The children were recruited at Nationwide Children’s Hospital in Columbus, Ohio, between 2012 and 2017. In the fully blinded, parallel-group trial, the intervention group received daily dissolvable powder containing 200 mg of DHA from algal oil and 200 mg of AA from fungal oil for 180 days. The placebo group received 400 mg of corn oil daily for the same period.

The supplement was administered during toddlerhood, when children may begin replacing breast milk or formula with solid foods containing less DHA. Researchers conducted the long-term follow-up from 2021 to 2024, when participants had a median age of 9.2 years. At least one of the examined outcomes was available for all 376 children eligible for follow-up, although data completeness varied by measure.

Caregivers of 317 children completed the Child Behavior Checklist, and medical records were available for 356 children. An exploratory analysis examined the 252 children who had results for all outcomes included in the analysis. Mixed linear models compared attention outcomes while accounting for clustering among siblings, twins and triplets, while generalized estimating equations with a log-binomial model compared the likelihood of recorded diagnoses.

The clearest group-level difference appeared on the National Institutes of Health Toolbox Flanker Inhibitory Control and Attention Test, a computerized task in which children focus on a target while ignoring competing visual cues. Children assigned to DHA plus AA scored 3.02 points higher than placebo recipients on the age-corrected Flanker scale, which ranges from 0 to 100 and gives higher scores for better attention and inhibitory control. The 95% confidence interval was 0.01 to 6.04.

The difference was therefore modest and close to the conventional threshold for statistical significance. No significant group difference was found in Flanker response-time variability or in overall caregiver- and teacher-reported attention-problem scores. Exploratory analyses suggested that the Flanker difference was larger among children with lower dietary omega-3 intake at the beginning of the trial.

For children below the median intake of DHA plus eicosapentaenoic acid, the supplemented group scored 4.88 points higher than the placebo group, with a 95% confidence interval of 0.53 to 9.23 and an effect size of 0.38. Among children above the median intake, the estimated difference was 1.06 points, with a 95% confidence interval of minus 3.24 to 5.37. In the analysis restricted to children with complete outcome data, the overall Flanker difference decreased to 2.84 points and was no longer statistically significant, although the estimated effect size remained similar.

Birthweight also appeared to influence the teacher-reported attention results. Among children with a birthweight above 1,500 g, those receiving DHA plus AA had 2.97 points fewer teacher-rated inattention symptoms than placebo recipients. The 95% confidence interval ranged from minus 5.38 to minus 0.55, and the effect size was minus 0.42.

No treatment effect was detected among children born weighing less than 1,500 g; the estimated difference was 0.44 points, with a 95% confidence interval of minus 2.50 to 3.39. These were exploratory subgroup findings. Interaction tests used a screening threshold of p below 0.20 before the researchers examined stratified estimates, making the subgroup results hypothesis-generating rather than definitive.

Medical records documented an ASD diagnosis in 25 of 356 children, or 7.0%, and an ADHD diagnosis in 85 children, or 23.9%. The likelihood of either diagnosis did not differ significantly between the DHA-plus-AA and placebo groups. For ASD, the estimated risk ratio was 0.79 with a 95% confidence interval of 0.37 to 1.68; for ADHD, it was 1.03 with a 95% confidence interval of 0.70 to 1.51.

Birthweight was screened as a possible moderator of ADHD risk, but neither the above-1,500-g nor below-1,500-g stratum showed a significant difference between treatment groups. The complete-outcome analysis produced similarly nonsignificant results for diagnosis outcomes. The study’s design strengthened the comparison between groups.

Random assignment, full blinding and placebo control reduced the likelihood that observed differences reflected expectations about the treatment, while the follow-up combined caregiver ratings, teacher ratings, a performance-based attention test and medical-record diagnoses. Nevertheless, some outcomes were missing, and families with lower household incomes and maternal education levels were less likely to participate in follow-up, although these characteristics did not differ between treatment groups. Other limitations constrain what the results can establish.

The medical records did not reveal how individual ADHD or ASD diagnoses had been made, and diagnostic coding or the absence of specific testing could have introduced error. The analysis also did not directly assess core autistic traits, making subtle changes in autism-related features difficult to detect. In a separate exploratory comparison that was not a test of supplementation, children with an ADHD diagnosis had significantly poorer caregiver-reported attention, teacher-reported attention and Flanker standard scores than children without an ADHD diagnosis; their Flanker response-time variability did not differ significantly, with p equal to 0.06.

Earlier Omega Tots follow-up data had also reported adverse findings in some subgroups, including poorer language outcomes among the lowest-birthweight children and reduced effortful control in several income strata. The long-term result is therefore a qualified signal rather than a general endorsement: six months of DHA plus AA in toddlerhood was associated with small advantages on selected attention measures in some preterm children, but it did not reduce the likelihood of ADHD or ASD diagnoses by age 8.5 to 10.5 years.

Subject of Research: Long-term attention and neurodevelopmental outcomes after DHA and arachidonic acid supplementation in children born preterm

Article Title: Fatty Acid Supplementation in Toddlers Born Preterm and Attention and Autism Outcomes at 8–10 Years: Omega Tots Randomized Controlled Trial Long-Term Follow-Up

Article References: Robinette, L. M., Taylor, H. G., Boone, K. M., Rogers, L. K., Rausch, J., Bartlett, C. W., Klebanoff, M. A., & Keim, S. A. (2026). Fatty Acid Supplementation in Toddlers Born Preterm and Attention and Autism Outcomes at 8–10 Years: Omega Tots Randomized Controlled Trial Long-Term Follow-Up. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07566-z

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07566-z

Keywords: Omega Tots trial, Preterm children, DHA supplementation, Arachidonic acid, Attention, Inhibitory control, ADHD, Autism spectrum disorder, Randomized controlled trial, Long-term follow-up, Fatty, Acid

Because the report describes only one patient, it cannot establish how frequently this result occurs or demonstrate that conservative care caused it. The boy attended the dental clinic about five hours after the November 29, 2012 injury. He had pain and increased mobility of the upper anterior teeth during chewing, along with a lower-lip laceration and mild swelling.

