Chronic Kidney Disease is a global health challenge and its early diagnosis is still a challenge, particularly when relying on conventional biomarkers like serum creatinine. In this systematic review, PRISMA guidelines were followed with a comprehensive search on various databases focusing on studies assessing estimated cystatin C levels, and creatinine levels among patients with chronic kidney disease, type 2 diabetes mellitus and hypertension. The Joanna Briggs Institute's critical assessment tool was used to estimate quality and risk bias of included studies. This systematic review included 21 studies with maximum studies demonstrating cystatin C based eGFR may provide more reliable and accurate estimate of kidney function than creatinine based eGFR, specifically for early identification of kidney dysfunction. The findings suggest that serum cystatin C is an early diagnostic and prognostic marker and its incorporation into routine testing will increase the clinical utility by improving risk stratification. In general, this systematic review highlights the diagnostic and prognostic utility of serum cystatin C for early detection of kidney dysfunction.

Type-2 diabetes mellitus remains a major global health challenge, requiring therapeutic strategies that ensure long-term safety while addressing its multifactorial pathology. Although existing pharmacotherapies effectively control glycemia, their largely single target mechanisms and variable tolerability underscore the need for complementary approaches. In this study, we present a comprehensive evaluation of NAMIG-5, an polyherbal formulation, for Type-2 diabetes mellitus management. Pharmacognostic and phytochemical analyses using spectroscopic and chromatographic techniques, confirmed the authenticity of the formulation along with the chemical consistency. In a nicotinamide-streptozotocin-induced diabetic model, NAMIG-5 exhibited significant antihyperglycemic activity without acute or sub-chronic toxicity. A randomized, active-controlled clinical trial involving 90 participants demonstrated significant reductions in fasting and postprandial glucose levels, improved lipid profiles, and excellent tolerability, with efficacy exceeding metformin, a widely prescribed anti-diabetic medication (p < 0.05). Mechanistically, the components of NAMIG-5 synergistically inhibited human islet amyloid polypeptide aggregation. Bioactivity-guided fractionation identified the key active constituents, establishing NAMIG-5 as a safe therapeutic candidate for Type-2 diabetes mellitus.

Spectral computed tomography (CT) has become an important extension of contrast-enhanced CT (CECT) in oncologic imaging by providing material-specific information beyond conventional morphologic assessment. Dual-energy CT (DECT), implemented on energy-integrating detector CT (EID-CT) platforms, has demonstrated the value of low-keV virtual monoenergetic imaging (VMI), iodine mapping, and material decomposition for improving tumor conspicuity, delineating local extent, and supporting tissue characterization. However, broader clinical adoption of EID-CT-based DECT has been limited by increased low-keV image noise and workflow complexity. Photon-counting detector CT (PCD-CT) addresses these limitations by offering improved energy resolution, reduced electronic noise, and routine acquisition of multi-energy data without dedicated dual-energy protocols. In particular, low-keV VMI around 40 keV can be generated with clinically acceptable noise, enabling consistent enhancement-based assessment in daily practice. Iodine-based reconstructions further complement morphologic evaluation by visualizing viable tumor enhancement and enabling quantitative analysis. This organ-based pictorial review summarizes practical applications of PCD-CT-based spectral imaging in oncology. Across organ systems, spectral CT may provide complementary problem-solving information by improving lesion detection, tumor extent delineation, and diagnostic confidence, particularly when conventional CT findings are equivocal, or MRI is unavailable, contraindicated, or limited. Emerging quantitative parameters, including electron density, effective atomic number, and advanced material decomposition, may further expand oncologic CT applications, although outcome-driven validation remains limited. Together, these features position PCD-CT as a practical spectral imaging platform for routine oncologic CT. KEY POINTS: Question How can PCD-CT address low-keV image noise and workflow barriers that have limited routine DECT-based spectral imaging in oncologic CT practice? Findings PCD-CT enables low-keV VMI and iodine-based reconstructions that may improve lesion conspicuity, tumor-extent assessment, and problem-solving across organ-specific oncologic workflows. Critical relevance statement This review clarifies practical, evidence-aware uses of PCD-CT spectral reconstructions in oncology, highlighting low-keV VMI as an adjunct, selective iodine-map problem-solving, and investigational quantitative parameters.

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction associated with increased maternal and fetal risks during pregnancy and the puerperal period.

To describe the longitudinal course of MG, maternal and neonatal outcomes, and the occurrence of transient neonatal myasthenia gravis (TNMG) from the pregestational period until 12 months postpartum in pregnancies complicated by MG.

