Glioblastoma (GBM) is the most aggressive primary malignant brain tumor in adults, with persistently poor survival despite chemoradiation and temozolomide (TMZ). Limited intratumoral drug delivery imposed by the blood-brain barrier (BBB), along with intrinsic and acquired resistance mechanisms, constrains TMZ efficacy. Focused ultrasound (FUS)-mediated BBB opening (BBBO) has emerged as a noninvasive strategy to transiently and locally enhance central nervous system drug delivery. To systematically synthesize preclinical and early clinical evidence evaluating the feasibility, safety, and therapeutic impact of FUS-enhanced TMZ delivery in GBM, and to identify key methodological and translational gaps informing future study design. A systematic search of PubMed, Cochrane Library, ClinicalTrials.gov, Embase, and Scopus was conducted from inception through December 2025. Eligible studies combined FUS-mediated BBBO with systemic TMZ in preclinical GBM models or human patients and reported pharmacologic, therapeutic, or safety outcomes. Nine studies (6 preclinical, 3 clinical) met inclusion criteria. All studies employed microbubbles to facilitate BBBO. Preclinical studies consistently demonstrated increased intratumoral TMZ delivery, improved tumor control, and prolonged survival with FUS plus TMZ compared with TMZ alone. Two studies directly quantified enhanced intratumoral drug exposure. Clinical studies demonstrated reproducible, MR-guided BBBO with favorable safety profiles and no procedure-related neurological complications. However, survival and pharmacokinetic endpoints remain preliminary. Focused ultrasound-mediated BBBO is a feasible and well-tolerated strategy to augment TMZ delivery in GBM. While preclinical evidence supports enhanced intratumoral drug exposure and therapeutic benefit, clinical efficacy remains unproven. Future studies should prioritize standardized protocols, direct pharmacokinetic validation, and adequately powered trials incorporating molecular stratification and clinically meaningful endpoints.

Myeloproliferative neoplasms (MPNs) are chronic haematological disorders with a significant symptom burden and implications for quality of life. Traditional physician-led outpatient models often lack sufficient time for in-depth symptom monitoring and patient engagement. This quality improvement project aimed to implement (1) a structured nurse-led visit within a haematology outpatient clinic in northern Italy, (2) routine symptom monitoring and (3) evaluation of patient-related experience.

The nurse-led visit was integrated into routine 1-day hospital activities and focused on a structured comprehensive symptom assessment, health education and self-management support. Patient-reported outcomes to assess physical, psychological, nutritional and functional aspects and patient satisfaction as patient-reported experience measures were collected using validated tools and recorded on a patient symptom diary with patients' self-care recommendations. The Plan-Do-Study-Act cycle and the person-centred care framework guided the intervention design and iterative improvement.

Over the first 6 months, 102 patients underwent nurse-led visits with a high adherence rate and follow-up compliance. Patients reported high satisfaction with the nurse-led visit, with a mean score of 9.6±0.75 points on a 0-10 points visual scale. The intervention optimised waiting times, promoted patient activation and strengthened nurse-physician collaboration. No adverse events occurred.

The implementation of nurse-led visits was feasible, sustainable and highly accepted by patients. This approach aims to enhance symptom management, patient engagement and care coordination for individuals with MPNs and may prove to be a promising model for broader implementation in chronic disease management.

Myasthenia gravis (MG) is an autoimmune disease affecting the postsynaptic neuromuscular junction. Treatment often includes corticosteroids, which may reduce bone mass.

To evaluate the prevalence and predictors of low bone mineral density (BMD) in MG patients.

A cross-sectional study included patients over 18 years with MG followed at the Neuromuscular Diseases Service, Hospital de Clínicas, Universidade Federal do Paraná (2018-2022). Data were obtained through clinical evaluation, medical records, MG Composite Scale, and Quantitative MG Test. Lumbar spine and proximal femur BMD were assessed using a GE Lunar densitometer, with T or Z-scores according to age/menopausal status. Logistic regression identified factors independently associated with BMD alterations.

