A real-world comparative study on the efficacy and safety of tocilizumab and rituximab in patients with neuromyelitis optica spectrum disease and myelin oligodendrocyte glycoprotein antibody-associated disease.

Outcomes of adults older than 70 years of age undergoing allogeneic stem cell transplantation.

The relationship between nicotine craving and state anxiety in daily and non-daily nicotine users.

Intravenous (IV) infliximab (IFX) combined with an immunomodulator (combination therapy) outperforms IV IFX monotherapy in terms of clinical, endoscopic, and immunogenicity outcomes in patients with inflammatory bowel disease (IBD). With the advent of subcutaneous (SC) IFX, which is associated with higher serum drug concentrations, it is essential to assess whether SC IFX monotherapy provides similar pharmacokinetic and clinical benefits as combination therapy. We conducted a systematic review and meta-analysis (until August 2024), of studies on patients with IBD treated with SC IFX. The primary outcome was anti-drug antibodies (ADAs) formation within 12 months (M) after starting SC IFX or after switching from IV to SC IFX. Secondary outcomes included treatment persistence, clinical efficacy, and biochemical parameters. Twenty-four studies (N = 3172) were included. Among patients transitioning from IV IFX induction to SC IFX, immunogenicity was more prevalent with monotherapy than combination treatment (median, 68% vs 48%; odds ratio [OR], 3.29; 95% confidence interval [CI], 1.71-6.31; P < .001). Clinical response rates at 12M were comparable, with a trend favoring combination therapy (OR, 0.73; 95% CI, 0.50-1.06; P = .10). In patients switching from IV maintenance to SC IFX, relapse rates were low (median, 12% at 6M, 11% at week 50), with stable biochemical markers. Treatment persistence was high (93% at 6M, 92% at 12M). Among patients with quiescent disease at the time of switching, 1-year relapse rates were 9% to 11%, with baseline immunogenicity predicting treatment failure. SC IFX monotherapy is associated with higher immunogenicity rates compared with combination therapy, particularly in new IFX starters. Although clinical response was comparable, a trend favoring combination therapy warrants further investigation.

Comparison of antidepressant deprescribing strategies in individuals with clinically remitted depression: a systematic review and network meta-analysis.

Practical Strategy to Mitigate Overdiagnosis in Asian Low-dose Computed Tomography Lung Cancer Screening.

SMARTs with treatment preference: Pragmatic SMART design and methods motivated by STAR*D.

Application of whole-genome sequencing for distinguishing relapse from reinfection in tuberculosis patients from Lithuania.

Measurable residual disease intervention in AML: a new therapeutic horizon.

Relapses occur in 14% to 44% of patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV). The French Vasculitis Study Group Relapse Score (FRS) was recently proposed to predict relapse risk. This study aimed to identify relapse-associated factors and evaluate the FRS performance in a Mexican cohort. We performed a medical records review study including patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) who were followed for ≥12 months at a Mexican tertiary care center. Demographic, clinical, laboratory, and treatment data were analyzed using descriptive statistics, survival analysis, and ROC curves. Among 147 patients (110 GPA, 37 MPA), the median age at diagnosis was 49 years (IQR: 36 to 59). Over a median follow-up of 93 months (IQR: 48 to 152), 90 patients (61%) relapsed. Cumulative relapse rates at 12, 24, 36, 48, and 60 months were 13.6%, 32.3%, 40.3%, 47.5%, and 58.0%, respectively. FRS scores of 1, 2, and 3 corresponded to median relapse-free survivals of 85, 68, and 33 months, with 5-year relapse risks of 40.5%, 48.4%, and 68.3%, respectively. Discrimination was significant (log-rank p < 0.0004). The C-statistic for FRS alone was 0.648 (95% CI: 0.586-0.710); for model 1 (adding cluster 4), 0.666 (95% CI: 0.605-0.728); and for model 2 (adding cluster 4 and rituximab as maintenance), 0.700 (95% CI: 0.643-0.757). An age cutoff of ≤50 years showed better accuracy (AUC: 0.67, p = 0.0006) for relapse prediction. In this cohort, relapses were frequent. Incorporating clinical clusters and rituximab therapy to the FRS may enhance its predictive performance.

Six-year safety and efficacy outcomes with first-line ofatumumab in recently diagnosed treatment-naive patients with relapsing multiple sclerosis.

Hematologic malignancies and an overview of emerging therapies for hematologic malignancies: a systematic review.

Ifenprodil inhibits nicotine-induced addiction-like behaviors in mice.