A retrospective, longitudinal case-series study of pregnancies in women with MG who were followed at a single tertiary center for neuromuscular disorders. Disease severity was assessed using the MG Foundation of America Clinical Classification (MGFA)and MG-Activities of Daily Living (MG-ADL) scale. Treatments, delivery mode, postpartum exacerbations, ventilatory support and TNMG in newborns were collected using a standardized proforma. Longitudinal MG-ADL scores were analyzed using generalized estimating equations.

Twenty-four pregnant women with MG were included. Patients had juvenile-onset (n = 12, 50%) or early-onset (n = 12, 50%) MG, which was mostly generalized (n = 20, 83%). Anti-AChR antibodies were positive in 71% (n = 17) and anti-MuSK antibodies in 4% (n = 1). Pyridostigmine was the main therapy; 8% of patients (n = 2) experienced exacerbations during pregnancy. Cesarean delivery occurred in 60% (n = 12), primarily for obstetric indications. The TNMG occurred in 15% of newborns (3 out of 20), and all fully recovered. The MG-ADL scores increased during the first and third trimesters, during the postpartum period, and at 12 months postpartum. Third-trimester MG-ADL scores ≥ 4 were associated with the occurrence of TNMG. No maternal or neonatal deaths occurred.

Pregnancy in MG was characterized by variable disease activity, with late gestation and the postpartum period representing clinically relevant periods of vulnerability to maternal exacerbations and neonatal involvement. Increased third-trimester MG-ADL scores, particularly among antibody-positive mothers, were associated with TNMG and postpartum exacerbations, supporting close monitoring during these periods.

Older patients with metastatic colorectal cancer (mCRC) are a heterogeneous population with wide variability in functional status, frailty, cognition, nutritional reserve, and comorbidity burden. Treatment decisions are often guided primarily by chronological age and performance status, which may not adequately capture vulnerability or patient-centered outcomes in this population.

The primary aim of this study is to prospectively evaluate the association of baseline geriatric assessment (GA)-derived frailty with overall survival in older patients with mCRC receiving first-line systemic therapy in routine clinical practice; secondary aims are to evaluate the associations of frailty with initial treatment intensity and early changes in quality of life (QOL).

Baseline GA includes activities of daily living, instrumental activities of daily living, the Clinical Frailty Scale, the Mini-Cog, nutritional assessment, the Charlson Comorbidity Index (excluding cancer-related items), and the Eastern Cooperative Oncology Group (ECOG) performance status. Blood-based prognostic biomarkers, including the prognostic nutritional index and neutrophil-to-lymphocyte ratio, are also collected. Initial treatment intensity is defined according to the first-line systemic regimen selected at baseline, whereas subsequent local therapies are recorded separately. QOL is assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) at baseline and 8 to 12 weeks after treatment initiation.

This study was registered in the UMIN Clinical Trials Registry (UMIN000060489) on April 1, 2026. This study received no external funding. Participant recruitment began on April 1, 2026 (the first participant enrolled in June 2026) and is planned to continue for approximately 2.5 years (projected completion: October 2028), with an anticipated sample size of approximately 100 participants; an early QOL follow-up is scheduled for 8 to 12 weeks after treatment initiation for each participant. As of the submission of this revised manuscript (August 2026), 4 participants had been enrolled, baseline QOL assessments had been completed for all 4 participants, and the 8- to 12-week follow-up QOL assessments had been completed for 3 participants; no outcome data were available. Analysis of the primary outcome will be conducted after final survival follow-up, with the main results anticipated for publication in 2030.

This protocol describes a pragmatic GA-based observational framework to examine associations between pretreatment vulnerability, initial treatment intensity, survival outcomes, and patient-reported QOL in older patients with mCRC. Given the exploratory, hypothesis-generating design, the study is expected to generate clinically relevant hypotheses for individualized, patient-centered treatment strategies and future geriatric oncology research.

UMIN Clinical Trials Registry UMIN000060489; https://tinyurl.com/3mn563er.

DERR1-10.2196/94561.

