nuclear factor-kappa B (NF-κB) signaling pathway, which in turn drives the progression of bladder cancer. These results suggest that AlkBH2 plays a critical oncogenic role in bladder cancer by modulating inflammation through the activation of the NF-κB pathway. These findings highlight the potential of AlkBH2 as a therapeutic target for bladder cancer treatment.

To evaluate the possible influence of gender and specialty on adverse drug reaction (ADR) reporting among physicians before and after the COVID-19 pandemic.

This retrospective nationwide register study analysed all ADR reports submitted by physicians to the Swedish Medical Products Agency during 2017 and 2023 (n = 4079 and 3740, respectively). The reporting rates were calculated and stratified by gender and specialty.

The highest reporting rate among physicians was observed in medical specialties, followed by primary care and psychiatry (27, 10, and 12, reports/100 physicians in 2017; 18, 15, and 9 in 2023). The lowest reporting rates were observed for surgical and hospital service specialties (8 and 1 in 2017; 6 and 1 in 2023). Male and female physicians reported ADRs to a similar extent and both reported more frequently on female patients. Gender concordance between physician and patient was associated with significantly higher reporting (p < 0.001 in 2017; p = 0.041 in 2023).

Reporting varied across specialties, and gender concordance emerged as a previously unrecognized factor influencing ADR reporting. These findings provide new opportunities for targeted interventions to enhance physician participation in pharmacovigilance.

There is limited high-quality data on antibiotic prescribing in low and middle-income countries, particularly in the private sector. Here, we use large-scale healthcare surveys to assess antibiotic prescribing levels and the factors influencing prescribing decisions for common infections in primary care and outpatient settings, predominantly within the private sector, in Pakistan, Egypt and Indonesia.

We analysed surveys completed by prescribers in Pakistan, Egypt and Indonesia, collected in primary care and outpatient settings, predominantly within the private sector, by IQVIA between 2017 and 2021, namely IQVIA's proprietary Medical Data Index (Medical Index of Pakistan (MIP), Egypt Medical Data Index (EMDI) and Indonesia Medical Data Index (IMDI)). IQVIA market research information reflects estimates of real-world activity and should be treated accordingly. We evaluated antibiotic prescribing categorised by WHO AWaRe and Essential Medicines List (EML) classifications for common infections. We used mixed-effects regression analyses to identify factors influencing prescribing decisions.

Among the 384 975 infection-related health consultation records analysed, antibiotics were prescribed in 82.0% of consultations in Pakistan, 81.2% in Egypt and 69.1% in Indonesia. Watch antibiotics accounted for 70.2% of antibiotic prescriptions in Pakistan, 52.9% in Egypt and 53.6% in Indonesia. Non-WHO EML antibiotics accounted for 26.8% of prescriptions in Pakistan, 39.9% in Egypt and 33.0% in Indonesia. Consultations for patients presenting with lower respiratory tract infections, urinary tract infections, multiple infections or differentiated fever had higher odds of receiving any or a Watch antibiotic. Consultations by respiratory-related specialists in Pakistan and Egypt and by most specialities in Indonesia were more likely to receive Watch antibiotics.

Similar patterns of high levels of total and Watch antibiotic prescribing for common infections-including those that generally do not require any antibiotics-were identified among prescribers in primary care and outpatient settings within the private sector in Pakistan, Egypt and Indonesia.

The aim of this study is to evaluate existing evidence on the effectiveness of amoxicillin and amoxicillin-clavulanate for community-acquired pneumonia in children and adults.

Systematic review and meta-analysis.

PubMed, Cochrane Library, Web of Science and Ovid-MEDLINER were searched with no language restrictions through 16 July 2024.

We included studies comparing the effectiveness of amoxicillin or amoxicillin-clavulanate versus other antibiotics or placebo.

Only randomised controlled trials comparing amoxicillin or amoxicillin-clavulanate with another antibiotic or placebo with a primary outcome of clinical resolution or clinical failure were eligible for our review. We used random-effects and fixed-effects logistic regression models to estimate the pooled treatment effect size. Heterogeneity of the studies was evaluated using the τ statistic. We performed an unplanned frequentist random-effects network meta-analysis for the indirect comparison between amoxicillin and amoxicillin-clavulanate. The revised Cochrane risk of bias tool for randomised trials was used to assess and categorise studies into low risk of bias, some concerns or high risk of bias.

We extracted data from 44 studies including 45 400 patients. We found no evidence of a differential effect on clinical resolution when comparing amoxicillin with other antibiotics (n=15 trials; pooled OR 0.88; 95% CI 0.56 to 1.38, where >1 favours amoxicillin) or amoxicillin-clavulanate with other antibiotics (n=17; OR 0.89; 95% CI 0.76 to 1.04). Similarly, evidence of difference in clinical failure between amoxicillin and other antibiotics was unclear and unable to rule out clinically important benefits or harms (n=8; OR 0.76; 95% CI 0.55 to 1.06, where <1 favours amoxicillin). We found no evidence of a differential effect on clinical resolution between adults treated with amoxicillin and amoxicillin-clavulanate (n=28; OR 1.04; 95% CI 0.64 to 1.70, where >1 favours amoxicillin-clavulanate). Sixty-three per cent and 29% of amoxicillin and amoxicillin-clavulanate studies, respectively, had low risk of bias according to the Cochrane risk of bias tool for randomised trials.

Current evidence is unclear as to whether amoxicillin or amoxicillin-clavulanate differs from other antibiotics, or from each other, in the treatment of community-acquired pneumonia, owing to the small number of trials and substantial heterogeneity in comparators used across study settings.

CRD42024568554.

In Australia, asthma is the most common chronic childhood disease, with prevalence and care varying across communities. In three local government areas (LGAs) in Melbourne's inner west, we compared childhood asthma-related emergency department (ED) visits to Victoria overall, and explored parents' perceived enablers and barriers to community-based asthma care.

We used an administrative dataset (2007-19) and a cross-sectional survey of parents across six primary schools in the three LGAs (2022-23). Descriptive analysis was conducted to present childhood asthma-related ED rates, and asthma control, management practices, parental perceived asthma care enablers and barriers. Differences in these measures across LGAs were also examined.

Childhood asthma-related ED visit rates were 26-53% higher in the three LGAs compared with Victoria overall. Parents (n = 545) identified general practitioners (GPs), pharmacists and EDs as the most helpful resources, but faced barriers to community-based asthma care, such as fear during asthma flare-ups, difficulty accessing GPs, and concerns about medication side effects.  DISCUSSION: Melbourne's inner west has disproportionately higher asthma-related ED presentation rates. This warrants further investigation and development of strategies to improve community-based asthma care and reduce triggers, including air pollution.