In total, 92 patients (64.1% female, mean age: 51.3 years) were included, of whom 79.3% had early-onset MG. Past or present corticosteroid use were reported in 94.5 and 45.6%, respectively. Only 27.6% practiced regular physical activity, though most had adequate calcium intake. There were six (7.8%) patients with fragility fractures, and ⅕ were at high fracture risk according to the FRAX results. We found that BMD alterations occurred in 43.5% of patients. No significant association was found with corticosteroid use or MG severity. Age was independently associated with BMD (OR = 1.06, 95% CI: 1.03-1.09, p = 0.0005). A cutoff age ≥ 49 years yielded 82.5% sensitivity, 63.5% specificity, and an area under the ROC curve of 0.72 (95% CI: 0.61-0.83).

Reduced BMD is frequent in MG, highlighting the importance of screening and prevention of low bone mass, osteoporosis, and fragility fractures, particularly in patients over 49 years, regardless of corticosteroid use or MG severity.

Prostate cancer treatment increasingly emphasizes quality-of-life maintenance alongside oncological control. Integrative Traditional East Asian Medicine (TEAM), including traditional Chinese medicine, traditional Korean medicine, and Kampo medicine, has been used as an adjunctive approach for symptom management during cancer treatment. However, evidence regarding its effectiveness and safety across different disease stages remains heterogeneous and has not been comprehensively synthesized.

This systematic review and meta-analysis aims to evaluate the clinical effectiveness, safety, and quality-of-life benefits of TEAM-based adjunctive therapies combined with standard conventional treatments in patients with prostate cancer.

Randomized controlled trials will be identified through comprehensive multilingual searches of PubMed, Embase, China National Knowledge Infrastructure, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, and other databases from inception to January 2026. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Cochrane risk of bias 2 tool. Primary outcomes will consist of tumor-related outcomes (prostate-specific antigen levels and Response Evaluation Criteria in Solid Tumors-evaluated tumor response rates) and survival outcomes (overall survival and progression-free survival). Secondary outcomes will include clinical symptoms (International Prostate Symptom Score), pain scores (visual analog scale or numeric rating scale), quality of life, and treatment-related adverse events. Potential herb-drug interactions reported in primary trials will also be systematically assessed. Meta-analyses will be performed using random effects models in RevMan (version 5.4). In cases of substantial heterogeneity (I²≥50%), sensitivity and subgroup analyses will be conducted. The certainty of evidence will be assessed with the Grading of Recommendations Assessment, Development, and Evaluation approach.

The study selection process will be illustrated using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Where appropriate, pooled effect estimates will be presented using forest plots.

This review will provide comprehensive evidence on the role of TEAM-based adjunctive therapies in prostate cancer care across disease stages and will inform the development of integrative oncology guidelines.

PROSPERO CRD420251275137; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251275137.

PRR1-10.2196/94053.

Tubular aggregate myopathy (TAM) and Stormorken syndrome (STRMK) are clinically overlapping disorders characterized by muscle weakness, thrombocytopenia, spleen anomalies and short stature. They are due to mutations affecting the Ca2+ sensor STIM1 or the Ca2+ channel ORAI1 and leading to aberrant Ca2+ homeostasis. Therapeutic approaches aiming to rebalance intracellular Ca2+ levels largely rescued the multi-systemic phenotype in Stim1R304W/+ mice harboring the most common TAM/STRMK mutation. However, the currently used biomarkers to follow disease progression are costly and inadequate for longitudinal studies. Here, we investigated the suitability of MYOM3 to serve as a robust blood-based biomarker for TAM/STRMK. Using only minimal blood volumes, we detected highly elevated circulating MYOM3 levels in plasma samples from Stim1R304W/+ mice and TAM/STRMK patients with different mutations, and we found that the MYOM3 levels were normalized in Stim1R304W/+ mice undergoing efficient therapies. We also identified skeletal muscle as the primary source of circulating MYOM3, a structural protein of the contractile unit in myofibers, and uncovered that MYOM3 is primarily expressed in regenerating muscle fibers and in fast-twitch type IIa fibers. Overall, this work emphasizes the utility of MYOM3 as a minimally-invasive biomarker for disorders involving myofiber degeneration, and highlights the ability of MYOM3 to detect early muscle dysfunction in TAM/STRMK and evaluate therapeutic efficiency.

