Inje University Haeundae Paik Hospital

Objectives To define the clinical and biological features specific to male SLE and to evaluate its prognostic implications.Methods A retrospective analytical cohort study within the Department of Internal Medicine at Ibn Sina University Hospital, Rabat, over a 13-year period.All male patients aged over 15 years who fulfilled the 2019 ACR/EULAR classification criteria for systemic lupus erythematosus were included in the study.Results A total of 297 patients was included, which 74 (25%) were male.No significant difference was found in age at diagnosis between male and female patients.Male sex was associated with the presence of malar rash (OR = 1.83, 95% CI: 1.09-3.08,p = 0.022), articular involvement (OR = 6.49, 95% CI 2.47-17.01,p < .001),lymphopenia (OR = 1.74, 95% CI: 1.03-2.94,p = 0.036), and anti-dsDNA antibodies (OR = 7.18, 95% CI: 3.62-14.24,p < .001),whereas anti-SSA (OR = 0.30, 95% CI: 0.10-0.86,p = .026)and anti-RNP antibodies (OR = 0.32, 95% CI 0.12-0.85,p = .021)were less frequent.Alopecia was less frequent among male patients (OR = 0.28, 95% CI 0.14-0.55,p < .001).Male sex was an independent risk factor of lupus nephritis (OR = 5.15, 95% CI: 1.58-16.86,p = 0.007) and was associated with a significant decrease in creatinine clearance (MDRD) by 30.4 mL/min (p < .001).Conversely, male sex was protective against neurological involvement (OR = 0.42, 95% CI: 0.23-0.76,p = 0.004), particularly central nervous system involvement (OR = 0.26, 95% CI: 0.09-0.75,p = 0.013).In multivariate analysis, male sex was an independent predictive factor for lupus disease remission (OR = 3.46, 95% CI: 1.82-6.57,p < .001)and was associated with a reduced number of disease relapses (p = 0.045).No significant gender difference was observed in ICU admission or SLE-related mortality.Conclusions This study confirms the association of male sex with greater severity of lupus nephritis and immunologic abnormalities.Male sex was inversely correlated with neurological involvement, and disease relapse.A better understanding of the distinct features of male SLE patients could inform more personalized approaches to monitor and manage the disease in this patients subgroup.

To provide up-to-date consensus recommendations on the acquisition, interpretation and reporting of MRI for the primary staging of rectal cancer. A panel of twenty-six abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) engaged in an online consensus process, led by three non-voting chairs. The process adhered to an adapted version of the RAND-UCLA appropriateness method. A total of 126 items were scored (22 general, 55 on primary staging, 49 on restaging after neoadjuvant treatment) and classified using ≥ 80% as the cut-off to establish consensus. Consensus was reached for 121 items (96%). The current manuscript addresses the resulting general recommendations and those focused on baseline staging. Key updates compared to the previous guideline editions include more detailed recommendations for image acquisition, adoption of the sigmoid take-off as a landmark to discern rectal from sigmoid cancer, updated definition of mesorectal fascia involvement by a distance of ≤ 1 mm, including involvement by irregular nodes and extramural vascular invasion; a transition to a patient-level approach for cN-category assessment with updated criteria for lateral nodes including a ≥ 7 mm size threshold, and recommendations on the limited use of DWI for primary staging. These updated expert consensus recommendations serve as clinical guidelines for the primary staging of rectal cancer using MRI. Recommendations for restaging and response evaluation after neoadjuvant treatment are addressed in a separate publication. Question Since the last ESGAR rectal imaging guideline update, the rectal cancer treatment landscape has further evolved, necessitating updates to the existing guidelines. Findings An online consensus process involving 26 panellists led to 96% consensus across 121 items discussed, including 22 general items and 55 related to primary staging. Clinical relevance Key updates related to primary staging include more detailed recommendations for image acquisition, adoption of the sigmoid take-off, refined criteria for MRF involvement, a new patient-level approach for cN-assessment, and recommendations on the limited use of DWI.

