Purpose: Access to electroencephalography (EEG) remains limited across low- and middle-income countries (LMICs) due to cost, infrastructure requirements, and a shortage of trained staff. This study evaluated the feasibility and clinical utility of a smartphone-based EEG system in a real-world setting. Methods: We conducted a multicenter observational study (November 2023 to April 2026) across 29 clinical sites in Kenya. A smartphone-based 27-lead EEG system enabled trained healthcare workers to acquire standardized recordings with remote expert interpretation. Results: 3,036 EEG sessions were performed. Male patients constituted 57.8 Among interpretable recordings, 917 (30.2 Conclusion: Large-scale, point-of-care EEG acquisition by non-specialist operators in a resource-limited setting is feasible. Expansion of smartphone-based EEG systems may improve equitable access to neurological diagnosis and care in LMICs.
Adult T-cell leukemia/lymphoma (ATLL) is a rare HTLV-1-associated malignancy with a dismal prognosis due to intrinsic chemoresistance and immunosuppression. This retrospective EBMT registry analysis evaluated outcomes of allogeneic stem cell transplantation (allo-SCT) in 73 ATLL patients transplanted between 2004 and 2021. With a median follow-up of 3.9 years, 2-year overall survival (OS) and progression-free survival (PFS) were 49
Recent advancements in systemic chemotherapy have fueled debates regarding the feasibility of combining systemic therapy with surgery for advanced intrahepatic cholangiocarcinoma (ICC). However, the absence of consensus on oncological resectability criteria has hindered discussions on optimal multidisciplinary management. This study sought to propose preoperative oncological resectability criteria for ICC. Patients undergoing upfront curative-intent hepatectomy for ICC were identified from an international multi-institutional database. Independent tumor-related prognostic factors for overall survival were identified by using multivariable Cox regression and utilized to develop resectability criteria. Among 953 patients, four independent tumor-related predictors of poor prognosis were identified: lymph node metastasis (LNM) on imaging (HR 1.3, 95
While postoperative adjuvant chemotherapy (AC) is generally recommended for intrahepatic cholangiocarcinoma (ICC), its benefit remains debated. This study aimed to identify patients that may benefit from AC following liver resection of ICC. Patients who underwent liver resection for ICC between 2000 and 2023 were identified from an international multi-institutional database. Individual multivariable Cox models were used to evaluate the interaction between each prognostic factor and the effect of AC on survival. Among 1412 patients, 431 (30.5
Background Existing models to predict recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on static preoperative factors such as alpha-fetoprotein (AFP) and tumor burden score (TBS). These models overlook dynamic postoperative AFP changes, which may reflect evolving recurrence risk. We sought to develop a dynamic, real-time model integrating time-updated AFP values with TBS for improved recurrence prediction. Patients and Methods Patients undergoing curative-intent hepatectomy for HCC (2000-2023) were identified from an international, multi-institutional database with RFS as the primary outcome. AFP trajectory was monitored from preoperative to 6- and 12-month postoperative values, using time-varying Cox regression with AFP as a time-dependent covariate. The predictive accuracy of this time-updated model was compared with a static preoperative Cox model excluding postoperative AFP. Results Among 1911 patients, AFP trajectories differed between recurrent and nonrecurrent cases. While preoperative AFP values were similar, recurrent cases exhibited higher AFP at 6 and 12 months. Multivariable analysis identified TBS (hazard ratio (HR):1.043 [95% confidence interval (CI): 1.002-1.086]; p = 0.039) and postoperative log AFP dynamics (HR:1.216 [CI 1.132-1.305]; p < 0.001) as predictors. Contour plots depicted TBS's influence decreasing over time, while postoperative AFP became more predictive. The time-varying Cox model was created to update RFS predictions continuously on the basis of the latest AFP values. The preoperative Cox model, developed with age, AFP, TBS, and albumin-bilirubin score, had a baseline C-index of 0.61 [0.59-0.63]. At 6 months, the time-varying model's C-index was 0.70 [0.67-0.73] versus 0.59 [0.56-0.61] for the static model; at 12 months, it was 0.70 [0.66-0.73] versus 0.56 [0.53-0.59]. The model was made available online (https://nm49jf-miho-akabane.shinyapps.io/AFPHCC/). Conclusions Incorporating postoperative AFP dynamics into RFS prediction after HCC resection enhanced prediction accuracy over time, as TBS's influence decreased. This adaptive, time-varying model provides refined RFS predictions throughout follow-up.