Oral examination showed that the coronal fragment of the right central incisor was partially extruded and had grade 2, or moderate, mobility. Both central incisors were tender to percussion, and sulcular bleeding was present. The neighboring maxillary left central incisor, #21, had increased mobility without displacement and was diagnosed as a concussion injury.

Initial periapical radiography showed an oblique fracture through the middle third of the immature root of #11, labio-palatal displacement of the coronal fragment and widening of the periodontal ligament space. The root was incompletely developed and had an open apex. The boy’s medical and family histories were unremarkable.

Clinicians chose a conservative strategy intended to preserve the pulp and periodontal tissues while retaining the tooth’s capacity for continued biological development. After cleaning and irrigating the injured area, they gently repositioned the displaced coronal fragment to restore anatomical alignment. The tooth was stabilized with a passive flexible splint composed of six braided 0.2-millimeter stainless-steel wire strands bonded to adjacent teeth with composite resin.

The splint extended to the left central incisor and to bilateral primary canines and primary molars, increasing stability and distributing occlusal forces while allowing physiological mobility. A postoperative periapical radiograph confirmed satisfactory alignment of the fracture fragments. The patient and parents were instructed to avoid loading the anterior teeth, maintain oral hygiene and attend regular clinical and radiographic follow-up examinations.

The early healing phase was complicated by limited compliance and repeated breakage of the splint. The precise dates of the individual failures were not consistently retained in the clinical records. As a result, the splint placed on the day of the injury remained in place for approximately five months, from November 29, 2012, until its removal on April 16, 2013.

This was considerably longer than the approximately four weeks generally recommended for a mid-root fracture, and the report emphasizes that the extended period resulted from breakage and delayed attendance rather than an intentional protocol. At removal, the tooth had reduced mobility, but the boy occasionally reported spontaneous discomfort. Electric pulp testing produced a value of 15.

Radiographs showed partial re-establishment of periodontal ligament continuity, although the fracture line remained visible. Despite the intermittent discomfort, the tooth continued to respond positively to pulp sensibility testing, and clinical and radiographic examinations showed no evidence of pulp necrosis, infection, inflammatory change or periapical pathology. The patient and his parents also declined the planned endodontic access, so the clinicians continued observation rather than entering the root canal.

Later examinations showed that the boy was asymptomatic, the fracture line was becoming less apparent and root development was continuing. The authors note an important distinction in how they interpreted the pulp findings: electric pulp testing assesses neural responsiveness rather than proving histologic vitality. In this case, the positive response was assessed together with symptoms, percussion findings, radiographs and the absence of signs of infection or necrosis.

On January 9, 2015, roughly two years after the original trauma, the patient sustained another episode affecting the maxillary anterior region, although the mechanism was not documented. Tooth #11 was mildly tender to percussion and had grade 0–1 mobility, but it remained responsive to pulp sensibility testing. Its crown color was unchanged, and no sinus tract had formed.

Radiographs showed slight widening of the periodontal ligament space without displacement of the fracture segments, root resorption or periapical pathological changes. In response to these findings, the clinicians continued conservative monitoring. Subsequent images showed further root maturation, reduced visibility of the fracture line and maintained calcified-tissue healing.

The reinjury therefore caused temporary symptoms but was not followed by a documented loss of sensibility response or development of radiographic pathology. At the final 12-year follow-up in February 2025, the patient was 19 years old and tooth #11 remained asymptomatic and functional. Clinical examination found normal crown color and physiological mobility, with no tenderness to percussion or palpation, swelling or sinus tract.

The patient reported normal masticatory function without discomfort, and electric pulp testing produced a value of 10, comparable with the contralateral tooth. The final periapical radiograph showed complete root development with apical closure, calcified healing at the fracture site and a normal-appearing periodontal ligament space. There was no evidence of pulp necrosis, inflammatory or replacement root resorption, ankylosis or periapical pathology.

The crown had a satisfactory appearance, and the surrounding gingival tissues appeared healthy. On serial radiographs, the healing pattern was consistent with healing by calcified tissue, recognized through progressive radiopacity, reduced fracture-line visibility, no persistent radiolucent line and maintenance of the periodontal ligament space. The case’s principal contribution is its duration and the unusual combination of circumstances surrounding the healing process rather than a new treatment method.

The authors note that longitudinal evidence on root fractures in immature permanent teeth remains limited. They cite earlier reports involving conservative treatment with shorter follow-up, preservation of pulp tissue in horizontal root fractures of maxillary incisors over 13 years, and a two-stage treatment of a more complicated crown-root fracture with an additional horizontal mid-root fracture followed for five years. A large case series cited in the paper reported 10-year survival rates of 89% for root fractures in the apical third, 78% in the middle third and 67% in the cervical third.

The present report adds an account of 12 years of continued root development to radiographic apical closure in a middle-third fracture complicated by initial displacement, prolonged stabilization and a second traumatic episode. As a single observation, however, it cannot determine the usual frequency of this outcome or establish a causal effect of the treatment approach. Several limitations restrict the conclusions that can be drawn.

As a case report, the findings cannot establish causal relationships or predict outcomes for other children, and the individualized management may not apply to teeth with pulp necrosis, infection, severe displacement or different fracture characteristics. Assessment relied on conventional two-dimensional periapical radiographs obtained without rigid standardization of projection geometry, meaning that root maturation, fracture healing and periodontal ligament changes were evaluated by visual comparison of serial images. Terms such as “complete healing” must therefore be understood within that imaging limitation.

