To critically and constructively explore the future of mental health nursing in Flanders (Belgium) by examining the historical evolution, current challenges, and potential strategies for clinical excellence and advancement. This study used a historically informed and contextualised grounded analyses to envision future perspectives that support strategically targeted perspectives in compact regions such as Flanders (Belgium). A synthesis of published literature, policy documents, academic sources, and Flemish nursing research was conducted to identify key directions. By addressing local challenges, particularly related to education and labor market scarcity, this paper proposes three key directions for progress: 'Back to good basics', 'Reclaiming the driver's seat of clinical advancement' and 'Revitalizing clinical excellence from within clinical nursing practice'. These interlinked perspectives provide a framework for revitalising mental health nursing in Flanders, supporting clinical excellence and development while responding to the most pressing contemporary challenges. Although rooted in a compact regional context, the insights and proposed directions may inspire similar reflections and initiatives in international mental health nursing contexts.

Background and Objectives: Because of its consistently high stone-free rates (SFRs), percutaneous nephrolithotomy (PCNL) continues to be the first-line treatment for renal stones larger than 20 mm. Standard 24 to 30 Fr access tracts, however, are linked to access-related morbidity, such as bleeding, pain, and extended hospital stays. These restrictions have led to progressive tract miniaturization and the development of mini-PCNL, ultra-mini PCNL, and micro-PCN techniques. Materials and Methods: We performed a narrative review of studies published through January 2026 using PubMed and Google Scholar. Search terms included percutaneous nephrolithotomy, mini-PCNL, ultra-mini PCNL, micro-PCNL, and vacuum-assisted PCNL. Original studies, systematic reviews, and meta-analyses reporting clinical outcomes, complications, and advancements were selected, whereas conference abstracts, non-English papers, and articles without accessible full text were excluded. Results: Across randomized trials, miniaturized PCNL generally preserves efficacy when patients are selected appropriately. Across randomized trials and meta-analyses, miniaturized PCNL achieved stone-free rates comparable to standard PCNL (typically ~80–90% for stones ≤20 mm and similar rates in selected stones >2 cm), while demonstrating lower hemoglobin decrease (mean difference approximately −0.6 to −1.0 g/dL), reduced transfusion rates, and shorter hospital stays, at the cost of longer operative time (mean difference ~8–12 min). On the other hand, operative time may increase, and smaller working channels can make visualization and fragment evacuation more demanding as stone burden rises. Raised intrarenal pressure is a recurring safety issue because it may increase infectious risk unless drainage is actively managed. Recent innovations aim to address these limitations, including vacuum-assisted access sheaths, pressure-controlled irrigation, improved laser and lithotripsy platforms, image-fusion guidance, navigation systems, and robotic assistance. Conclusions: PCNL now spans a spectrum of tract sizes rather than a single standard approach. When chosen appropriately and performed with attention to pressure control and fragment evacuation, miniaturized PCNL can reduce morbidity without sacrificing stone clearance. Future advancements in percutaneous stone surgery are more likely to rely on integrated technological solutions that improve accuracy, safety, and repeatability than on additional tract size reduction.

Overcoming resistance in oncolytic virotherapy: Nano-engineered solutions for systemic delivery and efficacy boost.

Epileptic activity in Alzheimer's disease: emerging insights and therapeutic implications.

Personality and Perception: A Qualitative Investigation of Factors That Shape Mentorship Satisfaction Among Hand Surgery Fellows.

Analgesic effect of cinobufagin is mediated by human-selective P2X7R antagonism governed by distinct extracellular domains.

Metabolic and immune dysfunction at the crossroads between type 1 diabetes and neurodegeneration.

