Myasthenic crisis is the most feared acute complication of myasthenia gravis (MG), yet simple clinic-based approaches to risk stratification remain limited. We examined which routinely recorded clinical features were associated with crisis occurrence across the observed disease course and whether a parsimonious model could provide retrospective group-level stratification.

This single-centre retrospective study included 86 adults with MG. Myasthenic crisis was defined as respiratory failure requiring mechanical ventilation. Disease severity was graded using the Myasthenia Gravis Foundation of America (MGFA) classification and grouped as mild, moderate or severe; MGFA class V was excluded to avoid circularity. Independent correlates were assessed by logistic regression and internally validated by cross-validation. The model was intended for retrospective group-level stratification, not prospective prediction of an individual future crisis.

Thirty-four patients (40%) had experienced a myasthenic crisis. Crisis frequency increased across severity groups: 11%, 26% and 73% in mild, moderate and severe disease, respectively (p < 0.001). Each severity grade increased the odds of crisis approximately seven-fold (OR 6.7, 95% CI 2.8-16.5), whereas more frequent outpatient visits were associated with lower odds (OR 0.73). The two-item model showed good discrimination (AUC 0.84; cross-validated AUC 0.79). Calibration-in-the-large was close to ideal, although the cross-validated calibration slope of 0.73 suggested moderate overfitting.

MGFA severity was the dominant clinic-available marker of crisis occurrence. Outpatient-visit frequency contributed less stable information and should be considered exploratory. These findings support retrospective group-level stratification but do not establish prospective prediction or a protective effect of follow-up.

Oral Potential Malignant Lesions (OPMDs), including oral leukoplakia (OLK) and lichen planus (OLP), as well as Oral Squamous Cell Carcinoma (OSCC) are influenced by oral dysbiosis and might represent a disease continuum. Our hypothesis was that the oral salivary metabolomic reflects the association of those diseases. Hence, we aimed to study and compare salivary metabolites and metabolic pathways in OPMDs and OSCC.

Unstimulated saliva samples were collected from 60 participants: OLK (n = 15), OLP (n = 15), OSCC (n = 15), and healthy controls (HCs; n = 15). Metabolites were quantified using NMR spectroscopy, and pathway analyses were performed with MetaboAnalyst 6.0.

Four metabolites (acetate, taurine, pyruvate, methylamine) were elevated, while proline was consistently decreased in all disease groups relative to HCs. Four key pathways were altered: pyruvate metabolism (in all disease groups), glutamate metabolism (in OLK and OSCC), taurine and hypotaurine metabolism (in OLP and OLK), and the glucose-alanine cycle. OLK shared more metabolic features with OSCC than with OLP.

Salivary metabolomic profiling reveals distinct metabolic alterations across OPMDs and OSCC, supporting their potential continuum and reflecting disease-related biochemical reprogramming. These findings highlight salivary metabolomics as a promising, non-invasive tool for understanding pathogenesis and for future development of biomarkers.

Divergent metabolic pathways in OLP and OLK may relate to their different pathogenesis and malignant transformation risks. Improved understanding of these pathways may support early diagnostics and targeted therapeutic strategies.

To explore the real-world uptake and engagement with OpenSYMPRO, a digital symptom-monitoring tool for patients with cancer undergoing systemic therapy, and potential barriers to its use.

The original study aimed to compare adolescents and young adults (AYAs) using openly accessible OpenSYMPRO with patients aged > 40 years using hospital-based regular SYMPRO. OpenSYMPRO was also accessible to older patients. Due to low recruitment, the planned comparative evaluation was abandoned. Engagement was summarized descriptively. All 20 enrolled participants were invited to provide feedback, and all available interviews and questionnaires were analyzed thematically, irrespective of age.

Of 20 enrolled participants, 18 registered through OpenSYMPRO and 2 through regular SYMPRO. Seven completed > 2 symptom questionnaires, 9 completed 1-2, and 4 completed none. Nine participants provided qualitative feedback through interviews (n = 4) or questionnaires (n = 5), including 7 AYAs and 2 participants outside the AYA age range. Potential barriers included concurrent studies, perceived overlap between studies, forgetting the tool, limited time or cognitive capacity, and limited perceived added value. Some participants found symptom tracking useful. Respondents reported no substantial problems with technical operation, although design-related barriers could not be excluded.