Detailed periodontal-probing records and the precise dates of individual splint breakages were also unavailable. Cone-beam computed tomography was not used because conventional radiographs were considered sufficient for clinical monitoring while limiting radiation exposure in a young patient. The case neither demonstrates nor supports the safety of routinely extending stabilization beyond recommended periods; its favorable outcome occurred in one selected tooth under continued clinical review, while clinical and radiographic findings remained reassuring.

Subject of Research: Long-term healing of a mid-root fracture in an immature permanent maxillary central incisor after conservative management

Article Title: Long-term conservative management of a mid-root fracture in an immature maxillary central incisor: a 12-year follow-up case report

Article References: Xie, L., & Wei, Y. (2026). Long-term conservative management of a mid-root fracture in an immature maxillary central incisor: a 12-year follow-up case report. Frontiers in Pediatrics, 14, Article 1962051. https://doi.org/10.3389/fped.2026.1962051

Image Credits: AI Generated

DOI: 10.3389/fped.2026.1962051

Keywords: dental trauma, immature permanent tooth, root fracture, pediatric dentistry, pulp sensibility, root development, calcified tissue healing, tooth splinting, long-term follow-up, case report, Long-term, conservative

The study followed 30 consecutive patients, 17 of them women, who underwent deep brain stimulation targeting the nucleus accumbens and the anterior limb of the internal capsule, a combined target abbreviated NAcc/ALIC, between 2004 and 2022. All of them had severe, functionally disabling OCD that had failed to respond adequately to established pharmacological and psychotherapeutic treatments, and all had been approved for surgery by a multidisciplinary team. The researchers assessed symptom severity with the Yale-Brown Obsessive Compulsive Scale, or Y-BOCS, at three time points: before surgery, one year after implantation, and at a final follow-up at least three years after the operation, which in some cases stretched to 21 years.

The technical logic of the procedure is rooted in the cortico-striato-thalamo-cortical circuits, the looping networks that connect the prefrontal cortex to deep gray-matter structures and are thought to be pathologically overactive in OCD. By placing electrodes so that one contact sits within the nucleus accumbens, one at the transition to the internal capsule, and the two most dorsal contacts within the capsule itself, surgeons can modulate activity across this circuit with millimeter-scale precision. In this cohort, leads were implanted bilaterally in 25 patients and unilaterally on the right side in five, using Medtronic model 3387 or SenSight leads with 1.5-millimeter contact spacing. Standard stereotactic coordinates were individualized to each patient’s anatomy, with trajectories planned to avoid blood vessels, cortical sulci, and the ventricular system.

Stimulation began within days of implantation and was titrated over the first two weeks to therapeutic amplitudes, typically between 1.5 and 3.0 volts or milliamperes. Parameters were adjusted every four to six weeks during the first three months, then roughly every three months until the first postoperative year, after which follow-up intervals were individualized. The response criterion was a reduction of at least 35 percent in Y-BOCS score from baseline, in line with international consensus definitions, although the retrospective design meant that the companion Clinical Global Impression ratings required for the full consensus categories were not systematically available.

The statistical picture was unambiguous. Repeated-measures analysis of variance showed that Y-BOCS scores fell significantly across all three time points, with a large effect size, and every Bonferroni-adjusted pairwise comparison, from baseline to one year, from one year to final follow-up, and from baseline to final follow-up, reached significance. Mean scores dropped from roughly 30 at baseline to about 20 at one year and about 14 at the latest assessment. Expressed as percentages, the average reduction was 32.4 percent at one year and 51.6 percent at final follow-up, meaning that on average patients continued to improve well beyond the first anniversary of their surgery.

At the final follow-up, 22 of 30 patients, or 73.3 percent, met the response criterion. That figure exceeds the pooled response rates of 66 percent and 57.9 percent reported in earlier meta-analyses, although the authors caution that excluding four operated patients who lacked complete follow-up data may have inflated the proportion. Response was seen across all baseline severity categories: 80 percent of patients whose symptoms had been rated extreme at baseline, 66.7 percent of those rated severe, and two of the three patients with moderate total scores, whose eligibility rested on severe, disabling obsessions despite minimal compulsions.

Perhaps the most clinically consequential finding concerns timing. Eight patients, 26.7 percent of the cohort, were delayed responders: they had not crossed the 35 percent threshold at one year but did so later, sometimes years later. One patient with extreme baseline symptoms showed only a 12.5 percent reduction at one year but a 95 percent reduction at 21 years. Conversely, among the 15 patients who responded by one year, 14 retained their response and only one lost it. The authors suggest that delayed improvement could reflect gradual neural adaptation, long-term optimization of stimulation settings, changes in concomitant treatment, psychosocial shifts, or natural fluctuation in OCD severity, and the retrospective data cannot distinguish among these explanations. But the practical implication is clear: judging a patient a non-responder at the one-year mark may be premature.

The study is candid about its limits. It is retrospective, uncontrolled, and single-center, which precludes causal conclusions about DBS itself or about the temporal course of improvement. Follow-up duration varied enormously, from 3 to 21 years, and was treated as a categorical assessment rather than a continuous variable, so the analysis cannot estimate a yearly rate of change. Medication and psychotherapy histories were not systematically recorded, adverse events were not captured with a standardized framework, and the inclusion period spanned 18 years, during which surgical techniques, hardware, and programming practices inevitably evolved. The researchers also note that some patients experienced transient symptom worsening during transitions between voltage-controlled and current-controlled devices, particularly around generator replacements, observations documented mainly in narrative clinical notes rather than standardized assessments.