Surgical palliation is a critical component of comprehensive care for patients with advanced, unresectable cancer, often measured by symptom relief and improved quality of life (QOL). Malignant gastrointestinal (GI) obstructions-gastric outlet obstruction (GOO), malignant bowel obstruction (MBO), and biliary obstruction-are some of the most common indications for palliative surgery and associated with life-limiting nausea, vomiting, per oral (PO) intolerance, or jaundice. Treatment is inherently multimodal, including percutaneous, endoscopic, and operative approaches, with selection determined by disease burden, patient condition, and prognosis. Despite such advances in modalities, disparities in access to and outcomes of palliative surgical care are poorly characterized. Current evidence suggests racial and ethnic minorities, lower socioeconomic status, and rural settings are associated with reduced access to palliative care, delayed presentations, and poor outcomes. However, data specific to palliative surgery, including malignant GI obstructions, are limited, as most studies prioritize comparing efficacy of treatment modalities as opposed to disparities in palliative surgical care. This review surveys current surgical palliative options for GOO, MBO, and biliary obstruction and examines available evidence on disparities in access, utilization, and outcomes. We also highlight gaps in palliative surgical research that may hamper high-quality disparities research and propose future directions focused on standardized definitions, patient-centered palliative outcomes, and improved methodologies to better identify and address disparities in palliative surgical care.

ASTRUM-006 provides phase 3 evidence that perioperative immune checkpoint inhibition improves event-free survival with Asian SOX-based chemotherapy in PD-L1-positive gastric cancer. Its postoperative chemotherapy-sparing strategy is attractive, although unmasking, event adjudication, and non-R0 or occult metastatic disease warrant consideration. The study nevertheless broadens the perioperative treatment framework and provides an important platform for refining patient selection and postoperative treatment intensity.

To establish an intraoperative CT/MR fusion imaging (FI)-guided core needle biopsy (CNB) approach for head and neck lesions and to evaluate its diagnostic performance in comparison with conventional CT-guided biopsy.

This retrospective study included patients undergoing CT-guided or FI-guided CNB for head and neck lesions between January 2020 and December 2024. Clinical information was collected, including demographics, lesion size, needle insertion depth, number of biopsy cores obtained, and complications. Diagnostic performance was evaluated at both the case-based and core-based levels by comparing biopsy histopathology with the final diagnosis. Subgroup analyses were performed according to lesion size, needle insertion depth, and pathological type.

A total of 152 patients with 426 biopsy cores were included, comprising 66 patients (183 cores) in the CT-guided group and 86 patients (243 cores) in the FI-guided group. At the case-based level, FI-guided biopsy demonstrated significantly higher diagnostic accuracy than CT-guided biopsy (98.8% vs 90.9%, p = 0.04), particularly for lesions < 3.7 cm and non-squamous cell carcinoma (non-SCC) lesions. At the core-based level, FI-guided biopsy also achieved higher accuracy (96.3% vs 73.2%, p < 0.001) and sensitivity (93.8% vs 65.0%, p < 0.001), with consistent advantages across all predefined subgroups. No major procedure-related complications were observed.

FI-guided CNB is a safe and feasible technique for head and neck lesions that improves diagnostic accuracy compared with conventional CT guidance.

Question Can CT/MR FI overcome the limitations of conventional CT guidance for precise targeting and accurate biopsy of anatomically complex head and neck lesions? Findings CT/MR FI-guided biopsy demonstrated higher diagnostic accuracy at both case-based and core-based analyses than conventional CT-guided biopsy for complex head and neck lesions. Critical relevance statement This study provides evidence that CT/MR fusion-guided biopsy improves targeting precision and diagnostic performance compared with conventional CT-guided biopsy, supporting its application for complex head and neck lesions in clinical radiology practice.

Myelodysplastic neoplasms (MDS) are characterized by insufficient hematopoiesis and alterations of the bone marrow microenvironment. However, bone health in MDS has not been evaluated in a prospective, longitudinal setting. Within the Bone and Hematology in Elderly (BoHemE) study, bone mineral density (represented as T-score) and bone-specific serum markers were assessed in patients with MDS (n = 111; 36% female) and age-matched controls (n = 84; 55% female) at baseline and after 3 years. At baseline, patients with MDS had a lower T-score [-0.2; p < 0.05] compared to controls, which was mainly attributed to the lower T-score in women with MDS [-0.3; p < 0.05]. Furthermore, the DNMT3A mutation was associated with a lower T-score within the MDS cohort [-0.7; p < 0.05], but the occurrence in controls had no effect. Albumin-adjusted calcium and phosphate levels correlated with T-scores within the MDS cohort [p < 0.0001 and p < 0.01, respectively], independent of age, sex, MDS duration, IPSS-M score, or transfusion dependence. Quality of life was lower in patients with MDS [p < 0.01], and remained stable over 3 years, whereas T-scores declined [-0.3; p < 0.05]. The presence of osteoporosis was associated with poor overall survival in MDS [p < 0.01]. In conclusion, bone health should be evaluated as part of the diagnostic work-up and clinical management of MDS.