The 2023 CONVINCE trial demonstrated improved survival with high-dose hemodiafiltration (HDF), prompting discussions about widespread adoption. However, this clinical advancement occurs amid growing awareness of healthcare's environmental impact, particularly dialysis treatments that consume extensive water and energy resources. This review examines the environmental implications of HDF adoption, synthesizing recent evidence on resource consumption and emerging sustainability solutions in the context of the climate crisis facing nephrology. Life cycle assessments indicate HDF has a carbon footprint 30-40% higher than conventional hemodialysis, consuming an additional 10 300 L of water per patient annually. However, recent technological innovations show promise: expanded hemodialysis (HDx) using medium cut-off membranes reduces water usage by >20% and energy consumption by >30% compared to HDF while potentially achieving similar clinical outcomes. Water conservation technologies, including reverse osmosis, reject water reuse and reduced dialysate flow protocols, can decrease environmental impact by 30-50% without any difference in patient outcomes. The adoption of HDF represents a critical test case for sustainable healthcare innovation. While the potential benefits should not be ignored, technology is not static and, if confirmed, additional sustainability work and comprehensive policy frameworks integrating environmental impact assessments into technology evaluation are urgently needed. The nephrology community must balance clinical excellence with planetary stewardship through technological innovation, resource optimization, and evidence-based environmental guidelines that benefit, not compromise, patient care.

Radiopharmaceutical therapy (RPT) has emerged as a transformative modality in oncology, particularly for patients with metastatic or inoperable tumors. By leveraging molecularly targeted carriers conjugated to cytotoxic radionuclides, RPT enables precise delivery of ionizing radiation to tumor sites while minimizing off-target effects. Central to this approach are alpha (α) and beta (β) particle-emitting radionuclides. This review aims to provide a comprehensive overview of all clinically relevant alpha and beta emitters and incorporates the most recent advances from 2017–2025, offering a comprehensive and up-to-date perspective. Alpha and beta emitters hold significant promises for the future, especially in nuclear medicine, energy, and environmental monitoring. Medically, these emitters are at the forefront of targeted radiotherapy, offering new hope for cancer treatment. Alpha emitters such as Actinium-225 and Radium-223 are gaining attention for their high linear energy transfer, which allows them to effectively kill cancer cells while minimizing damage to surrounding healthy tissues. Beta emitters, including Lutetium-177 and Iodine-131, are already widely used for treating thyroid cancer, neuroendocrine tumors, and prostate cancer. They offer a longer range in tissue penetration than alpha particles, making them suitable for larger or more diffuse tumors. Alpha and beta emitters hold tremendous promise in targeted radiotherapy. However, current research is limited by an incomplete understanding of resistance pathways, insufficient long-term safety and efficacy data, and underdeveloped personalized treatment frameworks. As production technologies improve and safety protocols advance, these emitters will likely play an even more prominent role in both health care and scientific innovation.

Low back pain (LBP) remains a leading cause of disability worldwide, imposing substantial socioeconomic burdens. Among its many causes, facetogenic pain accounts for a significant proportion of cases and is generally attributed to irritation of the richly innervated facet joint capsule, mediated by the medial branches of the dorsal rami. This narrative, hypothesis-driven review synthesises the current anatomical, biomechanical, neurophysiological, and clinical literature and advances a conceptual framework proposing a novel anatomical mechanism that may contribute to LBP. We hypothesise that ossification of the mamillo-accessory ligament (MAL) may be a plausible but under-recognised anatomical variant that may influence lumbar biomechanics and neural interfaces. The MAL connects the mammillary and accessory processes of lumbar vertebrae, serving as a stabilising anchor for deep paraspinal muscles and forming a conduit for the medial branch of the dorsal ramus (MBDR). Ossification of the MAL, resulting in a mamillo-accessory foramen, may theoretically impair spinal biomechanics via three principal mechanistic domains: (1) disruption of muscle attachment and segmental stabilisation, (2) potential compression of the MBDR causing denervation and muscle atrophy, and (3) chronic nerve entrapment leading to asymmetrical postural adaptations and persistent pain. Collectively, these pathways may contribute to spinal instability, facet degeneration, and variable response to standard interventional treatments such as radiofrequency ablation. Recognition of MAL ossification may have potential implications for clinical assessment, targeted imaging strategies, and treatment stratification in patients with chronic, non-specific LBP.