Those caveats notwithstanding, the trajectory data add an important dimension to a field that has often been judged on one-year outcomes. Long-term cohorts from Amsterdam and other centers have previously shown sustained benefit, but a dataset extending over two decades, with individual stimulation parameters and Y-BOCS scores documented for every patient, is rare. The finding that improvement continued to accrue between the first year and the final assessment, and that the cumulative reduction exceeded either interval-specific reduction, suggests that the therapeutic effect of NAcc/ALIC stimulation may mature slowly, in a way that shorter trials cannot capture.

For the roughly one in four people with OCD who do not respond to conventional treatment, the study offers a measured but meaningful message. Deep brain stimulation remains a last-resort intervention reserved for highly selected patients treated in specialized multidisciplinary centers, and no one should read these results as a guarantee. But they do provide descriptive evidence that clinically meaningful improvement can persist, and in some cases deepen, over very long follow-up, and that patience with the therapy, and with the patients, may itself be part of the treatment. The authors call for prospective studies with standardized follow-up intervals, systematic recording of concomitant treatments and adverse events, and analyses that incorporate exact follow-up duration to confirm what this two-decade cohort so strongly hints at.

Subject of Research: Long-term outcomes of deep brain stimulation for treatment-resistant obsessive-compulsive disorder

Article Title: Long-term outcomes of nucleus accumbens/anterior limb of the internal capsule deep brain stimulation in treatment-resistant obsessive-compulsive disorder

Article References: Cid-Rodríguez, F. X., Schmahl, R., Márquez-Franco, R., Heiden, P., Soriano-Ursúa, M. A., Wagemann, W., Huys, D., Baldermann, J. C., Kuhn, J., Visser-Vandewalle, V., & Andrade, P. (2026). Long-term outcomes of nucleus accumbens/anterior limb of the internal capsule deep brain stimulation in treatment-resistant obsessive-compulsive disorder. Frontiers in Psychiatry, 17, Article 1905823. https://doi.org/10.3389/fpsyt.2026.1905823

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1905823

Keywords: deep brain stimulation, obsessive-compulsive disorder, nucleus accumbens, anterior limb of the internal capsule, Y-BOCS, neuromodulation, treatment-resistant OCD, neurosurgery, psychiatry, long-term follow-up, cortico-striato-thalamo-cortical circuits, Frontiers in Psychiatry

The researchers applied PRISMA methodology, the internationally recognised reporting standard for systematic reviews, to identify studies that assessed FCR in survivors beyond the five-year mark. Their search strategy, constructed with the help of a senior librarian at the Beatson Cancer Centre, spanned three major bibliographic databases: Ovid MEDLINE from 1946 to June 2025, APA PsycInfo from 2002 to late June 2025, and Embase from 1974 to June 2025. The searches combined controlled vocabulary terms for neoplasm recurrence and fear with text-word phrases capturing expressions such as fear, worry, or anxiety paired with recurrence, return, or the cancer coming back. Publications were limited to those published between 2005 and 2025, and the reviewers applied strict inclusion criteria: studies had to use validated assessment measures, include more than 50 participants, and report FCR in survivors at least five years from diagnosis.

Two authors independently screened the search output for eligibility, a standard safeguard against selection bias in systematic reviews. Data extraction recorded the number of participants, tumour type, study design, the FCR measurement tool used, the time points at which fear was assessed, and the reported prevalence. Risk of bias was formally assessed to address study quality, allowing the reviewers to distinguish findings from more robust studies from those with methodological weaknesses. This structured approach reflects guidance for systematic reviews of observational studies reporting prevalence data, which emphasises transparent eligibility criteria and independent assessment as core quality controls.

From the extensive search, ten papers met the inclusion criteria. These studies reported FCR measurements taken anywhere from five years to beyond twenty years after diagnosis, covering a heterogeneous mix of tumour types and patient ages. Sample sizes ranged considerably, from as few as 64 participants to as many as 5,983, illustrating the wide variation in scale across the long-term survivorship literature. Only two of the included studies reported longitudinal measurements, meaning they tracked the same patients over time; the remainder were cross-sectional, capturing a single snapshot of fear at one point in survivorship. This scarcity of longitudinal data is a significant limitation, because cross-sectional designs cannot show whether fear rises, falls, or remains stable within individuals as the years pass.

The methodological consistency of the included studies was narrow. Only two validated instruments appeared across the ten papers: the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) and the Fear of Progression Questionnaire-Short Form (FOP-Q-SF). The FCRI, originally developed and validated by Simard and Savard, is a multidimensional measure of FCR, and its short form has been evaluated for its capacity to screen for clinical levels of fear. The FOP-Q, developed by Herschbach and colleagues, was designed to measure fear of progression in chronic diseases more broadly and has been applied to cancer-related progression fears in breast cancer survivors. The reliance on just two tools across the review underscores both the strength of standardisation in this subset of studies and the wider fragmentation of FCR measurement in the field, where numerous instruments, including the Cancer Worry Scale, the Concerns About Recurrence Scale, and single-item screening measures, have been used in different studies.

The headline finding concerns prevalence. Among the studies judged to have acceptable risk of bias and reporting distinct cohorts beyond five years, the prevalence of FCR above defined clinical thresholds ranged from 13 to 33.9 percent. In other words, between roughly one in eight and one in three long-term survivors experienced fear of recurrence at a level considered clinically relevant, years or even decades after their original diagnosis. This range, while broad, is consistent with the picture emerging from a large individual participant data meta-analysis published in 2022, which examined FCR prevalence across cancer survivors and patients more generally and found that a substantial minority experience high fear. The consistency of elevated prevalence at the five-year mark and beyond challenges any assumption that psychological adjustment follows a simple trajectory of steady improvement after treatment ends.

