To assess the effectiveness and safety of intravenous efgartigimod in patients with myasthenia gravis (MG) and to compare treatment responses between anti-acetylcholine receptor antibody (AChR-Ab)-positive and -negative subtypes.

A comprehensive search was conducted in the PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases up to 15 October 2025. Clinical trials and cohort studies evaluating the effectiveness and safety of efgartigimod in patients with MG were included. A random-effects model was used to pool mean differences (MDs) for continuous outcomes and proportions for categorical outcomes, with corresponding 95% confidence intervals (CIs). Subgroup analyses were performed based on study design and MG subtype.

Twenty-nine studies (1594 patients) were included. Overall, 83% of patients achieved clinically meaningful improvement (CMI; ≥ 2-point reduction in MG Activities of Daily Living [MG-ADL] score), and 36% achieved minimal symptom expression (MSE; MG-ADL score of 0 or 1) with no significant difference between AChR-Ab-positive and AChR-Ab-negative subtypes. MG-ADL score significantly decreased from baseline (MD: -4.3 points, 95% CI: -4.99 to -3.61), with no difference between the MG subtypes. Quantitative MG score (QMG; MD: -3.6 points, 95% CI: -4.28 to -2.91), MG Quality of Life 15-item revised scale (MG-QoL15r), IgG levels, and corticosteroid use showed significant reductions in the AChR-Ab-positive subtype; however, these outcomes were not reported in the AChR-Ab-negative subtype. Serious adverse events were reported in 4.42% of patients.

Efgartigimod significantly improved clinical symptoms and quality of life in patients with MG and may offer a steroid-sparing effect, with no significant differences observed between subtypes.

Chemotherapy-induced peripheral neuropathy (CIPN) is associated with a large amount of interindividual variability in signs and symptoms. The purposes were to use latent profile analysis to identify subgroups of survivors with distinct lower extremity (LE) loss-of-function CIPN profiles; evaluate for differences in demographic, clinical, and pain characteristics between the profiles and characteristics associated with membership in the more severe profile; and examine relationships between the profiles and measures of large fiber loss and C-tactile fiber function.

LE loss-of-function CIPN profiles were created using measures of worst pain, loss of light touch sensation, loss of cold sensation, loss of pain sensation, vibration threshold, and two balance measures.

Of the 405 survivors evaluated, two distinct profiles were identified: less severe loss of LE function (76.5%) and more severe loss of LE function (23.5%). Risk factors for membership in the more severe profile included being older, male, and having lower functional status. In terms of the loss of large fiber function, survivors in the more severe class had four more sites on average that lost light touch sensation; their vibration thresholds were 1.5 times higher; and their ratings of numbness were significantly higher. For C-tactile fiber function, significant between-group differences were found in survivors' ratings of the severity of sensitive skin and unpleasantness.

Findings suggest that distinct "CIPN phenotypes" can be identified in cancer survivors. Detailed phenotyping and molecular characterization of various CIPN phenotypes will lead to the development and testing of targeted and personalized interventions.

Prostate cancer is the most common cancer in men and the leading cause of malignancy-related mortality in Mexico. The Mexican Institute for Social Security (IMSS for its initialism in Spanish) introduced its first robotic system at the Oncology Hospital of the 21st Century National Medical Center in Mexico City.

To evaluate the accumulated experience, perioperative, oncologic and functional outcomes of the first 200 robot-assisted radical prostatectomy (RARP) cases.

A retrospective analysis of 200 patients undergoing RARP for localized prostate cancer was conducted. Perioperative and postoperative variables, pathology results, complications, and one-year continence rates were considered.

Mean surgical time was 242.1 minutes (90-600), with a console time of 197.6 minutes (68-495). Mean blood loss was 327.7 cc (10-1800). Positive surgical margins were observed in 34.5% of cases. Complications occurred in 22 patients (11%). No conversions to open surgery or mortality were reported. Mean hospital stay was 2.54 days (2-14). Postoperative antigen was undetectable in 88.5% of patients. The continence rate was 95.7%.