Flavones, or 2-phenylchromones, are a group of oxygenated heterocyclic compounds belonging to the family of flavonoids. Studying these secondary metabolites has regained interest due to their diverse pharmacological potential, including antioxidant, anticancer, antimicrobial, and anti-inflammatory activities. Some secondary metabolites, such as flavopiridol and riviciclib, have progressed to clinical trials as cyclin-dependent kinase (CDK) inhibitors. This review summarizes recent advances in the study of natural and synthetic flavones, with particular emphasis on their mechanisms of action and structure-activity relationships (SAR). Studies show that flavones have multiple functions, including regulation of oxidative stress, apoptosis, cell cycle arrest, microbial growth, and inflammation. Notably, the chemical modification of the flavone scaffold, particularly phenyl and chromone ring substitutions, affects the potency, selectivity, and therapeutic value and can therefore inform the rational design of drugs. The clinical advancement of flavopiridol and riviciclib demonstrates the potential for translating flavone-based compounds into targeted CDK inhibitors. In this respect, we can consider flavones as a bioactive class of compounds with considerable potential for the development of new drugs. We expect more detailed mechanistic studies with SAR correlation to enable the production of new flavone compounds to broaden the use of these compounds to treat cancer, inflammation, and infectious diseases.

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022 (Ozaki et al. in Cardiovasc Interv Ther 33:178-203, 2018), (Ozaki et al. in Cardiovasc Interv Ther 37:1-34, 2022). Following the publication of the 2023 European Society of Cardiology (ESC) Guidelines for the management of acute coronary syndromes, the CVIT Task Force released another revised version in 2024 (Ozaki et al. in Cardiovasc Interv Ther 39:335-375, 2024). In light of new clinical evidence and technological advances that have emerged since then, the Task Force now proposes an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2026 version.

European training requirements in geriatric medicine 2025: driving competency-based education and harmonisation across Europe.

Abstract In triple-negative breast cancer (TNBC), pembrolizumab combined with chemotherapy has become a standard of care in both neoadjuvant and adjuvant settings, as established by the KEYNOTE-522 trial. Despite these clinical advances, immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs) that can affect multiple organ systems and result in substantial morbidity. In other cancer types, older patients have been shown to experience higher rates of irAEs, potentially due to age-related immune dysregulation and a higher burden of comorbidities, while younger patients often face distinct survivorship challenges. However, real-world data on age-specific irAE patterns and outcomes in TNBC patients receiving pembrolizumab are lacking. To date, no studies have specifically evaluated the differential impact of pembrolizumab-based therapy on irAE incidence, severity, and outcomes across age groups in TNBC populations. This is a retrospective cohort study using TriNetX, TNBC patients treated with pembrolizumab between 2016 and 2024. Two age-stratified cohorts were created: younger (≤54 years) and older (≥55 years) of 1,661 patients per group after propensity score match. irAEs covering endocrine, hepatic, pulmonary, hematologic, and gastrointestinal toxicities were identified. Corticosteroid therapy and hospitalization were assessed as markers of toxicity severity. Kaplan-Meier survival curves were used. Older patients had a higher incidence of irAEs at 1 month (OR 1.43, 95% CI 1.01-2.04, p=0.048) and 3 months (OR1.43, 95% CI 1.11-1.79, p=0.0049), mainly due to thyroiditis (OR 1.67, 95% CI 1.08-2.13 p=0.017). Differences in irAE rates were no longer significant at 6 or 12 months. Despite lower irAE rates, younger patients had higher dexamethasone use at 3 months (OR 1.64, 95% CI 1.1-2.3, p=0.0047) and significantly worse survival (log-rank p=0.0071; HR 1.4, 95% CI 1.1-1.9). A composite marker of corticosteroid use and hospitalization showed younger patients consistently experienced more severe toxicities and poorer survival at all timepoints. At 1 month: OR 1.45, 95% CI 1.03-2.17, p=0.03; HR 1.3, 95% CI 1.01-1.9, log-rank p=0.04. At 3 months: OR 1.57, 95% CI 1.13-2.1, p=0.0087; HR 1.4, 95% CI 1.08-1.88, log-rank p=0.0105. At 6 months: OR 1.38, 95% CI 1.0-1.9, p=0.048; HR 1.3, 95% CI 1.03-1.69, log-rank p=0.027. At 12 months: OR 1.57, 95% CI 1.13-2.1, p=0.0063; median survival 171 days for younger vs. not reached in older group (log-rank p=0.0023; HR 1.49, 95% CI 1.1-1.8). At 3 months, total corticosteroid use and hospitalization remained higher in younger patients (OR 1.4, 95% CI 1.02-2.1, p=0.0359; HR 1.36, 95% CI 1.01-1.83; log-rank p=0.046). At 12 months, younger patients still had lower median survival (212 days vs. not reached; log-rank p=0.11; HR 1.2, 95% CI 0.95-1.59). While all-cause mortality was higher in older patients (p<0.0001), hospice referrals were similar between groups. In this real-world cohort of TNBC patients treated with pembrolizumab, older patients experienced a higher incidence of early irAEs—particularly thyroiditis—but demonstrated superior survival. In contrast, younger patients had fewer documented irAEs but showed greater corticosteroid use, more frequent hospitalizations, and significantly worse survival across all timepoints when toxicity severity was considered. These findings suggest that irAE incidence alone may not fully capture clinical burden or risk and that age-related differences in immune response, toxicity manifestation, and management practices may contribute to divergent outcomes. Further investigation is warranted to elucidate the immunologic mechanisms of aging in the context of ICI use and safety to guide toxicity monitoring and supportive care strategies. Citation Format: G. Gorecki, O. Abioye, K. Babu, R. Srinishant, N. Gupta, C. Hilton. Real-world immune toxicity and survival outcomes by age in triple-negative breast cancer patients receiving pembrolizumab [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-01-29.

