Recent ucladom items

Vision-language model-based semantic-guided imaging biomarker for lung nodule malignancy prediction.

Wed, 1 Jul 2026 00:00:00 +0000

OBJECTIVE: Machine learning models have utilized semantic features, deep features, or both to assess lung nodule malignancy. However, their reliance on manual annotation during inference, limited interpretability, and sensitivity to imaging variations hinder their application in real-world clinical settings. Thus, this research aims to integrate semantic features derived from radiologists' assessments of nodules, guiding the model to learn clinically relevant, robust, and explainable imaging features for predicting lung cancer. METHODS: We obtained 938 low-dose CT scans from the National Lung Screening Trial (NLST) with 1,261 nodules and semantic features. Additionally, the Lung Image Database Consortium dataset contains 1,018 CT scans, with 2,625 lesions annotated for nodule characteristics. Three external datasets were obtained from UCLA Health, the LUNGx Challenge, and the Duke Lung Cancer Screening. For imaging input, we obtained 2D nodule slices in nine directions from 50×50×50mm...

Monoclonal Immunotactoid Glomerulopathy Associated With Chronic Lymphocytic Leukemia: A Case Report.

Mon, 29 Jun 2026 00:00:00 +0000

Immunotactoid glomerulopathy (ITG) is exceedingly rare in clinical practice. A majority of cases are associated with an underlying hematological disorder and specifically chronic lymphocytic leukemia (CLL). The treatment consists of managing the underlying disease and supportive therapy. We present the case of an 80-year-old patient with a history of CLL who presented with proteinuria and acute kidney injury and eventually developed hematuria. His renal biopsy revealed monoclonal ITG. He began a course of chemotherapy for CLL and achieved remission with improved renal function.

Campylobacter jejuni Enteritis Mimicking Mechanical Small Bowel Obstruction.

Mon, 29 Jun 2026 00:00:00 +0000

In this case, we present an 84-year-old patient admitted for small bowel obstruction (SBO) with radiographic evidence of a clear transition point in the proximal small bowel on a computed tomography (CT) scan. Given his prior history of hemicolectomy, surgical adhesions were suspected as the likely cause. After several days of poor response to supportive treatment, he developed significant secretory diarrhea with stool samples positive for Campylobacter jejuni. In rare cases, C. jejuni enteritis can mimic SBO. We suggest that his SBO initially resembled mechanical obstruction on imaging due to significant bacterial induced circumferential bowel thickening and edema as opposed to the usual pseudo-obstruction from bacterial activated pro-inflammatory mediators, which disrupt intestinal motility. His obstruction resolved with a course of azithromycin antibiotics and conservative measures.

The mental health and well-being effects of wildfire smoke: a scoping review.

Fri, 19 Jun 2026 00:00:00 +0000

Background

Smoke from wildfires is a growing public health risk due to the enormous amount of smoke-related pollution that is produced and can travel thousands of kilometers from its source. While many studies have documented the physical health harms of wildfire smoke, less is known about the effects on mental health and well-being. Understanding the effects of wildfire smoke on mental health and well-being is crucial as the world enters a time in which wildfire smoke events become more frequent and severe. We conducted a scoping review of the existing information on wildfire smokes impact on mental health and well-being and developed a model for understanding the pathways in which wildfire smoke may contribute to mental health distress.

Methods

We conducted searches using PubMed, Medline, Embase, Google, Scopus, and ProQuest for 1990-2022. These searches yielded 200 articles. Sixteen publications met inclusion criteria following screening and eligibility assessment....

Use of Evidence-Based Type 2 Diabetes Preventive Therapies and Rates of Progression to Diabetes Among Veterans with Prediabetes by Race and Ethnicity, 2010–2019

Thu, 18 Jun 2026 00:00:00 +0000

Use of Evidence-Based Type 2 Diabetes Preventive Therapies and Rates of Progression to Diabetes Among Veterans with Prediabetes by Race and Ethnicity, 2010–2019

End-of-Life Care Processes and Outcomes for Older Adults Treated by International Medical Graduates vs. US Medical Graduates