The review’s conclusions carry clinical weight. The authors state that the limited evidence suggests clinically relevant FCR persists in some survivors at five years, and they argue that this persistence demands attention from clinicians and health services. FCR is not a trivial concern: research has linked it to psychological distress, impaired quality of life, and altered health behaviours, and a 2025 survey-administrative data linkage study found that fear of cancer recurrence is associated with higher primary care use after cancer treatment. Persistent fear may also drive repeated reassurance-seeking, over-monitoring, or avoidance of follow-up appointments, each with implications for both patient wellbeing and health system resources. The authors highlight the need to implement effective interventions for those whose fear remains clinically significant long after treatment.

Fortunately, the intervention evidence base has been growing. A 2019 meta-analysis published in the Journal of Clinical Oncology found that psychological interventions can reduce FCR, and randomised controlled trials such as ConquerFear, a theoretically based psychosocial intervention tested in a randomised trial reported in 2017, have demonstrated benefits for survivors with high fear. Adaptations of approaches such as Mindful Self-Compassion have been explored for feasibility and acceptability in cancer populations, and novel interventions, including written exposure to worst-case scenarios for patients with advanced disease, are under investigation. A virtual version of Family Caregiver-Fear Of Recurrence Therapy has been developed to address fear in family caregivers, recognising that FCR affects the wider support network. However, most intervention trials have focused on patients earlier in the survivorship trajectory, and the new review’s findings raise the question of whether long-term survivors with persistent fear can access and benefit from these evidence-based treatments.

Beyond the headline prevalence figures, the review exposes deeper structural problems in FCR research. The heterogeneity of patient populations across the included studies, spanning different tumour types, ages, and time points from five to more than twenty years post-diagnosis, makes it difficult to draw precise conclusions about who is most at risk or how prevalence changes over time. The authors emphasise the need for improved consensus on measurement approaches, so that future studies produce comparable rather than fragmented data. They also call for more prospective longitudinal research representing a comprehensive variety of tumour types, which would allow researchers to map the natural course of fear over decades and identify the points at which intervention might be most effective. Such studies are resource-intensive but essential for building a genuinely developmental understanding of FCR across the survivorship trajectory.

The review arrives at a moment when cancer survivorship is gaining formal recognition in health policy. Expert consensus statements from the European Society for Medical Oncology have promoted high-quality survivorship care and research in Europe, and national cancer survivorship standards have been developed in the United States using consensus approaches. Survivorship science has been a growing focus at the National Institutes of Health, with dedicated analyses of funded grants in recent years. Against this backdrop, the finding that a meaningful proportion of survivors remain troubled by fear of recurrence five years and beyond provides a concrete evidence point for advocates arguing that survivorship care should include routine psychological assessment and access to targeted interventions, not just in the first year after diagnosis but throughout the long-term follow-up period. As the population of long-term survivors expands with improving cancer outcomes, understanding and addressing the persistent psychological footprint of cancer will become an increasingly central task for oncology.

Subject of Research: Prevalence of fear of cancer recurrence in long-term cancer survivors beyond five years

Article Title: How prevalent is fear of cancer recurrence beyond 5 years: a systematic review of validated assessments across tumour types

Article References: Wheeler, C., & O’Rourke, N. (2026). How prevalent is fear of cancer recurrence beyond 5 years: a systematic review of validated assessments across tumour types. Supportive Care in Cancer, 34(10), Article 936. https://doi.org/10.1007/s00520-026-11180-1

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11180-1

Keywords: fear of cancer recurrence, cancer survivors, systematic review, survivorship, psychological distress, long-term follow-up, FCRI-SF, FOP-Q-SF, prevalence, PRISMA, supportive care, psycho-oncology

The study’s design was straightforward but rigorous. The researchers collected clinical data and contrast-enhanced cranial MRI images from all patients admitted with intracranial tuberculosis between January 2018 and March 2026. Each patient underwent follow-up lasting at least 12 months, after which outcomes were graded using the modified Rankin Scale, a standard clinical measure of functional disability. Patients scoring 0 to 2, meaning little to no disability, formed the favorable prognosis group of 67 individuals, while those scoring 3 to 6, ranging from moderate disability to death, formed the poor prognosis group of 52 patients.

Contrast-enhanced MRI was central to the investigation because it reveals pathological changes that plain CT and non-contrast imaging often miss. Gadolinium-based contrast agents leak across disrupted blood-brain barriers, highlighting thickened, inflamed meninges, tuberculomas, abscesses, and the characteristic basal enhancement pattern of tuberculous meningitis. This technique allowed the team to classify patients into imaging subtypes and to document complications such as cerebral infarction, hydrocephalus, and cerebral arteritis with far greater sensitivity than conventional approaches.

When the two prognosis groups were compared, striking differences emerged. Patients in the poor prognosis group were older and more frequently male. They more often presented with meningeal-type or mixed-type intracranial tuberculosis rather than the parenchymal form, and they showed significantly higher rates of meningeal thickening, involvement of the basal and pericallosal cisterns, multi-site meningeal involvement, acute cerebral infarction, hydrocephalus, and cerebral arteritis. Conversely, parenchymal-type disease and tuberculomas were less common in the poor outcome group, suggesting that disease confined to brain tissue with discrete granulomas may carry a better outlook than diffuse meningeal inflammation.

To move beyond simple associations, the researchers performed multivariate logistic regression, a statistical technique that isolates the independent contribution of each variable while controlling for all others. Three factors emerged as independent risk factors for poor long-term prognosis: age, acute cerebral infarction, and hydrocephalus. This finding is clinically meaningful because it separates true prognostic drivers from markers that merely travel alongside them. Meningeal thickening and arteritis, for example, were more common in poor-outcome patients but did not retain independent predictive value once infarction and hydrocephalus were accounted for.

The predictive model built from these three variables performed impressively well. Evaluated with receiver operating characteristic analysis, it achieved an area under the curve of 0.861, sensitivity of 70.1 percent, specificity of 89.6 percent, and overall accuracy of 80.7 percent. In practical terms, the model correctly identified nearly nine out of ten patients who would ultimately do well, while capturing seven out of ten of those destined for poor outcomes. An AUC above 0.85 is generally considered strong discrimination for a clinical prediction model, particularly one built on routinely available imaging and demographic data.