Professional title promotion is a critical pathway for clinical nurses' career development in China, yet nursing managers observe substantial heterogeneity in nurses' self-management behaviors during the promotion process. Clarifying how managers perceive these differences is important for designing targeted strategies to support clinical nurses' professional title promotion. A purposive sampling method was employed to select 15 frontline clinical nursing managers for semi-structured interviews regarding their observations and perceptions of staff nurses' self-management in professional title promotion. Data were analyzed using Colaizzi's seven-step method for qualitative analysis. Based on Benner's theoretical framework and interview content, key self-management characteristics of clinical nurses in professional title promotion were extracted, and a profile model was constructed. Visualization was achieved through word clouds and tables. Five core characteristics were identified in nursing managers' descriptions of clinical nurses' self-management: personal traits, career awareness, educational background, professional experience, and sociocultural influences. Four perceived self-management profiles of clinical nurses were categorized: aggressive, potential-mining, stable-conservative, and laissez-faire. Based on interviews with 15 nursing managers from three tertiary hospitals in Jiangsu Province, we identified four perceived self-management profiles of clinical nurses in professional title promotion across five key dimensions. These findings, which reflect nursing managers' observations rather than clinical nurses' self-reported experiences, suggest that tailoring managerial support and development interventions to these perceived profiles may help support clinical nurses' career advancement in similar hospital contexts; however, further research is needed to examine the transferability of these profiles to other regions and to nurses' own accounts. Given the hierarchical nature of hospital nursing, these manager-derived personas may also reflect organizational expectations and power dynamics; future studies should triangulate managers' views with nurses' own accounts and other data sources. Not applicable.

Sepsis is a life-threatening organ dysfunction syndrome with high mortality. Due to the heterogeneity of its clinical manifestations and treatment responses, it has long faced great challenges in clinical management. In recent years, the progress of molecular biology and omics technology has promoted the application of precision medical strategies based on molecular endotypes in sepsis research, which has opened up a new way for individualized treatment. Glucocorticoids are commonly used drugs in sepsis treatment, but their efficacy and safety vary significantly among patients with different molecular endotypes. The traditional one-size-fits-all therapy has been difficult to meet the complex clinical needs. This review systematically summarizes molecular endotype classifications in sepsis. It explores glucocorticoid mechanisms across different endotypes and summarizes recent clinical and preclinical advances. The article aims to provide theoretical foundations and practical guidance for precision therapy in sepsis, ultimately promoting personalized medicine in this field.

Cerebral toxoplasmosis is one of the most common opportunistic infections among AIDS patients. Clinical and neuroimaging manifestations are diverse and non-specific, resulting in frequent delayed diagnosis and even misdiagnosis, leading to neurological impairment, coma, and death. In addition to clinical and serological examinations, multimodal neuroimaging is indispensable for early diagnosis and subsequent treatment evaluation. Indeed, functional magnetic resonance imaging technologies and positron emission tomography provide complementary information for early diagnosis and treatment, which can improve prognosis when combined with prevention strategies. Recent advances in vaccine development have provided new hope for the prevention of cerebral toxoplasmosis. This article reviews multimodal imaging evaluation strategies and other recent clinical advances for the prevention, diagnosis, and treatment of AIDS-related cerebral toxoplasmosis.