Uptake and engagement appeared to be influenced primarily by organizational, communication, and personal factors rather than technical operation. Stronger integration into clinical workflows, person-tailored communication of purpose and added value, active healthcare professional involvement, and attention to potential design barriers warrant further evaluation. Given the small and heterogeneous sample, and limited feedback from non-users and non-participants, findings are hypothesis-generating.

Purpose To classify the causes and pathologic characteristics of false-negative screening digital breast tomosynthesis examinations. Materials and Methods All false-negative screening examinations at a single center from March 1, 2019, through December 31, 2023, were collected. Seven fellowship-trained breast radiologists independently reviewed the false-negative screening and diagnostic mammograms preceding biopsy. For each mammogram, radiologists recorded the cancer as visible or not visible. Cancers were classified as mammographically occult (not visible on mammogram), missed (visible on screening mammogram), or true interval cancers (visible on diagnostic mammogram only). Between-classification comparisons were performed with the Pearson χ² test or analysis of variance. Results A total of 117 female patients (median age, 60 years [IQR, 49-70 years]) with false-negative screening mammograms were included. Most cancers manifested symptomatically (88 of 117, 75.2%) a median of 237 days (IQR, 187-301 days) after screening mammography. Among cancers, 47.9% (56 of 117), 26.5% (31 of 117), and 25.6% (30 of 117) were missed, mammographically occult, and true interval cancers, respectively. True interval cancers were more often estrogen receptor- (50.0% [15 of 30] vs 16.1% [five of 31] vs 21.8% [12 of 55]) and progesterone receptor-negative (66.7% [20 of 30] vs 22.6% [seven of 31] vs 35.7% [20 of 56]) than mammographically occult and missed cancers. Mammographically occult cancers were more often stage T0 (32.3% [10 of 31] vs 7.1% [four of 56] vs 10.0% [three of 30]) and detected at MRI (48.4% [15 of 31] vs 3.6% [two of 56] vs 10.0% [three of 30]) and developed in younger female patients (51 vs 62 vs 59 years of age, all P < .05) than missed and true interval cancers. Conclusion Half of false-negative screening mammograms were missed, one-quarter were true interval, and one-quarter were mammographically occult cancer, with differences in pathologic characteristics. Keywords: Mammography, Screening © RSNA, 2026 See also the commentary by Elahi and Slanetz in this issue.

Extensive oncologic resection in the maxillofacial region frequently results in functional deficits that compromise oral competence and patient quality of life. The present clinical report describes a patient who underwent commando surgery with partial maxillectomy and reconstruction using a pectoralis major myocutaneous flap following treatment for squamous cell carcinoma. The patient presented with an extensive facial defect, inadequate mouth closure, persistent salivary drooling, tissue exposure and discomfort during routine activities. A custom facial shield prosthesis was fabricated to provide passive external support and protect the reconstructed tissues. A lightweight clear acrylic prosthesis was designed to conform to the postoperative facial contours. Following insertion, the prosthesis provided passive coverage and support of the reconstructed tissues, with satisfactory clinical adaptation and patient-reported acceptance. Because comfort and salivary leakage were assessed only descriptively, these observations were not treated as objective functional outcomes. The primary clinically supported role of the prosthesis was protection of reconstructed tissues during postoperative healing when definitive correction was not feasible.

The aim of this study was to analyze the distribution of maxillofacial defects with respect to etiology, defect classification, demographic characteristics, and prosthetic treatment modalities over a 9-year period at a tertiary care center.

This retrospective study analyzed institutional data from a tertiary care hospital, encompassing patients rehabilitated with maxillofacial prostheses over a 9-year period (2017-2025).

Clinical records of patients rehabilitated with maxillofacial prostheses between 2017 and 2025 were reviewed. Data extracted included demographic characteristics, etiology of defects, classification systems (Aramany, Cantor-Curtis, Veau, and Cordeiro), and type of prosthesis delivered. All variables were predefined and uniformly recorded to ensure consistency in data extraction.