The real-world experience of biologics for neuromyelitis optica spectrum disorders as first-line and switched therapy.

Background The global prevalence of multiple sclerosis (MS) is increasing worldwide. Although many disease-modifying therapies (DMTs) have been approved, they can cause serious adverse events, including infections. Dimethyl fumarate (DMF), an immunomodulator, has a favorable safety profile. In this era of personalized therapy, it is important to select an appropriate DMT for individual patients. This study evaluated DMF treatment outcomes in Japanese patients with MS. Methods The medical records of Japanese patients with MS treated with DMF at a single institution between January 6, 2013, and October 31, 2022, were reviewed retrospectively. The reasons for discontinuation of DMF, switching from other DMTs to DMF, transition of DMF to other medications, absolute lymphocyte count, disease activity assessment, comparison of DMF continuation versus discontinuation, and factors associated with the annualized relapse rate during DMF use were assessed. Results Of the 116 DMF-treated patients, DMF treatment was continued to prevent relapse recurrence in 54.7% of RRMS (n=86) and 23.3% of SPMS (n=30) patients. The main reasons for not continuing DMF treatment included failure to prevent relapse or disease progression (63% of patients who did not continue DMF). A lower annual recurrence rate prior to DMF initiation, lower Expanded Disability Status Scale score, shorter duration from disease onset to DMF initiation, fewer relapse recurrences during DMF therapy, and diagnosis of RRMS were associated with DMF continuation. Conclusion Continuous monitoring is essential after initiating DMF treatment because patients may require transition to other therapies. Overall, 47% of the MS patients were effectively managed with DMF, with favorable outcomes observed in 54.7% of the RRMS patients.

Real-world evaluation of subcutaneous natalizumab in patients with highly active relapsing-remitting multiple sclerosis.

Backgrounds: Graves' disease (GD) is the most common cause of hyperthyroidism, characterized by autoimmune stimulation of the thyroid gland. Long-term treatment options include antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy, but there is no universal agreement on which treatment approach is best. Each modality has different benefits and limitations, making comparative evaluation is important to help guide individual treatment decisions. Methods: This literature review summarizes evidence from clinical trials, meta-analyses, and observational studies evaluating the efficacy, recurrence rates, safety profiles, and long-term outcomes of antithyroid drugs (ATD), RAI, and thyroidectomy in the management of Graves’ disease. Databases such PubMed, SpringerLink, ScienceDirect, and references inside the extracted studies were used. Results: ATDs remain the preferred first-line therapy in many regions due to their non-invasive approach and potential for remission, although 30–70% of patients relapse after discontinuation. Long-term low-dose therapy can reduce recurrence but requires monitoring for hepatotoxicity. RAI demonstrates high cure rates (&gt;90%) and is cost-effective, but frequently results in permanent hypothyroidism and may worsen orbitopathy. Thyroidectomy provides the most definitive treatment, with a relapse rate about zero and rapid achievement of euthyroidism, although it carries risks such as recurrent laryngeal nerve injury and hypoparathyroidism. Comparative studies consistently show superior remission with surgery, followed by RAI, while ATDs have the highest recurrence. Conclusions: Each treatment modality for GD offers distinct advantages and disadvantages. Thyroidectomy provides the most reliable cure, RAI offers effective and economical definitive therapy, and ATDs remain valuable first-line options. Optimal treatment selection should be individualized based on patient preference, comorbidities, and desired long-term outcomes.

This study revisits the prohibition of khamr through a multidisciplinary lens to address the challenges of modern addictive substance abuse. Its objective is to test the compatibility of the Qur'anic prohibition with evidence from neuroscience and toxicology, while simultaneously formulating a contextual Islamic legal framework. This study develops an epistemological convergence matrix that maps neurobiological and toxicological indicators as the ‘illah (effective cause) of law within the framework of Maqāṣid al-Sharī‘ah. The methodology combines a thematic exegesis (tafsīr mawḍū‘ī) of verses on khamr, a comparative analysis of five schools of jurisprudence (madhāhib), and a synthesis of laboratory data on the neurological, physiological, and social damage caused by alcohol, cocaine, heroin, and synthetic psychoactive substances. Validity is maintained through triangulation with experts in exegesis, neurology, and toxicology. The findings indicate an expansion of the definition of khamr from fermented beverages to the functional category of “any substance that envelops the intellect.” Brain imaging reveals a reduction in dopamine receptors and hypofunction of the prefrontal cortex; toxicological data show a narrow margin of exposure and systemic organ damage. A matrix based on Maqāṣid al-Sharī‘ah affirms that addictive substances simultaneously threaten the preservation of intellect (ḥifẓ al-‘aql), life (ḥifẓ al-nafs), property (ḥifẓ al-māl), progeny (ḥifẓ al-nasl), and religion (ḥifẓ al-dīn). The convergence of exegesis and science yields an integrated policy model: legal prohibition, neuroscience-based education, and spiritual rehabilitation proven to reduce relapse rates. This study concludes that the Qur'anic prohibition of khamr possesses strong empirical rationality, while also providing an ethical foundation for narcotics regulation in contemporary Muslim societies. The findings underscore the importance of sustained transdisciplinary dialogue to respond to the emergence of new synthetic substances and to evaluate the effectiveness of Maqāṣid-based policies.