Radical cystectomy (RC) is the standard therapy for muscle-invasive bladder cancer (MIBC) and refractory high-risk non-muscle-invasive bladder cancer (1-3). Single-port robot-assisted radical cystectomy (RARC) offers notable minimally invasive advantages (4-6), whereas conventional transperitoneal approaches are associated with intestinal and gastrointestinal complications (7). This study evaluated an optimized extraperitoneal single-port RARC with orthotopic neobladder reconstruction for improved surgical safety and clinical outcomes.

A 57-year-old male presented with three months of intermittent painless gross hematuria. Pelvic CT revealed a bladder mass. Preoperative biopsy confirmed high-grade urothelial carcinoma with muscularis propria invasion, and the patient received gemcitabine-cisplatin neoadjuvant chemotherapy before radical surgery. Preoperative MRI identified a 3.2×2.9×2.6 cm bladder lesion without extravesical invasion or lymphadenopathy. During the procedure, the patient was placed in a supine position with buttocks elevated. A 5-cm infraumbilical single incision was made for da Vinci Xi-assisted extraperitoneal RARC, and a single-port multichannel device was deployed through the incision. Robotic instruments including a 30° endoscope, monopolar scissors, bipolar forceps, and a robotic stapler were arranged in a chopstick configuration. Via the extraperitoneal approach, we mobilized the bilateral ureters, bilateral vas deferens, and umbilical artery, dissected the bladder lateral ligaments with vascular ligation, and established a sufficient extraperitoneal working space. Bladder and prostate dissection was performed along the perivesical avascular plane, with careful protection and precise hemostasis of the dorsal venous complex. Standard pelvic lymphadenectomy was concurrently conducted during radical resection of the bladder and prostate (8). A segment of ileum was then harvested to construct an orthotopic neobladder (9), followed by anastomosis with the bilateral ureters and urethral stump.

Operative time was 400 minutes with 200 mL blood loss and no transfusion. No perioperative complications occurred, and the patient was discharged on postoperative day 6. Pathological diagnosis was pT2aN0M0 with negative surgical margins and negative lymph nodes. The 12-month follow-up showed no tumor recurrence, normal renal function, complete daytime continence, and mild nocturnal incontinence requiring one nightly pad.

Extraperitoneal single-port RARC with orthotopic neobladder reconstruction is a feasible minimally invasive procedure for MIBC. The optimized infraumbilical single-incision technique preserves peritoneal integrity and avoids intestinal mobilization, effectively reducing abdominal complications. It achieves reliable oncological results and improves patients' postoperative continence and quality of life.

Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting.

A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10).

In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.

Gastric cancer is a biologically heterogeneous disease with variable patterns of lymph node (LN) metastasis influenced by tumour biology and anatomical location. Contemporary Western data on LN dissemination remain limited.

This retrospective multicentre study evaluated data from patients with resectable gastric adenocarcinoma who underwent curative-intent gastrectomy at five high-volume European centres. LN retrieval and metastatic involvement were analysed according to tumour location, Lauren histotype, pathological (p) stage, neoadjuvant chemotherapy, and microsatellite status (microsatellite instability (MSI) or microsatellite stable (MSS)). Lymph node stations were analysed individually and grouped into three anatomical tiers based on proximity to the stomach, according to the Japanese Gastric Cancer Association classification.

In all, 950 patients were included in the study. The incidence of LN metastasis in diffuse and mixed histotypes was approximately twice that of intestinal-type tumours, along with higher metastatic rates across multiple perigastric first-tier and selected second-tier stations (P < 0.050 to P < 0.001). The anatomical pattern of lymphatic spread was site-specific, with consistent drainage pathways across tumour locations. In early gastric cancer, LN metastases were rare and largely confined to stations 3 and 4. Neoadjuvant chemotherapy reduced overall nodal burden without altering the anatomical distribution of metastatic stations. MSI tumours exhibited lower nodal involvement than MSS tumours, with higher rates of node-negative disease (49.3% versus 41.3%) and fewer patients with pN3 tumours (15.9% versus 27.7%; P = 0.044).

Tumour location influenced the anatomical pattern of LN spread, whereas histological and molecular features were associated with differences in metastatic risk and extent. The integration of biological and anatomical factors may support more tailored surgical strategies.