Thu, 18 Jun 2026 00:00:00 +0000

ImportanceInternational medical graduates (IMGs—physicians who graduated from a medical school outside the US) hold a significant role in the US healthcare system. Research suggests that clinicians’ attitudes towards end-of-life (EOL) care may vary across countries.ObjectiveTo compare EOL care processes and outcomes for older adults treated by IMGs vs. US medical graduates (USMGs).DesignCross-sectional study.ParticipantsA 20% random sample of Medicare fee-for-service beneficiaries aged 66 years or older who died in 2016–2019.Main MeasuresSeven EOL care-related measures: (i) palliative care counseling or hospice enrollment in the last 180 days of life; (ii) emergency department visits, (iii) hospital admissions, (iv) intensive care unit admissions, (v) use of mechanical ventilation or cardiopulmonary resuscitation, or (vi) feeding tube placement in the last 30 days of life; and (vii) death in an acute care hospital. We adjusted for beneficiary- and physician-level confounders;...

A diagnostically challenging case of pemphigus foliaceus without histologic evidence of acantholysis

Thu, 18 Jun 2026 00:00:00 +0000

A 77-year-old woman presented with pruritic, scaly, erythematous papules and plaques on the face which then spread to involve the trunk. Over nearly two years, five skin biopsies were performed which overall suggested a subacute to chronic eczematous process without acantholysis or intraepidermal bullae. After two years of failed treatment, antibody testing via enzyme-linked immunosorbent assay demonstrated elevated anti-Desmoglein-1 IgG and normal anti-Desmoglein-3 IgG, and a skin biopsy with direct immunofluorescence revealed IgG and C3 in the intercellular space. A diagnosis of pemphigus foliaceus was made, and the patient was treated with rituximab with significant improvement. Here, we present a diagnostically challenging case of pemphigus foliaceus in which multiple biopsies failed to detect acantholysis or intraepidermal bullae – classic histological findings of this condition, thus highlighting the importance of immunologic testing in the workup of suspected autoimmune...

Dietary Therapies for Gastrointestinal Disorders.

Thu, 18 Jun 2026 00:00:00 +0000

Alterations in gastrointestinal function (digestion, absorption, motility, secretion, and elimination) play important roles in the pathophysiology of many gastrointestinal disorders. Food also strongly influences gastrointestinal health and disease. Some foods act as antigens that trigger an enteric immune response, while others can serve as substrates with direct or indirect biological effects. Food can also be metabolized by gut microbes into bioactive molecules that alter physiology. This review discusses the current research evidence and the clinical use of food as medicine through dietary therapies for the management of various gastrointestinal conditions, including disorders of gut-brain interaction, eosinophilic esophagitis, celiac disease, inflammatory bowel disease, gastroparesis, and short bowel syndrome with intestinal failure.

Pharmacist-Led Discharge Care to Reduce Postdischarge Health Care Utilization

Wed, 17 Jun 2026 00:00:00 +0000

Importance: Pharmacist-led peridischarge transitions of care (TOC) interventions reduce adverse drug events after hospitalization. However, health care organizations do not usually see a financial incentive to fund these interventions. Objective: To test whether pharmacist-led TOC interventions could drive reductions in health care resource utilization after hospital discharge. Design, Setting, and Participants: This pragmatic randomized clinical trial was conducted in 2 urban teaching hospitals in the US. Participants were hospitalized adults aged 55 years or older taking 10 or more long-term prescribed medications or 3 or more high-risk medications (defined as anticoagulants, antiplatelet agents, or antihyperglycemics including insulin), enrolled between December 23, 2019, and December 30, 2022. Data were analyzed from January 2023 to June 2025. Intervention: Pharmacist-led peridischarge and postdischarge medication management with patients and their care partners, including...

A Rare Case of Methamphetamine-Induced Diffuse Gastrointestinal Ischemia

Wed, 17 Jun 2026 00:00:00 +0000

Methamphetamine is a widely used substance known for cardiovascular and neurological complications; however, its gastrointestinal effects remain poorly understood. While rare, methamphetamine-induced gastrointestinal ischemia has high morbidity and mortality rates, with limited case reports in the literature. We present a case of a 48-year-old man with a history of gastroesophageal reflux disease, alcohol use disorder in remission, and previously documented methamphetamine use who presented with two weeks of episodic abdominal pain, nausea, and hematemesis. Significant laboratory and imaging findings included acute anemia, urine toxicology confirming the presence of amphetamines, and computed tomography imaging showing wall thickening in the distal esophagus and stomach. On endoscopy, he was found to have diffuse ulcerations in the distal esophagus and post-pyloric region with pathology indicative of methamphetamine-induced gastrointestinal ischemia. This case highlights...