Survival outcomes for infants born at 22–23 weeks’ gestation vary widely across neonatal units. This national, prospective cohort study evaluated 919 infants born at 22–23 weeks’ gestation in South Korea between 2013 and 2022, using Korean Neonatal Network data. Infants were categorized based on the level of neonatal care: 785 in lower-level centers (Group A) and 134 in higher-level centers (Group B). Survival was significantly higher in Group B (64.9%) compared to Group A (29.3%) (P < 0.0001). Early deaths occurred more frequently and earlier in Group A. Proactive care—including antenatal corticosteroids, antenatal antibiotics, and immediate surfactant administration—was more common in Group B. Antenatal corticosteroid was significantly associated with reduced risk of death (hazard ratio 0.58; 95% confidence interval, 0.49–0.69; P < 0.0001). The timing of rapid decline in survival was delayed in higher-level centers. In addition, classifying institutions into higher- and lower-level groups according to the survival of infants born at 22–23 weeks’ gestation (≥50% vs. <50%) provides a good reflection of the quality of neonatal care. These findings highlight the importance of proactive care and timely in utero transfer to higher-level units in improving survival for peri-viable infants.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-28428-1.

Chronic spontaneous urticaria (CSU) is associated with a substantial disease burden due to its prolonged course and significant impairment of quality of life. The diagnostic process for CSU involves confirming the diagnosis itself and identifying disease phenotypes or endotypes, cofactors, and comorbid conditions, which may affect disease activity and severity. Immunoglobulin E (IgE) and non-IgE-mediated mast cell degranulation are the major pathogenic mechanisms of CSU, where FcεRIα, a high-affinity IgE receptor, is the critical therapeutic target. Although the first-line treatment for CSU is typically second-generation H1-antihistamines, anti-IgE antibodies are recommended for patients who are refractory to up-dosed antihistamines. However, some patients with autoimmune phenotypes show incomplete responses. Recently, dupilumab, an anti-interleukin (IL)-4/IL-13 receptor antibody that inhibits type 2 inflammation, was approved by the US Food and Drug Administration. Patients with autoimmune phenotypes treated with Bruton's tyrosine kinase inhibitors have shown promising efficacy. Additionally, emerging biological agents, such as anti-KIT antibodies targeting mast cell activation and survival, and novel anti-IgE therapies (e.g., YH35324), are currently under investigation and are anticipated to become potential therapeutic options. This review provides an update on the pathogenic mechanisms of CSU, including IgE- and non-IgE-mediated mechanisms, and suggests potential therapeutic targets for improving clinical remission rates.

BackgroundPlasma phosphorylated tau (p‐tau) 217 has shown strong performance in detecting β‐amyloid (Aβ) positivity on positron emission tomography (PET). However, kidney dysfunction, body mass index (BMI), and anemia are known to affect p‐tau217 levels. How the optimal cutoffs for p‐tau217 vary in relation to these factors has not been thoroughly explored.MethodIn this multi‐center cross‐sectional study (2016–2023), 2,571 individuals with unimpaired cognition, mild cognitive impairment, or Alzheimer's‐type dementia underwent Aβ PET imaging, plasma p‐tau217 measurement (Alzpath Simoa immunoassay), and assessment for estimated glomerular filtration rate (eGFR), BMI, and anemia. Participants were categorized by eGFR (>60, 45–60, and <45 mL/min/1.73 m^2), BMI (underweight, normal weight, obesity, and super‐obesity), and anemia (anemia vs. non‐anemia). We identified optimal p‐tau217 cutoffs for detecting Aβ positivity (PET centiloid ≥25.5) and evaluated accuracy, sensitivity, and specificity in each subgroup.ResultOptimal p‐tau217 cutoffs were elevated in those with kidney dysfunction, underweight or obesity, and anemia compared to the reference groups. Specifically, optimal cutoffs for Aβ positivity were higher among individuals with eGFR <60 (0.635 for eGFR 45–60; 0.935 for eGFR <45) than among those with eGFR >60 (0.425). When the reference cutoff (0.425) was applied in the eGFR <45 group, diagnostic accuracy dropped to 48.3%. Underweight and anemia groups also showed increased optimal cutoffs (0.620 and 0.595) relative to the reference group (0.425), though using the reference cutoff slightly lowered specificity in these groups.ConclusionThese findings emphasize the importance of tailoring plasma p‐tau217 cutoffs based on kidney function, BMI, and anemia status to enhance diagnostic accuracy, especially in populations with more severe kidney dysfunction (eGFR <45).

