Tata Medical Center

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.

Myelodysplastic syndromes (MDS) are clonal stem cell disorders managed by risk stratification: lower-risk disease receives erythropoiesis-stimulating agents; higher-risk disease receives azacitidine. Red blood cell (RBC) transfusions manage symptomatic anaemia and improve quality of life (QoL) but carry risks of iron overload and alloimmunisation. No standardised transfusion strategy exists, requiring systematic evidence synthesis comparing liberal versus restrictive haemoglobin (Hb) thresholds for their effects on quality of life and transfusion-related complications. We performed a systematic review evaluating liberal versus restrictive RBC transfusion thresholds in adults with MDS not undergoing curative treatment such as stem cell transplantation. Primary outcome was health-related QoL measured by validated instruments. Secondary outcomes included mortality, transfusion reaction, iron overload, RBC utilisation and rise in ferritin level. Of 4,295 records screened, 212 articles underwent full-text review, with three RCTs meeting inclusion criteria. Liberal transfusion strategies were associated with improved QoL compared to restrictive approaches, with pooled standardised mean difference (Hedges g) of 0.54 (95% CI 0.06–1.02; p = 0.33; I²=9.7%). Subgroup analysis of EQ‑5D outcomes across studies revealed minimal but statistically significant difference between strategies (pooled mean difference 0.084; 95% CI: 0.033 to 0.134). Mortality (hazard ratio 0.913; 95% CI 0.167–4.98) and transfusion reactions (risk difference − 0.01; 95% CI-0.10 to 0.09) did not differ. Notably, liberal thresholds required average of 4 additional RBC units per patient (95% CI 1.43–6.79), raising concerns about iron overload (rise in ferritin; mean difference 868 µg/L; 95% CI 482–1255). Limited evidence suggests that liberal transfusion strategies in MDS may improve short-term QoL but at the cost of increased transfusion burden, with no clear impact on survival or safety. A patient-centred, multidisciplinary approach remains essential when tailoring transfusion thresholds.The study protocol has been registered in PROSPERO (CRD420251085221). https://www.crd.york.ac.uk/PROSPERO/view/CRD420251085221.Supplementary informationThe online version contains supplementary material available at 10.1007/s00277-026-06789-5.

Publikasi Digital governance telah banyak dilakukan secara implementatif, tetapi masih minim penelitian yang menyajikan pemetaan sistematis, tren penelitian, dan hubungan antar-topik melalui pendekatan bibliometrik untuk memahami perkembangan ilmiah di bidang ini. Tujuan penelitian ini adalah untuk menganalisis tren penelitian “digital governance”. Metode penelitian adalah analisis bibliometrik dengan pendekatan kuantitatif deskriptif. Sumber database akademik adalah dari Scopus, dan jumlah artikel yang digunakan dalam penelitian ini sejumlah 247 dokumen. Hasil penelitian menunjukkan bahwa tren penelitian mengalami peningkatan jumlah publikasi selama periode tahun 2020 s.d. 2024, dengan publikasi terbanyak pada tahun 2024, yaitu sejumlah 117 artikel. Apabila dilihat dari visualisasi co-authorship, maka penulis terbanyak yang mempublikasikan digital governance berasal dari negara China, sedangkan penulis dari negara Indonesia masih minim memberikan kontribusi penelitian. Secara occurrence, terdapat pergeseran topik penelitian dari tata kelola digital ke arah isu-isu baru yang mengaitkan digital governance dengan pengelolaan sumber daya dan ekonomi publik. Kesimpulannya, tren penelitian “digital governance” memberikan peluang penelitian masa depan untuk mengeksplorasi hubungan antara tata kelola digital dan isu-isu multidisipliner yang mulai muncul, seperti pengelolaan sumber daya, keberlanjutan, serta dinamika ekonomi digital yang terus berkembang. Penelitian ini berkontribusi sebagai dasar konseptual dan empiris bagi pengembangan studi dan kebijakan tata kelola digital di masa depan. Kata Kunci: Digital governance, Analisis Bibliometrik, Digitalisasi Pelayanan Publik.

BackgroundNodal metastasis in oral cavity squamous cell carcinoma (OCSCC) is associated with poorer prognosis. Limited evidence is available on the predictive factors and prognostic significance of level IV nodal metastasis. This study evaluated patient outcomes by analyzing disease-free survival (DFS) and overall survival (OS) in individuals with level IV nodal involvement.MethodsThe cohort for this retrospective study comprised all patients with node-positive OCSCC who underwent surgery between August 2011 and June 2021. The patients’ demographic and treatment details were abstracted from the electronic medical records. DFS and OS were analyzed using a log-rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis.ResultsAmong the cohort of 578 node-positive patients, 27.2% exhibited level IV nodal metastasis. The two-year DFS and OS rates in the level IV nodal metastasis group were 55% and 72.2%, respectively. Patients with level IV involvement had a median age of 53 years (range: 21-85 years), were predominantly male (69.2%), and had a median follow-up of 30.1 months (range: 1-131.9 months). A significantly higher prevalence of level IV nodal metastasis was associated with pathological tumor stage 4b (pT4b) (45.3% vs. 11.7%, p < 0.01), pathological nodal stage 3b (pN3b) (30.6% vs. 29.0%, p = 0.01), larger maximum tumor size (Tmax) (3.36 cm vs. 3.42 cm, p < 0.01), and greater depth of invasion (DoI) (1.44 cm vs. 1.63 cm, p < 0.01).In univariate analysis, DFS was significantly associated with the primary site, Tmax, DoI, involved margins, lymphovascular invasion (LVI), perineural invasion (PNI), masticator space involvement, extranodal extension (ENE), and level IV nodal metastasis, in addition to pathological tumor stage (pT), pathological nodal status (pN), and overall stage. In multivariate analysis, the primary site, Tmax, involved margins, LVI, and PNI remained independently associated with DFS. For OS, univariate analysis identified the primary site, Tmax, DoI, involved margins, LVI, PNI, bone involvement, and ENE, as well as pT, pN, and overall stage, as significant predictors. Following multivariate adjustment, the primary site, Tmax, involved margins, and PNI emerged as independent predictors of OS.ConclusionThe two-year DFS and OS rates for 578 patients with node-positive OCSCC were 55% and 72.2%, respectively. Among these patients, 157 (27.2%) exhibited level IV nodal metastasis, with skip metastasis to level IV observed in only 3.2% of cases. Patients with pT4b disease, pN3b disease, larger Tmax, and greater DoI were significantly more likely to have level IV metastasis. In univariate analysis, level IV metastasis was significantly associated with worse DFS. Additionally, primary tongue tumors, larger tumor size, involved surgical margins, and the presence of LVI or PNI were predictive of poorer DFS. For OS, significant predictors included primary tongue origin, larger tumor size, positive margins, and PNI.