American Thyroid Association 2026 Guidelines for Thyroid Disease in Preconception, Pregnancy, and Postpartum.

Wed, 17 Jun 2026 00:00:00 +0000

Background

Thyroid disease in pregnancy, preconception, and postpartum is a common and clinically relevant problem. Since the publication of the American Thyroid Association (ATA) guidelines in 2017, substantial new clinical and scientific evidence has become available. The aim of these guidelines is to provide clinicians, patients, researchers, and policymakers with evidence-based recommendations on the care of women with thyroid disease before, during, and after pregnancy.

Methods

The clinical questions addressed were informed by prior ATA guidelines, stakeholder feedback, a global needs assessment, and input from the multidisciplinary task force. Systematic literature searches were conducted with the support from a medical librarian and evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Recommendations were formulated based on the quality of evidence, balance of benefits and harms, patient values, feasibility, and...

Evaluating the Acceptability of Using Virtual Reality to Promote Physical Activity Among Latino, Latina, and Latine Adults With Cardiometabolic Risk Factors and Obesity in Underresourced Settings: Protocol for a Qualitative Focus Group Study

Wed, 10 Jun 2026 00:00:00 +0000

Background: Obesity represents a significant public health challenge in the United States, particularly among Latino, Latina, and Latine communities and those in underresourced settings. Virtual reality (VR) is a new and innovative technology that can promote physical activity and has the potential to overcome some structural barriers. However, there are few studies that explore the acceptability of using this new technology among high-risk groups in underresourced settings. Objective: We outline a community-informed protocol for conducting focus groups with Latino, Latina, and Latine adults who have cardiometabolic risk factors and obesity residing in underresourced communities. The focus groups will assess the acceptability of a culturally aligned VR program to promote physical activity. Methods: Using a community-engaged approach informed by community health workers and a community advisory board, we delivered an immersive VR dance experience to Latino, Latina, and Latine adult...

Predictors of pathologic complete response in early-stage triple-negative breast cancer treated with neoadjuvant chemo-immunotherapy: a multi-institution study.

Fri, 5 Jun 2026 00:00:00 +0000

Introduction

The KEYNOTE-522 clinical trial demonstrated that the addition of pembrolizumab to 8 cycles of neoadjuvant chemotherapy (NAC) improves pathologic complete response (pCR) rates and overall survival in early-stage triple-negative breast cancer (TNBC). However, predictors of response and the benefit of alternative NAC backbones with immunotherapy are not known. This multi-institutional study evaluates clinical factors and treatment variables associated with pCR following NAC plus pembrolizumab in a diverse, real-world cohort.

Methods

This multi-institution retrospective study analyzed patients with early-stage TNBC diagnosed between July 1, 2021, and December 31, 2023, across three hospital systems. Eligible patients received at least one cycle of NAC and pembrolizumab. Predictors of pCR were assessed using logistic regression.

Results

Of the 374 patients included, the pCR rate was 61.2%. The cohort was racially and ethnically diverse, with 29.1%...

Translating a Preclinical Hydrogel Platform into a Human Therapeutic for Delivering Targeted Low-Dose Anti-CTLA-4

Thu, 4 Jun 2026 00:00:00 +0000

Systemic administration of antibodies that target immune checkpoint inhibitor pathways is a highly effective approach to cancer immunotherapy, but systemic toxicity can limit clinical utility. In preclinical testing, a peri-tumor injection of a low dose of hydrogel-encapsulated cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) antibody was shown to selectively activate T cells in tumor-draining lymph nodes, induce tumor infiltration by cytotoxic T cells, and result in tumor regression, protective immunity, and long-term survival. In contrast to systemic therapy, there was limited systemic exposure or risk for autoimmune toxicity. The current study focuses on translating this platform into a biocompatible human therapeutic. The hydrogel matrix was reformulated using a low-molecular-weight hyaluronic acid. A recombinant human hyaluronidase (rHuPH20) was incorporated to promote lymph node targeting and self-resorbing features. Formulations were optimized to operate at neutral...