Each of the three predictors tells a coherent biological story. Older patients have less physiological reserve, more comorbidities, and blunted immune responses that impair clearance of infection and repair of tissue damage. Acute cerebral infarction in tuberculous meningitis typically results from inflammatory occlusion of small perforating arteries at the base of the brain, where exudate accumulates in the subarachnoid space and triggers vasculitis. Once brain tissue is lost to infarction, recovery is limited, and the infarct itself serves as a proxy for both disease severity and vascular involvement. Hydrocephalus, meanwhile, arises when inflammatory debris obstructs cerebrospinal fluid flow through the ventricular system or impairs its resorption at the arachnoid granulations, raising intracranial pressure and compressing neural tissue.

The Evans index, a ratio comparing the width of the frontal horns of the lateral ventricles to the maximal internal diameter of the skull, was among the imaging variables recorded, providing a quantitative measure of ventricular enlargement. Its inclusion alongside direct assessments of hydrocephalus reflects the study’s effort to capture both qualitative radiological judgments and reproducible morphometric markers. Similarly, the initial Glasgow Coma Scale score was documented for each patient, anchoring the clinical assessment at admission and allowing the investigators to account for baseline neurological status.

The implications for clinical practice are substantial. Patients with intracranial tuberculosis who present with advanced age, evidence of acute infarction on contrast-enhanced MRI, or ventricular enlargement can now be flagged early as high risk, prompting intensified monitoring, earlier consideration of surgical intervention for hydrocephalus such as ventriculoperitoneal shunting, and closer attention to antitubercular therapy optimization. Conversely, patients with parenchymal-type disease and tuberculomas, who showed more favorable outcomes in this cohort, may be candidates for less intensive follow-up protocols, though the authors caution that individualized assessment remains essential.

Limitations of the study are worth noting. As a single-center retrospective analysis, its findings require validation in larger, multicenter cohorts before widespread adoption of the risk model. The retrospective design also means that imaging protocols and clinical management may have varied over the eight-year enrollment period. Nevertheless, the study demonstrates that contrast-enhanced cranial MRI, already a mainstay of diagnosis in intracranial tuberculosis, can be repurposed as a prognostic tool, transforming a routine diagnostic scan into a roadmap for risk stratification and early intervention. As tuberculosis continues to pose a global burden, particularly in regions with limited neurosurgical resources, simple imaging-based predictors of outcome could help clinicians allocate intensive care where it matters most.

Subject of Research: Risk stratification of intracranial tuberculosis patients using contrast-enhanced MRI predictors of long-term prognosis

Article Title: Risk stratification in intracranial tuberculosis patients based on contrast-enhanced MRI

Article References: Wang, Y.-J., Qiu, X.-W., Wang, A.-L., Hu, Y.-N., Li, W.-Q., & Huang, X.-S. (2026). Risk stratification in intracranial tuberculosis patients based on contrast-enhanced MRI. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14479-w

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14479-w

Keywords: intracranial tuberculosis, contrast-enhanced MRI, hydrocephalus, cerebral infarction, tuberculous meningitis, prognosis, risk stratification, neuroradiology, modified Rankin Scale, cerebral arteritis, BMC Infectious Diseases, Risk

The study, conducted at Cerrahpaşa Medical Faculty in Istanbul and approved by the institutional review board there, retrospectively evaluated the clinical and follow-up records of patients diagnosed and managed at the centre over a ten-year period. Engin performed the skin biopsies, diagnosed and treated the patients, and led the manuscript; Yildirim assisted with follow-up and drafted the text; Erkoc classified treatments and staging and analysed the data. The work was carried out in accordance with the Declaration of Helsinki, and the authors report no conflicts of interest. As is typical for retrospective cohort analyses of rare lymphomas, the value of the dataset lies less in dramatic new findings than in the granular picture it paints of how one busy dermatology service handles a diagnostically treacherous disease over time.

Technically, mycosis fungoides belongs to the primary cutaneous lymphomas, a family of extranodal non-Hodgkin lymphomas that arise in the skin rather than in lymphoid organs. The current diagnostic framework is anchored by the 2018 update of the WHO-EORTC classification, which separates indolent entities such as early-stage mycosis fungoides from aggressive ones such as Sézary syndrome, the leukemic variant characterised by widespread erythroderma, circulating malignant T cells and a markedly worse prognosis. The International Consensus Classification of mature lymphoid neoplasms, published in 2022, further refined this landscape. Within that framework, mycosis fungoides follows a characteristic clinical course: patch-stage lesions progress to plaques, then potentially to tumours, and in a minority of patients to visceral involvement. Most patients, however, never advance beyond the early stages, which is why accurate staging at diagnosis is the single most important prognostic exercise.

That staging depends on a synthesis of clinical, histopathological and, where indicated, molecular data. Skin biopsies are examined for epidermotropism, the migration of atypical T lymphocytes into the epidermis, and for the formation of Pautrier microabscesses, small clusters of these cells that are highly characteristic though not always present. T-cell receptor gene rearrangement studies can demonstrate clonality, distinguishing a malignant population from a reactive infiltrate, but early lesions may lack convincing clonal evidence, forcing clinicians to repeat biopsies over months or years. Blood tests assess for Sézary cells, and in advanced cases, imaging and lymph node biopsy complete the tumour-node-metastasis-blood staging algorithm. The Istanbul study reflects this layered diagnostic process, with the corresponding author personally performing and interpreting the skin biopsies that anchored each patient’s diagnosis.