The first 200 RARP cases at our institution demonstrate the accumulated experience with the procedure, showing low complication rates. These results are consistent with those of high-volume centers, which require additional long-term functional follow-up.

Cushing'sdisease (CD), caused by an adrenocorticotropin-secreting pituitary adenoma, is a rare but severe endocrine disorder associated with high cardiometabolic morbidity and mortality. Diagnosis is challenging as many symptoms are nonspecific, and biochemical or imaging results may be inconclusive, contributing to substantial diagnostic delay. Although the core features of CD are consistent across the lifespan, certain clinical manifestations of chronic hypercortisolism vary from childhood through older age, reflecting differences in growth, puberty, metabolism, and comorbidity burden. In children, impaired growth coupled with weight gain is most prominent, whereas adolescents often present with pubertal disturbances and psychological or academic difficulties. Adults typically exhibit the classic Cushingoid features such as round face, plethora, and central obesity, along with metabolic and reproductive complications. Older individuals typically present with frailty, sarcopenia, fractures, and cognitive decline. Age also influences the interpretation of endocrine tests, the accuracy of pituitary magnetic resonance imaging, the role of inferior petrosal sinus sampling, perioperative risks, and the long-term impact of remission or persistent disease. Given this context, this narrative review used five representative clinical vignettes (pediatric, adolescent, adult female, adult male, and elderly) to illustrate how the presentation, diagnostic evaluation, and management of CD vary across the lifespan. Each case was paired with a structured synthesis of current evidence, highlighting both shared principles and age-specific nuances essential for timely diagnosis, appropriate treatment selection, and effective long-term multidisciplinary care. Understanding age-related differences is crucial to improving outcomes and reducing the substantial morbidity and mortality associated with CD throughout the lifespan.

BackgroundColorectal cancer (CRC) remains a leading cause of cancer-related death worldwide. Although colonoscopy is effective screening method, its widespread adoption is hampered by poor compliance. Development of patient-friendly screening methods that are minimally invasive is of paramount importance to improve CRC screening participation.MethodsA single-center case-control study was conducted. Blood samples were collected from 119 participants (79 CRC patients, 20 patients with colorectal adenomas, and 20 healthy colonoscopy-negative controls) during May 2023 and March 2025. The methylated SEPT9 (mSEPT9) DNA in peripheral blood was analyzed by droplet digital polymerase chain reaction (ddPCR).ResultsThe sensitivity and specificity of mSEPT9 detection in peripheral blood for diagnosis of all stages of CRC patients was 68.35% and 95.00%, respectively. The positive rate were similar between left-sided CRC and right-sided CRC (65.31% vs 72.41%，p ＞ 0.05). mSEPT9 detection in all healthy people with normal colonoscopy were negative. When mSEPT9 detection was combined with CEA and CA199, positive rate could be raised to 82.67%.ConclusionsBlood-based mSEPT9 detection by ddPCR method is a sensitive and specific method for non-invasive diagnosis of CRC. Combination with CEA and CA19-9 could improve its performance. It may serve as a viable alternative for individuals unwilling or unable to undergo invasive procedures.

The increase in incidence of early-onset pancreatic cancer (EOPC) is of concern and poorly understood. The aim of this study was to investigate the clinical outcomes of surgically resected patients with EOPC and the potential molecular heterogeneity between EOPC and late age-onset disease.

A retrospective cohort study was conducted, with clinical, pathological, and survival outcome data obtained from two large independent prospective cohorts curated by the Australian Pancreatic Genome Initiative (APGI) and the West of Scotland Pancreatic Unit (Glasgow Royal Infirmary) between 1997 and 2022. Patients were categorized into two age groups (<50 and ≥50 years) at time of diagnosis. Clinicopathological features and survival outcomes, in addition to gene expression and tumour microenvironment data, were compared between groups.