Elevated AD biomarkers do not explain cognitive performance in a community‐recruited clinical trial cohort

Thu, 4 Jun 2026 00:00:00 +0000

INTRODUCTION: To examine the generalizability of Alzheimer's disease (AD) biomarker models in real-world older adults, we examined AD biomarker relationships with cognition in two multicenter cohorts that differ with respect to recruitment approach and health risk factors but were matched on a variety of characteristics. METHODS: We compared harmonized health and demographic data, AD and cerebrovascular biomarkers, and cognitive performance in the community-recruited U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) Imaging substudy and a matched sample from the Alzheimer's Disease Neuroimaging Initiative (ADNI) which recruited primarily from academic specialty clinics. RESULTS: Elevated β-amyloid (Aβ) and tau were associated with cognitive performance in ADNI but not U.S. POINTER. Findings were consistent across different cohort matching schemes, and were not explained by discrepancies in vascular risk. DISCUSSION: The role of Aβ...

Clinical Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors Among Older Patients Hospitalized for Heart Failure With Reduced Ejection Fraction.

Wed, 3 Jun 2026 00:00:00 +0000

BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors (SGLT2i) reduce cardiovascular events in randomized controlled trials of patients with heart failure with reduced ejection fraction (HFrEF), but these trials enrolled outpatient, relatively younger patients (median age 66-67). The effectiveness of SGLT2i in older patients hospitalized for HFrEF in routine US clinical practice is not well studied. METHODS: This study included Medicare beneficiaries aged ≥65 years hospitalized for HFrEF and eligible for SGLT2i in Get with the Guidelines-Heart Failure between July 1, 2021 and June 30, 2023. Primary outcomes were 30-day and 1-year all-cause mortality, all-cause readmission, and HF readmission. Association between SGLT2i and outcomes was assessed with Cox regression and overlap weighting using propensity score estimates. RESULTS: A total of 8847 patients were eligible for but not prescribed SGLT2i at hospital admission (Median age 77; 40% women; median left ventricular EF...

Disseminated multidrug-resistant Salmonella enterica serovar Dublin infection associated with plasmid-borne CMY-2 gene in a patient with travel to a farm in Mexico

Wed, 3 Jun 2026 00:00:00 +0000

Disseminated Salmonella enterica infections represent a severe form of non-typhoidal salmonellosis increasingly complicated by antimicrobial resistance. We describe a case of disseminated non-typhoidal Salmonella in a man presenting with septic shock concerning for a thoracoabdominal endovascular graft infection with involvement of the urinary and respiratory tracts and thoracic skeleton. Hybrid whole-genome sequencing identified Salmonella enterica serovar Dublin and two significant plasmids, an IncC multidrug resistance plasmid harboring blaCMY−2, blaTEM−206, tet(A), and sul2 and an IncFII(S)/IncX1 virulence plasmid containing a spvA-D/spvR operon associated with systemic infection. This case highlights a potential food-borne or zoonotic acquisition of invasive, plasmid-mediated AmpC-producing Salmonella Dublin.

Representation of People Experiencing Homelessness in U.S. Medical Licensing Exam Question Banks

Wed, 3 Jun 2026 00:00:00 +0000

Representation of People Experiencing Homelessness in U.S. Medical Licensing Exam Question Banks

A primer on quality improvement

Wed, 3 Jun 2026 00:00:00 +0000

This Last Page provides a guide that can help trainees and faculty navigate the quality improvement process, introduce them to available resources, and become valuable agents of change.

Medicaid Coverage Restrictions and On-Label Buprenorphine Prescribing for Chronic Pain

Wed, 3 Jun 2026 00:00:00 +0000

Medicaid Coverage Restrictions and On-Label Buprenorphine Prescribing for Chronic Pain

Postpartum Persistent Opioid Use After Opioid Exposure for Childbirth

Wed, 3 Jun 2026 00:00:00 +0000

Objective

To assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure.

Methods

Retrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use , defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup...

Addressing Primary Care Needs in People Living With Sickle Cell Disease : A Narrative Review.