Data were analyzed using descriptive statistics including frequency and percentage distributions using Microsoft Office Excel (version 2019; Microsoft Corporation, Redmond, WA, USA). Categorical variables were expressed as frequencies and percentages, while continuous variable (age) was summarized using median and interquartile range. Associations between categorical variables were analyzed using Chi-square/Fisher's exact test, and continuous variables across groups were compared using Kruskal-Wallis test with Dunn's post hoc analysis. Statistical analysis was performed using Stata 18.0, with P < 0.05 considered statistically significant.

A total of 246 patient records were analyzed, with Aramany-classified maxillary defects constituting the most common defect category (48.0%). Infections were the leading etiological factor (33.3%), followed by trauma (28.9%) and neoplasms (25.6%). Infection- and neoplasm-related defects showed a significant association with Aramany-type maxillary defects ( P = 0.001). Obturator prostheses were the most frequently delivered treatment modality (56.1%). A significant correlation was found between age and maxillofacial defects ( P = 0.04). Smoking (54%) and smokeless tobacco use (24%) were commonly associated risk factors.

Acquired maxillofacial defects constituted the majority of cases requiring prosthetic rehabilitation. Infection-related defects, particularly mucormycosis, represented a substantial proportion of cases during the study period, reflecting changing disease patterns observed in the post-coronavirus disease 2019 era. Older age groups demonstrated significantly higher frequencies of malignancy and mucormycosis-related defects. Standardized classification systems facilitated systematic documentation and communication of defect characteristics, while prosthetic rehabilitation was individualized according to the extent of tissue loss, anatomical involvement, and functional requirements. Obturator prostheses remained the most frequently utilized rehabilitation modality for maxillary defects.

Atrial fibrillation (AF) and cancer frequently coexist, particularly in elderly patients, creating a complex clinical scenario with increased thromboembolic and hemorrhagic risk. In these patients, in addition to established risk factors, cancer‑related factors, such as thrombocytopenia, organ dysfunction, and drug-drug interactions (DDIs), should be considered when managing anticoagulant treatment. Despite a growing prevalence of this clinical overlap, cancer patients have been under‑represented in randomized controlled trials of direct oral anticoagulants (DOACs) for AF. Consequently, evidence guiding anticoagulation decisions in this population derives largely from post hoc analyses and observational studies. The CHA2DS2‑VASc and Hypertension, Abnormal Renal / Liver Function, Stroke, Bleeding History or Predisposition scores, widely used for thromboembolic and bleeding risk stratification in the general AF population, demonstrated suboptimal predictive performance in cancer patients, underscoring the need for a risk factor-based approach specific for cancer patients. Emerging data consistently suggest that DOACs are at least as effective and safe as vitamin K antagonists in cancer patients with AF, with potential advantages in reducing the risk of stroke, major and intracranial bleeding, and mortality. However, DOAC use is still debated in some settings, such as gastrointestinal and genitourinary cancer, brain metastasis, and in the case of strong DDIs. This review summarizes current evidence on ischemic and bleeding risk assessment in cancer patients with AF, evaluates the performance of existing risk stratification tools, identifies cancer‑specific bleeding risk factors, and proposes a practical management algorithm for anticoagulation in this challenging population.

High-tech medical resources play an increasingly important role in cancer diagnosis and treatment. However, accessing information about these technologies remains challenging due to their complexity and a lack of clear information pathways to obtain reliable information. This, in turn, contributes to inequalities in healthcare. Patient/material and methods: The Joint Action Network of Expertise on Cancer (JANE-2) is one of the largest networks under Europe's Beating Cancer Plan. In JANE-2, the work package on High-Tech Medical Resources comprises seven domains of rapidly evolving technologies, namely Nuclear Medicine, Radiomics, Innovative Radiotherapy, Innovative Surgery, Physical Methods of Ablation, Cell Therapies, and Ex-vivo Testing of Agents. Leaders from these domains, together with patient representatives, have authored a review of the challenges of providing patients with information about high-tech medical resources, and have proposed potential solutions.

This article describes the challenges associated with providing adequate information to patients, the resulting consequences, and potential solutions. The article also specifically describes technologies related to the seven high-tech domains that are central to cancer treatment. Patient information tools related to these technologies are provided as supplementary material to the article.