The successful design and implementation of artificial intelligence (AI)-driven solutions in health care requires early and continuous multidisciplinary and multiprofessional collaboration. However, diverse disciplinary educational backgrounds, varying languages, and cultural or geographic differences can lead to misunderstandings. To bridge this gap, a structured approach to AI requirements specification can facilitate a shared terminology and a deep mutual understanding among stakeholders, serving both as a guide for technological development and as a means of defining clear pathways for clinical implementation. While technical requirements are well-established in traditional technology development domains, this structured approach remains relatively underused within clinical and social science contexts. Consequently, valuable insights derived from participatory and stakeholder-driven approaches are often overlooked, limiting the relevance and trustworthiness of AI systems in health care settings.

This study presents a methodology for requirements gathering, specification, mapping, and verification, specifically engineered for the complex, multistakeholder environment of clinically applied AI. The methodology was implemented within the specific case of an international multidisciplinary project evaluating an AI-based prediction tool for neoadjuvant chemotherapy treatment response for breast cancer and forming a part of the developed AI validation framework.

The process for AI requirements gathering, specification, and monitoring included 3 iterative rounds of discussion, engaging nearly 150 social, clinical, technical, ethical, and regulatory experts and patients across Europe, South America, North Africa, and Eurasia. It combines established requirements engineering methods (including the MoSCoW [Must have, Should have, Could have, Will not have] framework) with social innovation techniques to ensure inclusivity and contextual relevance.

A key finding is the successful development of a structured framework integrating participatory social innovation with formal requirements engineering in an international AI health care setting, through a traceable multisource workflow including clinical, ethical, and regulatory aspects. It is supplemented with an extensive list of 184 actionable consensus-based requirements, categorized by stakeholder group, providing valuable insights for AI researchers in the oncology field with the potential to be transferable to other digital health domains. The requirements align with the fairness, universality, traceability, usability, robustness, and explainability in the AI (FUTURE-AI) framework, ensuring the tool is trustworthy and comprehensive from a multistakeholder perspective, and ensuring comprehensive consideration of all elements of FUTURE-AI.

The proposed methodology represents a significant advancement for requirements engineering in digital health by extending traditional technical processes to systematically incorporate nontechnical requirements from diverse global stakeholders. This unified approach is essential for ensuring AI solutions are not only technically robust but also clinically relevant, legally compliant, and socially acceptable.

Computer-aided diagnostic systems such as S-Detect (Samsung Medison) are increasingly integrated into breast ultrasound workflows. Notwithstanding extensive past evaluation of S-Detect's diagnostic accuracy, its intrasystem repeatability at the software level with identical static images, a fundamental prerequisite for clinical reliability, has not been systematically investigated.

This study aimed to evaluate the intrasystem repeatability of the S-Detect computer-aided diagnostic system in classifying breast nodules in identical static ultrasound images.

This retrospective, registered, blinded repeatability study analyzed 398 breast nodules from 261 women (mean age 43.10, SD 12.57 years) who underwent surgery between February 2019 and March 2020 at a single institution. Identical stored static ultrasound images, acquired by a single experienced sonographer on 1 Samsung RS80A ultrasound system, were each analyzed twice using the same S-Detect workstation: immediately after acquisition (S-Detect 1) and again at least 4 weeks later under blinded conditions with manual cursor repositioning (S-Detect 2). Repeatability was assessed using concordance rate and Cohen κ. The diagnostic performance of each run was compared against surgical histopathology.

Of 398 nodules, 156 (39.2%) were initially classified as possibly benign, and 242 (60.8%) were initially classified as possibly malignant. On repeat analysis, 37.4% (149/398) and 62.6% (249/398) of the nodules were classified as possibly benign and malignant, respectively. A total of 4.5% (7/156) of the nodules initially classified as benign were reclassified as malignant, whereas no malignant-to-benign changes occurred. The overall concordance rate was 98.2% (391/398), with a Cohen κ of 0.95 (95% CI 0.94-0.99; P<.001). Diagnostic performance remained stable across runs (area under the curve=0.913 vs 0.902; P=0.702).

Under controlled conditions with identical static images, S-Detect showed high intrasystem repeatability, underscoring strong software-level consistency, although its translation to real-world clinical reproducibility requires further validation.