In total, 851 patients were identified, of whom 68 (8%) were aged <50 years. EOPC was associated with significantly earlier recurrence after surgery (median disease-free survival (DFS) 10.9 versus 14.2 months; P = 0.011) and there was no statistically significant difference in disease-specific survival (median 19.9 versus 23.8 months; P = 0.117). There were no differences in validated clinicopathological variables to account for the shorter DFS in the EOPC group. Despite an increased proportion of patients with EOPC receiving adjuvant chemotherapy (P = 0.032), DFS was significantly worse (DFS 12.6 versus 16.0 months; P = 0.022). EOPC demonstrated enrichment of genes associated with more aggressive molecular pathology and the squamous (basal-like) molecular subtype of pancreatic ductal adenocarcinoma, including S100A2 (P < 0.001) and TP63 (P = 0.044), and down-regulation of GATA6 (P = 0.016).

EOPC is associated with a shorter time to recurrence and more aggressive, adverse molecular pathology.

Lymph node dissection is crucial for accurate staging and prognosis assessment in esophageal squamous cell carcinoma (ESCC). While sufficient examined lymph nodes (ELNs) are generally linked to better outcomes, how ELN count affects prognosis under immunotherapy remains unclear.

This study analyzed 621 ESCC patients who underwent R0 resection with or without neoadjuvant chemo-immunotherapy (NACI). Patients were stratified into surgery alone (SA) (n = 451) and NACI (n = 170) groups. Propensity score matching balanced baseline characteristics. The relationship between ELN count and overall survival was analyzed using Cox regression models. Single-cell RNA and T-cell receptor sequencing were performed on paired tumor and lymph node samples to elucidate underlying immune mechanisms.

In the NACI cohort, both insufficient (ELN ≤ 23) and excessive (ELN > 31) lymph node resection were independent risk factors for worse overall survival (ELN ≤ 23: HR = 2.29, 95% CI 1.11-4.71, p = 0.024; ELN > 31: HR = 2.71, 95% CI 1.17-6.26, p = 0.020). However, the SA cohort derived continuous survival benefit from higher ELN counts. Single-cell sequencing revealed that NACI enriched a population of activated, tumor-reactive cytotoxic T cells within metastasis-negative lymph nodes.

The optimal ELN count is contingent on treatment strategy. For SA, a more extensive lymphadenectomy improves survival. However, for NACI, a "Goldilocks" principle applies-an ELN count between 24 and 31 balances accurate staging with the preservation of antitumor immunity, advocating for function-preserving, personalized surgery in the immunotherapy era.

To evaluate the prevalence of European Association of Urology-defined combination and platinum eligibility at first-line treatment initiation, and to assess their impact on conventional treatment sequence and overall survival in a real-world Japanese cohort.

We retrospectively analyzed 148 patients with metastatic urothelial carcinoma who initiated systemic chemotherapy between 2018 and 2024 at a single institution in Japan. Cisplatin eligibility was assessed according to the Galsky criteria. Combination therapy eligibility and platinum eligibility were defined according to the European Association of Urology guideline.

Among the 148 patients, 128 (86.5%) were combination-eligible and 20 (13.5%) ineligible. Among combination-eligible patients, 70 (54.7%) were cisplatin-eligible, 47 (36.7%) cisplatin-ineligible but platinum-eligible, and 11 (8.6%) platinum-ineligible. Median overall survival was significantly longer in combination-eligible patients than in combination-ineligible patients (25 vs. 16 months, p = 0.019, HR 2.46, 95% CI 1.16-5.23). Within the combination-eligible group, cisplatin-eligible patients tended to show superior median overall survival (not reached) compared with cisplatin-ineligible/platinum-eligible (25 months) and platinum-ineligible (15 months, p = 0.11 and p = 0.082, respectively). Only 25.0% (32/128) of combination-eligible patients received the chemotherapy-immune checkpoint inhibitor-enfortumab vedotin sequence, while 20.0% (4/20) of combination-ineligible patients also completed this sequence.

European Association of Urology-defined combination and platinum eligibility were associated with survival outcomes and treatment sequence capability in a real-world setting. These findings highlight the prognostic value but practical limitations of eligibility criteria, emphasizing the need to develop more practical classification frameworks that ensure broader access to effective therapy.