One of the best-documented problems in the field is diagnostic delay. A frequently cited Danish study by Skov and Gniadecki found that the histopathological diagnosis of mycosis fungoides is often delayed, with patients carrying the disease for years before a biopsy confirms it, partly because early histology is subtle and mimics spongiotic or psoriasiform dermatitis. Every additional year of misdiagnosis represents deferred access to skin-directed therapy and prolonged uncertainty for the patient. A ten-year single-centre dataset is precisely the kind of evidence that quantifies this burden in a specific population, and the Turkish authors frame their work explicitly as an evaluation of clinical and follow-up data, the raw material from which such delays and their consequences can be measured.

Treatment for mycosis fungoides is stage-adapted, and the European Organisation for Research and Treatment of Cancer issued updated consensus recommendations in 2023 that codify the current hierarchy. Early-stage disease is managed with skin-directed therapies: topical corticosteroids and retinoids, phototherapy with narrowband UVB for patches and thin plaques, psoralen plus ultraviolet A for thicker lesions, and localised radiotherapy or total skin electron beam therapy for more extensive or refractory cutaneous involvement. Advanced disease adds systemic options, including interferon-alpha, retinoids such as bexarotene, histone deacetylase inhibitors, antibody-based therapies and, in selected cases, allogeneic stem cell transplantation, the only treatment with potential for durable cure. Combination approaches, pairing a skin-directed modality with a systemic agent, are common in tumour-stage disease. The Istanbul team’s classification of treatments and staging across their cohort maps directly onto this algorithm and illustrates how a high-volume centre deploys it in practice.

Single-centre cohort studies of this kind occupy an important niche in rare-disease research. Randomised trials in mycosis fungoides are difficult to power because the disease is uncommon and its early stages progress slowly, so much of what is known about natural history, treatment patterns and outcomes comes from institutional series accumulated over years or decades. Previous examples include the retrospective analysis of 133 cutaneous lymphoma patients from a single Japanese centre published by Fujita and colleagues, which similarly documented presentation patterns and outcomes over a multi-year window. The Turkish dataset joins this tradition, offering a Mediterranean and Middle Eastern patient population whose demographic profile, referral pathways and treatment access may differ meaningfully from the Northern European and Japanese cohorts that dominate the literature.

The follow-up dimension of the study deserves particular emphasis. Mycosis fungoides can smoulder for decades, and late relapse or transformation to a more aggressive large-cell phenotype can occur years after apparent stability. Longitudinal data from a single centre, where patients are followed by the same diagnostic and therapeutic team, reduce the heterogeneity that plagues multi-site registries, though they also introduce the limitations inherent to retrospective design: reliance on recorded notes, potential loss of patients to follow-up, and the absence of a standardised prospective protocol. The authors’ explicit contribution statement, detailing who diagnosed, biopsied, treated, staged and analysed, underscores the continuity of care that gives such datasets their internal consistency.

For the wider scientific audience, the significance of this research letter lies in what it represents rather than in any single headline number. It demonstrates that cutaneous lymphoma care in Turkey is organised around internationally recognised classification and treatment frameworks, that long-term follow-up is feasible in a public hospital dermatology service, and that the diagnostic bottleneck remains the central challenge of the disease. It also reinforces a message that dermatologists have been repeating for years: persistent, treatment-resistant or unusually distributed skin lesions in adults warrant a low threshold for biopsy and, when histology is equivocal, serial re-biopsy and specialist referral. Earlier recognition will not change the biology of mycosis fungoides, but it moves patients into appropriate surveillance and stage-appropriate therapy sooner, which matters for quality of life and, in the minority who progress, for survival.

The study is available as a research letter in volume 318 of the Archives of Dermatological Research, and its full clinical tables and figures are accessible through the journal. As genomic profiling, targeted immunotherapies and biomarker-driven risk stratification enter the cutaneous lymphoma field, datasets like this one, grounded in a decade of unbroken clinical contact with patients, will serve as the historical baseline against which the next generation of diagnostics and treatments is judged. For now, the Istanbul experience stands as a reminder that in rare lymphomas of the skin, the most powerful clinical instrument remains the patient chart kept faithfully over many years.

Subject of Research: A 10-year single-centre retrospective evaluation of clinical presentation, staging, treatment and follow-up in patients with mycosis fungoides, the most common cutaneous T-cell lymphoma.

Article Title: Evaluation of clinical and follow-up data in patients with mycosis fungoides: a 10-year single-centre experience

Article References: Engin, B., Yildirim, G., & Erkoc, Y. C. (2026). Evaluation of clinical and follow-up data in patients with mycosis fungoides: a 10-year single-centre experience. Archives of Dermatological Research, 318(1), Article 449. https://doi.org/10.1007/s00403-026-04943-7

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04943-7

Keywords: mycosis fungoides, cutaneous T-cell lymphoma, dermatology, WHO-EORTC classification, diagnostic delay, skin biopsy, staging, skin-directed therapy, Sézary syndrome, retrospective cohort study, Istanbul, long-term follow-up

The technology at the heart of this effort, chimeric antigen receptor T-cell therapy, involves extracting a patient’s own T lymphocytes and genetically engineering them to express an artificial receptor that recognises a specific molecular target. In oncology, the most common target is CD19, a protein displayed by many B-cell malignancies, but the same target has proved decisive in autoimmunity for a different reason: pathogenic B cells drive diseases such as systemic lupus erythematosus, myositis and systemic sclerosis. When engineered CAR T cells encounter CD19-expressing B cells, they eliminate them with a depth that conventional immunosuppressive drugs rarely achieve, and in doing so they can interrupt the autoimmune cascade at its source. Early clinical reports have described patients with severe, treatment-refractory disease entering drug-free remission after a single infusion, an outcome that would have seemed implausible only a few years ago.

