Citations

ABSTRACT Circulating tumor DNA (ctDNA) as a liquid biopsy is an emerging tool used for diagnosis and disease monitoring, yet not all tumors shed DNA equally, thus currently limiting the clinical applicability of this tool. Our institution has developed and validated a droplet digital Polymerase Chain Reaction (ddPCR) ctDNA test for BRAF V600 mutation. We collected data on all BRAF mutated melanoma patients tested with the ddPCR BRAF assay at our institution over the years 2018–2024 and correlated the test results with clinical and radiological baseline parameters, with a focus on Positron Emission Tomography‐Computed Tomography (PET‐CT) data, incorporating both location of lesions and volume of disease. Linear and logistic regression modelling was used to assess possible associations between the baseline parameters and the ctDNA results. We identified 71 BRAF mutated melanoma patients, of which 65 had active disease on imaging studies and 43 had PET‐CT data available for analysis. Multivariate modelling has shown that patients were more likely to have a positive ctDNA result if they had elevated serum lactate dehydrogenase (LDH) (OR = 9.9), had a higher number of lesions on imaging studies (> 10 lesions: OR = 11.3), and if they were younger than 65 (OR = 11.8), with an AUC of 0.84. The PET‐CT calculated total metabolic tumor volume correlated with the quantitative ctDNA result with a Pearson r factor of 0.49. In conclusion, ctDNA ddPCR BRAF testing is easily obtained and might be especially beneficial for patients diagnosed with a clinically aggressive disease, based on elevated LDH, higher PET‐CT metabolic tumor volume, and younger age.

Summary Chimeric antigen receptor T cells directed against CD‐19 are highly effective therapies for various subtypes of B‐cell non‐Hodgkin lymphoma (NHL). We have studied the impact of patient‐specific lymphocyte growth kinetics after lymphoid depletion chemotherapy on both long‐term outcomes and toxicity in patients with diffuse large B‐cell non‐Hodgkin lymphoma (DLBCL). The growth of the lymphocyte populations early after chimeric antigen receptor T‐cell (CAR‐T) therapy is well described by an exponential function and the growth rate of the cells appears to be one of the most critical determinants of overall survival in these patients. The maximum lymphocyte peak and the area under curve for lymphocytes within the first 4 weeks after CAR‐T therapy had no impact on survival. Receiver operator characteristic analysis determined that a replication rate ≥0.3876/day is associated with superior rates of complete response and durable responses. This threshold is associated with higher grades of cytokine release syndrome and the need for tocilizumab. However, patients with this threshold have a median overall survival of 3.04 years compared to 1.035 years for patients with slower lymphocyte replication ( p = 0.0206). The major determinant of depth of response and durability of response to CAR‐T in NHL is the speed of lymphocyte expansion.

The 6th edition of the WHO Classification of Breast Tumours introduces both major and minor changes based on recent advances in our understanding of breast biology, developments in diagnostic modalities, identification of specific molecular targets and new treatment regimens necessitating modifications to pathology reporting and tumour biomarker categorisation. This review summarises the main changes that strive towards a classification of global relevance. In invasive carcinoma, predictive factors increasingly inform modern breast cancer treatment. The 6th edition provides an update on HER2 reporting categories following the DESTINY‐Breast 04 and 06 trials. Terminologies used to classify invasive tumours are clarified, with the term ‘variant’ now reserved for molecular/genetic alterations. Invasive lobular carcinoma (ILC) with extracellular mucin is recognised as a new diagnostic entity with prognostic implications. The diagnosis of mucinous carcinoma (MC) is reserved for mucin secreting carcinomas with grade 1 or 2 morphology and a favourable biomarker profile. The diagnosis of malignant phyllodes tumours requires only four of the original five adverse histological criteria. Classification of neuroendocrine tumours (NETs) is revised, recognising that the unified model, promoted in the 5th edition, is difficult to apply to the breast. New approaches to the classification of adenomyoepithelioma are discussed but the 5th edition system is broadly retained. A new section on ‘Small Diagnostic Samples’ outlines the merits of non‐operative biopsy diagnosis, the B coding system and the importance of multidisciplinary review. Changes to diagnostic practice and the emerging role of artificial intelligence, with advantages and challenges, are discussed in a new section on ‘Digital Pathology’.

Cisgender males remain less likely to report depressive symptoms or initiate mental health conversations with primary care providers. Guided by the Health Belief Model and Gender Role Theory, this study examined how cisgender males perceive and address depression, with a focus on their comfort with the Patient Health Questionnaire-9 and factors influencing their willingness to discuss mental health concerns. An anonymous mixed-methods survey link was disseminated to 62 cisgender males between November 2024 and January 2025. Quantitative items assessed preferences for mental health discussions, willingness to initiate conversations, and experiences with the PHQ-9. Qualitative responses were analyzed to identify perceived barriers, attitudes toward screening, and beliefs shaped by masculine role norms and health-belief constructs. Most participants (n = 48, 77.42%) preferred in-person mental health discussions with primary care providers. Half (n = 31, 50%) had previously received a mental health screener. Despite this, a large majority (n = 54, 87.10%) reported comfort completing screeners such as the PHQ-9 independently. However, n = 14 (22.58%) were unlikely to initiate mental health conversations. Qualitative findings revealed 3 dominant themes stigma, fear, and trust, that shaped comfort with screening and willingness to disclose symptoms. The HBM highlighted perceived barriers and low perceived susceptibility, while GRT contextualized how masculine norms discouraged disclosure. Cisgender males show readiness to engage with depression screeners when tools are accessible, yet stigma, fear, and trust remain central influences on disclosure. Integrating the PHQ-9 into routine primary care with deliberate conversations and strengthening patient-provider trust may enhance early identification of depression.