Wed, 3 Jun 2026 00:00:00 +0000

Adults with sickle cell disease (SCD) are living longer due to advances in care but face a growing burden of chronic comorbid conditions that fall within the scope of primary care. However, primary care providers often lack structured guidance because literature on managing these conditions in the context of SCD is limited. This article outlines clinical approaches to hypertension, diabetes, obesity, chronic constipation, reproductive health, cognitive impairments, depression, and anxiety in people living with SCD. The authors highlight relevant epidemiology, screening recommendations, and treatment considerations that differ from those in the general population. Primary care providers play a crucial role in delivering comprehensive and preventive care to people living with SCD. Specific management of common chronic conditions in this population is necessary to reduce morbidity and improve quality of life.

Oxysterol, Oxy210, Inhibits Hepatic Expression of Senescence-Associated and Pro-Fibrotic Genes in Humanized Hyperlipidemic Mice During Development of MASH and in Human Hepatocytes In Vitro

Wed, 3 Jun 2026 00:00:00 +0000

Background: Senescence, a state of permanent cell cycle arrest, is a complex cellular phenomenon closely affiliated with age-related diseases and pathological fibrosis. Cellular senescence is now recognized as a significant contributor to organ fibrosis, largely driven by transforming growth factor beta (TGF-β) signaling, such as in metabolic dysfunction-associated steatohepatitis (MASH), idiopathic pulmonary fibrosis (IPF), chronic kidney disease (CKD), myocardial fibrosis that can lead to heart failure, cystic fibrosis, and fibrosis in pancreatic tumors to name a few. MASH is a progressive inflammatory and fibrotic liver condition that has reached pandemic proportions, now considered the largest non-viral contributor to the need for liver transplantation. Methods: We previously studied Oxy210, an antifibrotic and anti-inflammatory, orally bioavailable, oxysterol-based drug candidate for MASH, using APOE*3-Leiden.CETP mice, a humanized hyperlipidemic mouse model that closely...

Cardiotoxicity prevention trials in the era of contemporary cancer therapies: a systematic review

Tue, 2 Jun 2026 00:00:00 +0000

BackgroundCardiovascular toxicity is an increasingly important limitation of effective contemporary cancer therapies. Yet, the extent to which trials focus on preventing cardiotoxic events in patients receiving contemporary therapies is unknown.MethodsLeveraging PubMed, CENTRAL, clinicaltrials.gov, and publicly available reviews to identify all randomized controlled trials (RCTs) testing interventions for prevention or management of cardiotoxicity in cancer patients through 2024, we assessed the proportion of cardiotoxicity prevention trials that studied contemporary cancer therapies (biologic, targeted, or immune-based therapies). We included RCTs of interventional therapies/strategies against cardiotoxicity during cancer treatment. Data on trial baseline characteristics, design, funding, and reporting were extracted. Regression models were used to define trial and population factors associated with drug selection, reporting bias, and subsequent translation into guidelines.ResultsOverall,...

Sex Differences in Cancer and Cardiotoxicity: Mechanisms, Outcomes, and Clinical Implications Across Solid and Hematological Malignancies

Tue, 2 Jun 2026 00:00:00 +0000

Sex differences influence cancer incidence, treatment response, and susceptibility to cardiovascular toxicity. Males exhibit higher rates and poorer outcomes in most non-sex-specific cancers, while females more frequently experience treatment-related adverse events, including cancer therapy-related cardiac dysfunction. Biological factors such as hormonal status, genetic polymorphisms, immune responses, and pharmacokinetics contribute to these disparities. In cardio-oncology, women—particularly premenopausal or with specific genotypes—may be at increased risk for cardiotoxicity after treatment with anthracyclines, immune checkpoint inhibitors or radiotherapy. Clonal hematopoiesis and certain germline genetic variants such as single nucleotide polymorphisms (e.g., RARG rs2229774, HAS3 rs2232228) are emerging as potential sex-informed biomarkers for predicting cardiotoxicity risk. Despite growing evidence, sex remains insufficiently integrated into clinical trials and guideline development...

Estimating Lung Cancer Screening Eligibility in the Veterans Health Administration Using Patient-Reported Smoking Histories

Fri, 22 May 2026 00:00:00 +0000

Background

The Veterans Health Administration (VHA) serves a population at increased risk for lung cancer, but lung cancer screening (LCS) rates historically have been low. Understanding the size and characteristics of the screening-eligible population can provide insights for improving screening rates. Many screening eligibility recommendations rely on smoking intensity quantified in "pack-years," which historically has been challenging to obtain at scale from the medical record. Recent introduction of structured smoking data as part of VHA LCS efforts now allows for more robust identification and estimation of the screening-eligible population using a large body of patient-reported smoking histories.