Background: Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system characterized by inflammation, axonal injury, and progressive neurological decline. Current disease-modifying therapies (DMTs) reduce relapse rates but remain insufficient for halting neurodegeneration or promoting repair, particularly in progressive MS. Stem cell–based therapies have emerged as promising strategies by integrating immunomodulation, neuroprotection, and remyelination. Objective: This review critically evaluates the therapeutic potential, mechanisms of action, clinical evidence, and translational challenges of stem cell–based interventions for MS. Methods: A comprehensive synthesis of preclinical and clinical studies was performed, emphasizing randomized controlled trials, systematic reviews, and meta-analyses evaluating autologous hematopoietic stem cell transplantation (aHSCT), mesenchymal stem cells (MSCs), neural stem/progenitor cells (NSPCs), and induced pluripotent stem cells (iPSCs). Results: aHSCT achieves durable immune “resetting” and superior relapse and disability outcomes compared with high-efficacy DMTs in aggressive relapsing MS, albeit with significant procedure-related risks. MSCs exhibit favorable safety and potent paracrine immunomodulatory and neuroprotective actions; however, efficacy signals across trials remain inconsistent, underscoring the need for standardized dosing, delivery routes, and larger multicenter studies. Early investigations of NSPCs and iPSC-derived oligodendrocyte progenitors demonstrate feasibility and remyelinating potential but remain preclinical or early phase. Across modalities, mechanistic studies highlight immunoregulation, trophic support, microglial modulation, and restoration of metabolic resilience as central pathways. Emerging biomarkers, including neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and advanced imaging metrics, are being integrated to establish causal links between biological effect and clinical outcome. Conclusions: Stem cell therapies represent a transformative avenue for MS treatment, offering potential beyond immunosuppression to promote central repair. aHSCT provides high-potency immune reconstitution but at higher procedural risk, while MSCs deliver safer, paracrine-driven neurorepair with unresolved efficacy. Translation to clinical practice will require harmonized manufacturing.

Introduction: Dystonia is a movement disorder characterized by involuntary, sustained, and patterned muscle contractions, which cause twisting and repetitive movements. Dystonia includes various types of movement disorders such as cervical, generalized, task specific focal hand dystonia. Several potential stereotactic targets have been suggested for the treatment of dystonia such as GPi and PTT. Materials and methods: All the patients of generalized dystonia who underwent surgical interventions in Annapurna Neurological Institute and Allied Sciences since January 2015 till December 2023 were included in our study. We performed unilateral pallidotomy/ pallidothalamic tractotomy for cervical dystonia and bilateral pallidotomies or unilateral pallidotomy and contralateral pallidothalamic tractotomy for generalized dystonia. We used ZD Fishers frame and the thermal lesioning machine of Cosman Radiofrequency (RF) generator with the lesioning electrode of 0.75 mm internal diameter and 2 mm exposed tip was used. Results: There were altogether 16 cases of generalized dystonia. There was overall 70 percent decrease in the symptoms of dystonia. The mean age was 41.49 years±12 years. The male: female ratio was 3:1. The mean percentage change in BFMDRS was 70 percent (p value&lt;0.05) in postoperative period. There was relapse of symptoms in 3 cases of generalized dystonia. One case of tardive dystonia with repeated bilateral pallidotomy had status dystonicus and finally she got better with intrathecal baclofen pump. One case had transient hemiparesis, three cases had transient dysarthria and two cases had dysphagia. Conclusion: Lesioning surgery is quite rewarding for generalized dystonia. However, tardive dystonia and some cases of generalized dystonias have higher relapse rate. Recurrent cases may need DBS or further potential targets. Unilateral PTT and contralateral Gpi lesioning in generalised dystonia is rewarding.