Cancer diagnosis and treatment are not only becoming increasingly effective but also more complex with the adoption of novel technologies. This article discusses the challenges and potential solutions related to the availability of patient information and provides examples of patient information tools for seven key and rapidly advancing technologies.

Breast carcinoma remains the most frequently diagnosed malignancy among women globally, carrying a substantial burden of incidence and fatality. Timely diagnosis and intervention are of utmost significance for improving patient prognosis. Accumulating evidence suggests that microRNAs (miRNAs) derived from plasma exosomes may serve as potential diagnostic biomarkers for mammary carcinoma. To conduct an exploratory analysis of the role of exosomal miRNAs, expression profiles were obtained from breast cancer patients and healthy controls recruited between February 20, 2025, and May 20, 2025 (a 3-month period), with written informed consent from all participants prior to enrollment, using high-throughput sequencing. Subsequently, differentially expressed miRNAs were analyzed through an integrated bioinformatics approach that included gene ontology (GO) term enrichment analysis, Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis, and target gene network analysis to predict their potential biological functions, involved pathways, and regulatory networks. An initial comparative analysis identified 265 miRNAs with modified expression profiles in breast cancer patients. Among them, 203 miRNAs were upregulated, and 62 miRNAs were downregulated. Notably, hsa-miR-6866-5p, hsa-miR-376c-3p, hsa-miR-656-3p, and hsa-miR-641 were significantly upregulated, whereas a cluster of miRNAs sharing a seed sequence, including hsa-miR-519a-5p, hsa-miR-519b-5p, hsa-miR-518e-5p, hsa-miR-522-5p, and hsa-miR-523-5p, were significantly downregulated. Moreover, functional analyses suggested that these miRNAs potentially participate in crucial signaling pathways, including Rap1, phospholipase D, oxytocin, and vascular endothelial growth factor. Predictions of the target gene network indicated their potential regulatory roles in the pathogenesis and progression of breast cancer. This exploratory study identified 9 miRNAs, including hsa-miR-6866-5p, hsa-miR-376c-3p, hsa-miR-656-3p, hsa-miR-641, hsa-miR-519a-5p, hsa-miR-519b-5p, hsa-miR-518e-5p, hsa-miR-522-5p, and hsa-miR-523-5p, that were dysregulated in plasma exosomes of breast cancer patients from Baize, China. Elucidating the precise regulatory functions of these candidate miRNAs in breast cancer development warrants extensive future empirical exploration.

The role of inflammatory cytokines in the prognosis of colorectal cancer (CRC) has been evaluated. However, the impact of perioperative changes on prognosis has not yet been evaluated. The aim was to investigate the correlation between postoperative-to-preoperative ratios of inflammatory cytokines and cancer‑specific survival (CSS) rates in patients with CRC who underwent curative resection. In this retrospective cohort study, patients with CRC who underwent radical resection between September 2019 and December 2020 were analyzed. The effects of the postoperative-to-preoperative ratios of inflammatory cytokines (including IFN-α, IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, and TNF-α) and six other clinical factors on cancer‑specific survival were assessed through univariate and multivariate Cox regression analyses. Survival curves were generated via Kaplan-Meier analysis. A total of 153 CRC patients who underwent radical resection were included in this study. Univariate analysis revealed that age (hazard ratio (HR) = 1.05, p = 0.031), tumor stage (HR = 3.61, p < 0.001), and the IL-1β ratio (HR = 1.00, p = 0.012) were significant prognostic factors. Multivariate analysis indicated that both the IL-1β ratio (adjusted HR = 1.05, p = 0.037) and tumor stage (adjusted HR = 3.83, p < 0.001) remained independent prognostic factors. Kaplan-Meier analysis confirmed the significant association between a high IL-1β ratio and poorer cancer‑specific survival. The postoperative-to-preoperative IL-1β ratio may serve as a potential prognostic biomarker for patients with CRC following radical resection, with higher ratios indicating poorer cancer‑specific survival; however, these exploratory findings require validation in prospective cohorts with standardized sampling protocols.