Orbital rhabdomyosarcoma (RMS) is the most common primary orbital malignant tumour in children. The majority of cases are of the embryonal subtype, which carries a favourable prognosis when promptly diagnosed and appropriately managed. Advances in molecular profiling have further refined risk stratification, distinguishing PAX3/7::FOXO1 fusion-negative embryonal from fusion-positive alveolar RMS. Imaging, particularly MRI, plays a central role in diagnosis and tumour extent. Current biopsy recommendations favour open incisional procedures for orbital RMS. Treatment follows risk-adapted protocols incorporating systemic chemotherapy with radiotherapy for local control. Emerging studies show the benefit of novel radiotherapeutic approaches that have high control rates but lower toxicity, including brachytherapy in the AMORE protocol. Despite overall excellent survival rates, challenges remain in reducing long-term morbidity and personalising treatment through genetic and molecular knowledge. This review offers current recommendations and highlights the importance of a multi-disciplinary approach in the diagnosis, staging and treatment of orbital RMS.

Antibody-drug conjugates (ADCs) represent a transformative class of targeted therapies designed to deliver potent cytotoxic agents specifically to tumor cells, minimizing systemic toxicity. This review provides a comprehensive overview of ADCs, detailing their mechanisms of action, design strategies, and clinical advancements. ADCs utilize monoclonal antibodies to selectively bind tumor-associated antigens, enabling the precise delivery of toxic payloads to cancer cells. The review explores the critical components of ADCs, including the antibody, linker, and payload, and highlights how these elements can be optimized to improve efficacy and minimize off-target effects. We examine the evolution of ADC design from early constructs to the latest innovations and the development of novel payloads that extend therapeutic possibilities beyond traditional cytotoxic agents. Additionally, we discuss the clinical success of ADCs, with examples from approved therapies such as gemtuzumab ozogamicin, brentuximab vedotin, and trastuzumab emtansine, which have redefined the treatment landscape for various cancers. Despite their success, ADCs face challenges such as tumor heterogeneity, resistance mechanisms, and toxicity, which are actively being addressed through ongoing research. The review concludes with an outlook on the future of ADCs, highlighting emerging strategies in conjugation technology, payload design, and combination therapies that are poised to enhance their therapeutic potential across oncology and other disease areas.

Peptide receptor radionuclide therapy (PRRT) has established itself as a pivotal component in the management of advanced, somatostatin receptor (SSTR)-positive neuroendocrine tumours (NETs). The NETTER-1 phase III trial demonstrated that [177Lu]Lu-DOTATATE significantly prolongs progression-free survival (PFS) and improves quality of life in patients with midgut NETs refractory to somatostatin analogues, leading to regulatory approval by both EMA (2017) and FDA (2018). The recent NETTER-2 phase III trial further extended these findings by supporting the first-line use of PRRT in Grade 2 and 3 gastroentero-pancreatic (GEP)-NETs (Ki-67 ≥ 10 ≤ 55%). Beyond standard β-emitting therapy, several developments are reshaping the field: the clinical adoption of SSTR antagonists such as radiolabelled JR-11 and LM3, targeted α-particle-emitting therapies (225Ac, 212Pb, 213Bi) for resistant disease, and rational combination strategies with chemotherapy, DNA-repair inhibitors, and immunotherapy. Parallel innovation in radiopharmaceutical chemistry has yielded new peptide ligands, including cholecystokinin-2 receptor (CCK2R)-targeted compounds such as DOTA-MGS5, which show promise for rare NETs such as medullary thyroid carcinoma (MTC) and small-cell lung cancer (SCLC). This review summarises clinical evidence, translational advances, and future perspectives for PRRT as a cornerstone of precision nuclear oncology. Emphasis is placed on expanding indications, integrating α-emitters, improving safety and dosimetry, and developing novel theragnostic ligands that enable personalised treatment strategies for NETs patients.