Yet the expert panel is emphatic that enthusiasm must be tempered by caution. CAR T-cell therapy remains an evolving discipline in autoimmunity, with most evidence derived from small, single-arm studies rather than large randomised trials. Because high-level evidence is still emerging, the recommendations were constructed using the EBMT’s structured practice harmonisation methodology, a formal consensus process designed precisely for situations where clinical practice is racing ahead of definitive data. The result is not a rigid protocol but a shared framework: a set of expectations about who should be treated, where, by whom, and with what degree of monitoring before and after the cells are infused.

The cornerstone of the framework is patient selection. The consensus recommends considering CAR T-cell therapy only for patients with severe autoimmune disease that remains active or progressive despite appropriate standard treatment, meaning that conventional therapies must have been given a genuine opportunity to work before the cellular option is pursued. Whenever possible, the experts say, treatment should be delivered within the controlled environment of a clinical trial, where systematic data collection can accelerate the field’s understanding of efficacy and risk. When trial participation is not feasible, the decision to proceed should be documented through a multidisciplinary assessment involving both autoimmune disease specialists and haematology or cellular therapy experts, ensuring that perspectives from both sides of this unusual therapeutic border are represented before an irreversible step is taken.

Where the therapy is delivered matters as much as who receives it. The recommendations call for treatment in experienced centres, preferably those accredited by FACT or JACIE for immune effector cell therapies, because accreditation signals consistent quality and safety standards in cell processing, manufacturing oversight and toxicity management. The panel also stresses that autoimmune diseases differ enormously from one another in organ involvement, comorbidity burden and prior treatment exposure, so disease-specific assessment and monitoring remain essential even within a common framework. A patient with refractory lupus nephritis, a patient with severe multiple sclerosis and a child with juvenile dermatomyositis present distinct anatomical and immunological challenges, and the guidance explicitly resists the temptation to impose a one-size-fits-all pathway on this heterogeneity.

Raffaella Greco of San Raffaele Hospital in Milan and Dominique Farge of St-Louis Hospital in Paris, who coordinated the consensus process, framed the initiative as a balance between promise and prudence. CAR T-cell therapy, they noted, is emerging as an important new therapeutic approach for patients with severe and refractory autoimmune diseases, but the field is evolving rapidly, and careful patient selection, multidisciplinary management and long-term follow-up are essential. Their stated aim is a shared framework that supports patient safety and greater consistency in clinical practice while the evidence base continues to be built, a formulation that captures the panel’s central tension: how to standardise care without freezing a science that is still moving.

A substantial portion of the guidance concerns what happens around the infusion itself. The recommendations place strong emphasis on activities before and after CAR T-cell administration, including diagnostic assessment, treatment planning, immune monitoring and the management of treatment-related toxicities. One of the most clinically demanding challenges highlighted is the need to distinguish inflammatory complications caused by the therapy, such as cytokine release syndrome or immune effector cell-associated neurotoxicity, from a flare or progression of the underlying autoimmune disease. These entities can overlap in presentation, and misattributing one for the other can lead to harmful treatment decisions. The panel therefore calls for close collaboration between haematology, cellular therapy and autoimmune disease teams, so that the interpretation of fevers, neurological changes or serological shifts is informed by expertise on both sides.

Long-term follow-up and systematic data collection emerge as the panel’s most urgent priorities. The experts strongly recommend reporting every patient treated with CAR T-cell therapies to the EBMT Registry, a step intended to build understanding of long-term outcomes, durability of response and late toxicities. This emphasis echoes recent statements from both the United States Food and Drug Administration and the European Medicines Agency, which have underscored the need for extended surveillance of patients receiving these genetically modified cells. Because CAR T cells can persist in the body for years and deplete B-cell lineages for prolonged periods, questions about hypogammaglobulinaemia, infection risk, secondary malignancy and immune reconstitution cannot be answered without registry-scale data. The EBMT Registry has accordingly been expanded to support structured follow-up of patients with autoimmune diseases across participating centres, converting scattered clinical anecdotes into a coherent evidence base.

Children and adolescents receive dedicated attention in the update, reflecting both the particular vulnerability of younger patients and the relative scarcity of paediatric evidence. The recommendations call for multidisciplinary assessment that weighs disease severity and previous treatments against factors unique to growing patients: organ damage accumulated during development, fertility preservation, quality of life and the long-term consequences of chronic immunosuppression, which in young patients can span decades. The calculus of offering a single potentially curative infusion to a teenager instead of a lifetime of steroid and immunosuppressant exposure is compelling, but the panel insists that the limited paediatric data demand heightened deliberation rather than reduced scrutiny.

Looking forward, the authors identify priorities that will shape the next phase of research: larger controlled clinical trials to establish efficacy beyond single-arm cohorts, biomarkers capable of predicting which patients will respond and which will suffer toxicity, novel CAR targets that might extend the approach beyond B-cell-driven disease, and strategies to improve treatment access so that the therapy does not remain confined to a handful of specialised centres. The 2026 recommendations are explicitly conceived as living guidance under the auspices of EBMT, ISCT and JACIE, and they will continue to evolve as new evidence and clinical experience emerge. For now, they represent the most comprehensive attempt yet to impose scientific discipline on one of the most exciting developments in modern immunology, ensuring that as CAR T cells march from the oncology ward into the rheumatology clinic, they do so under conditions designed to protect the very patients they are meant to help.

Subject of Research: Consensus recommendations for CAR T-cell therapy in severe autoimmune diseases

Article Title: International consensus sets updated framework for CAR T-cell therapy in severe autoimmune diseases

Article References: International consensus sets updated framework for CAR T-cell therapy in severe autoimmune diseases. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: CAR T-cell therapy, autoimmune diseases, EBMT, ISCT, JACIE, The Lancet Rheumatology, patient selection, immune monitoring, long-term follow-up, clinical trials, paediatric care, registry data