Older adults with cancer frequently experience high symptom burden, psychological distress, and reduced quality of life. Integrating palliative nursing interventions into routine oncology care has the potential to improve these outcomes, yet evidence examining their measurable effects remains limited. This study aimed to examine the effects of integrated palliative nursing interventions on quality of life, psychological outcomes, and symptom burden among older adults with cancer.

A quasi-experimental one-group pre-test-post-test design was conducted at King Khaled Hospital, Al-Kharj, Saudi Arabia, including 80 older adults (≥60 years) with confirmed cancer diagnosis. Participants received a structured 6-week integrated palliative nursing intervention comprising 12 sessions (2 sessions/week) addressing physical, psychological, social, functional, and spiritual needs. Outcome measures included the Functional Assessment of Cancer Therapy-General (FACT-G) for quality of life, the National Comprehensive Cancer Network (NCCN) Distress Thermometer for psychological outcomes, and the Edmonton Symptom Assessment System (ESAS-r) for symptom burden. Pre- and post-intervention assessments were conducted, and data were analyzed using paired t-tests, Pearson correlations, and multiple linear regression.

All 80 participants completed the study, and no attrition was observed during the 6-week intervention period. Post-intervention, participants demonstrated significant improvements in overall quality of life (FACT-G total: 39.65 ± 5.51 → 66.41 ± 6.25, p < .001) and all subscales. Distress scores (NCCN) decreased from 21.93 ± 2.49 to 6.99 ± 2.37 (p < .001), and total symptom burden (ESAS) declined from 63.56 ± 6.31 to 41.09 ± 6.88 (p < .001). Regression analysis identified baseline scores as significant predictors of post-intervention outcomes: pre-intervention FACT-G scores and cancer type for quality of life [R² = 0.660, F (8, 71) = 17.199, p < .001), pre-intervention NCCN scores for distress (R² = 0.219, F (8, 71) = 2.487, p = .019), and pre-intervention ESAS scores for symptom burden (R² = 0.757, F (8, 71) = 27.697, p < .001). These results indicated that baseline status strongly predicts post-intervention outcomes, while demographic and clinical variables had minimal impact.

Structured integrated palliative nursing interventions significantly enhance quality of life and reduce psychological distress and symptom burden in older adults with cancer. Incorporating multidimensional, patient-centered palliative care within routine oncology practice can improve clinical outcomes, with baseline status serving as an important determinant of intervention effectiveness.

Turnaround time (TAT) for routine skin specimens may be prolonged at times, delaying diagnosis and treatment in cases with a unexpected high-risk neoplasia. This quality improvement study assessed the prevalence, types and characteristics of such cases.

This was a descriptive study of all routine skin specimens submitted by general practitioners (GPs) and private dermatologists in 2022-2023 at the Department of Pathology, Viborg Regional Hospital, Denmark. From Systematized Nomenclature of Medicine (SNOMED) codes, various premalignant and malignant neoplasias were identified; melanocytic and soft tissue neoplasms were included.

Among 33,280 routine specimens, 77 (0.23%) were a high-risk premalignant or malignant neoplasia: 66 melanocytic (54 melanomas, 0.16%) and 11 sarcomas. Superficial spreading melanoma (n = 36) and the in situ variant (n = 10) were the most frequent high-risk neoplasia in lesions clinically assessed as benign. Among melanocytic lesions, 61% had involved/unassessable margins, and 67% of melanomas had a depth ≥ 1.0 mm. The mean TAT was 64 calendar days. Mean age: 64.1 years, with a notable proportion aged 41-50 years. Referrals: GPs 73%, dermatologists 26%, surgeons 1%.

excision 58%, curettage 25%, biopsy 10%, unspecified 7%. Suspicious shape/colour features were noted in 36% of melanocytic lesions. 7.5% had prior melanoma.

Unexpected high-risk neoplasia are rare (0.23%) but often advanced, highlighting the need for improved clinical assessment and a short TAT for routine skin specimens. The results serve as a reference for future AI-based screening.

None.

Not relevant.