BackgroundHuman papillomavirus (HPV) independent cervical malignancies (HPV-IDCMs) have recently been classified by the World Health Organization (WHO) 5th edition. These malignancies have historically received limited attention due to their rarity and the potential for evasion of HPV-based screening.MethodsWe retrospectively reviewed 5,854 biopsy-confirmed cervical malignancies from 22 institutions over 3 years (July 2020–June 2023). Histologic classification followed the WHO guidelines. HPV independence was confirmed by dual negativity for p16 and HPV; discordant cases (p16-positive/HPV-negative) underwent additional HPV testing using paraffin-embedded tissue. Cytological results were matched sequentially to histological confirmation.ResultsThe prevalence of HPV-IDCM was 4.4% (257/5,854) overall and was 3.6% (208/5,805 cases) among primary cervical malignancy. Patient age of HPV-IDCM was 29 to 89 years (median, 57.79). Its histologic subtypes included primary adenocarcinoma (n = 116), endometrial adenocarcinoma (n = 35), squamous cell carcinoma (n = 72), metastatic carcinoma (n = 14), carcinoma, not otherwise specified (n = 10), neuroendocrine carcinoma (n = 3), and others (n = 7). Among 155 cytology-histological matched cases, the overall and primary Pap test detection rates were 85.2% (132/155) and 83.2% (104/125), respectively. The interval between cytology and histologic confirmation extended up to 38 months.ConclusionsHPV-IDCMs comprised 3.6% of primary cervical malignancies with a high detection rate via cytology (83.2%). These findings affirm the value of cytological screening, particularly in patients with limited screening history or at risk for HPV-independent lesions, and may guide future screening protocols.

Objective Systemic lupus erythematosus (SLE) is associated with increased cancer risk. However, the patterns of cancer incidence remain unclear. This study aimed to evaluate the cancer risk in patients with SLE. Method This population-based cohort study identified 24 241 patients with newly diagnosed SLE between 2004 and 2020 using Korean National Health Insurance Service data. Patients were followed up until cancer diagnosis, death, or December 2021. Standardized incidence ratios (SIRs) were calculated to compare cancer risk between patients with SLE and the general population. Subgroup analyses were performed based on the age at diagnosis, follow-up duration, and use of immunosuppressive agents. Results Patients with SLE had higher risks of overall [SIR 3.3, 95% confidence interval (CI) 3.2–3.4], solid (SIR 3.1, 95% CI 3.0–3.2), and haematological (SIR 9.8, 95% CI 8.9–10.9) cancers compared with the general population. Among solid cancers, liver cancer had the highest risk, followed by ovarian cancer. The relative cancer risk peaked among patients aged 20–39 years (SIR 4.9, 95% CI 4.6–5.2) and during the first year after diagnosis (SIR 4.7, 95% CI 4.3–5.1). The SIRs for haematological, cervical, and lung cancers in cyclophosphamide-treated patients were higher than those for the corresponding cancers in the overall SLE population. Conclusion Patients with SLE have increased cancer risk compared with the general population. Increased relative cancer risk is associated with younger age, first year post-diagnosis, and cyclophosphamide treatment.