Introduction Blood-based biomarkers offer a promising, minimally invasive approach to Alzheimer’s disease (AD) diagnosis, yet validation in admixed populations remains limited. We investigated whether plasma biomarkers predict CSF-defined AD pathology in a Brazilian cohort. Methods Seventy-eight older adults [including individuals with mild cognitive impairment (MCI), subjective cognitive decline (SCD), and cognitively unimpaired controls] underwent cognitive testing, neuroimaging, and plasma biomarker assessment. CSF data were available for symptomatic participants (MCI and SCD; n = 61), and regression and ROC analyses were performed in the subset with both CSF and APOE genotyping data ( n = 53). Plasma Aβ42, p-Tau181, p-Tau217, t-Tau, and derived ratios were quantified. Multivariable logistic regression and ROC analyses evaluated prediction of abnormal CSF p-Tau181/Aβ42 and t-Tau/Aβ42, adjusting for age, sex, and APOE ε4 status. Results Approximately 25% of individuals with MCI exhibited abnormal CSF p-Tau181/Aβ42 and t-Tau/Aβ42 ratios. Moderate correlations were observed between plasma and CSF biomarkers (r > 0.4), particularly for Aβ42/p-Tau217 and p-Tau217. In adjusted models, plasma p-Tau217 and the Aβ42/p-Tau217 ratio independently predicted abnormal CSF pathology. Each one standard deviation increase in p-Tau217 was associated with 3.53–4.83-fold higher odds of abnormal CSF ( p ≤ 0.003). In contrast, higher Aβ42/p-Tau217 ratios were associated with substantially lower odds of pathology, with each one standard deviation increase corresponding to a 91%–93% reduction in risk ( p ≤ 0.002). The ratio showed stronger associations than p-Tau217 alone. ROC analyses demonstrated good discrimination. For CSF p-Tau181/Aβ42, Aβ42/p-Tau217 achieved an AUC of 0.88 (83% sensitivity, 85% specificity), compared with 0.83 for p-Tau217. For CSF t-Tau/Aβ42, both biomarkers yielded AUCs of 0.89. Discussion Plasma Aβ42/p-Tau217 and p-Tau217 effectively identify CSF-defined AD pathology in an admixed cohort. While higher p-Tau217 levels were associated with increased odds of pathology, higher Aβ42/p-Tau217 ratios were associated with lower pathological burden and demonstrated stronger effect sizes, supporting the added value of combining amyloid and tau biomarkers. These findings provide initial evidence for local validation of blood-based AD biomarkers in Brazil.

ABSTRACT The HLA‐DQB1*03:506:01:01 allele is characterised by a single nucleotide substitution in codon 130 in exon 3.

Abstract Background Accurate assessment of left ventricular outflow tract (LVOT) gradients is critical for hypertrophic cardiomyopathy (HCM) management, yet Doppler-based measurements are technically demanding and require expertise. Objective To develop a multi-view deep learning model capable of classifying LVOT obstruction (> 20mmHg) using routine 2D echocardiographic windows without reliance on Doppler imaging. Methods We trained and externally validated a cross-attention-based video-to-video fusion framework that integrated EchoPrime-derived video representations from three standard transthoracic echocardiographic views to classify LVOT gradients. Results Training was performed on a derivation cohort (N = 1833) from a tertiary care system in the United States, with model performance evaluated on an internal held-out test set (N = 275) and a Korean external validation cohort (N = 46). Single-view baselines showed limited discrimination (external AUROCs 0.47–0.70). Conversely, domain-specific foundational model (EchoPrime) achieved superior single-view performance (AUROCs 0.75–0.80 internal; 0.79–0.83 external), highlighting the importance of echo-specific pretraining and temporal modeling. The proposed multi-view fusion further enhanced predictive performance, with the late fusion model reaching an AUROC of 0.84 on the external cohort with significant population-shift. Conclusions These results suggest LVOT physiology is encoded in routine 2D imaging and can be leveraged for clinically relevant gradient classification without Doppler input- proposed AI-guided strategy demonstrates substantial cost savings compared with the screen-all approach. By integrating complementary spatial-temporal information across multiple views, our approach generalizes robustly across populations and may enable real-time decision support, extend LVOT assessment to portable or resource-limited settings, and complement Doppler-based evaluation for longitudinal HCM management.