Objective

To estimate the magnitude and characteristics of the LCS-eligible population served by the VHA nationwide based on United States Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) recommendations.

Design

We performed a retrospective,...

Assessing mpox knowledge and sexual behaviours within high-risk populations in the Democratic Republic of the Congo.

Fri, 22 May 2026 00:00:00 +0000

Background

Historically, the Democratic Republic of the Congo (DRC) has faced the greatest public health burden from mpox, including more than 70 000 probable cases from 1 January 2024 to 2 February 2025. However, there has been a relative paucity of investigation focused on mpox community engagement in DRC, including assessments of disease knowledge and risk perception.

Methods

Given the ongoing Clade I mpox public health emergency of international concern, and the linkage between sustained human-to-human transmission and dense sexual networks, we sought to investigate mpox knowledge and sexual behaviours among key populations. Between 20 March 2024 and 25 August 2024, we recruited 2794 participants distributed across Kinshasa, Kwango and North Kivu provinces, with a focus in urban centres where mpox risk was considered high.

Results

Most participants were considered other at-risk populations (948; 33.9%), followed by men who have sex with men (MSM, 828;...

Drp1 regulates mitochondrial health and controls skeletal muscle mass through the Erk1/2-Nur77 pathway

Fri, 22 May 2026 00:00:00 +0000

The maintenance of skeletal muscle mass relies on mitochondrial quality control, including balanced dynamics and mitophagy. Dynamin-related protein 1 (Drp1), a central mediator of mitochondrial fission, is essential for these processes, yet its role in muscle mass regulation remains incompletely defined. Here, we show that acute Drp1 deletion in the skeletal muscle increases Parkin-mediated mitochondrial degradation, reduces mitochondrial DNA (mtDNA) content, and leads to severe muscle atrophy. Although dual deletion of Drp1 and Parkin restores mtDNA content, muscle loss persists. Mechanistically, Drp1 loss impairs mitochondrial respiratory chain activity, suppressing extracellular signal-regulated kinase 1/2 (Erk1/2) signaling and down-regulating the nuclear receptor subfamily 4 group A member 1 (Nur77). Pharmacologic β2-adrenergic receptor activation with clenbuterol reactivated Erk1/2, restored Nur77 expression, and rescued muscle atrophy. These findings define a Drp1-Erk1/2-Nur77...

New age of Lupus Nephritis: Updates in guidelines, biomarkers, and therapies.

Thu, 21 May 2026 00:00:00 +0000

Lupus nephritis (LN) is the most common visceral organ manifestation of systemic lupus erythematosus (SLE). It affects approximately 50% of SLE patients, accounting for significant morbidity and mortality especially in ethnic minorities. Building on decades of landmark trials, the field has continued to evolve. The 2024 American College Rheumatology (ACR) Lupus Nephritis guideline represents an important shift toward earlier triple therapy. The guideline also recommends routine proteinuria screening and reaffirms kidney biopsy as the diagnostic gold standard. In parallel, urinary biomarkers are emerging as potential tools to better track infrarenal pathology. Furthermore, the therapeutic pipeline continues to expand with emerging strategies targeting B-cells, cytokine receptors, and co-stimulatory mechanisms. In this article, we review updates from the ACR guideline, the emerging data on urinary biomarkers, and highlight novel targeted therapies in LN.

Sleep Duration and Prostate Cancer Risk in the Southern Community Cohort Study

Thu, 21 May 2026 00:00:00 +0000

INTRODUCTION: The relationship between insufficient sleep and prostate cancer incidence is unclear. Our goal was to investigate the association of sleep duration, restless sleep, and prostate cancer incidence and aggressiveness, and whether race influences any sleep-prostate cancer association. METHODS: The Southern Community Cohort Study (SCCS) recruited study participants from 12 Southeastern states from 2002 to 2009. The cohort included nearly 35,000 males, predominantly African American (AA, 67%). Sleep exposures were measured via a baseline questionnaire at enrollment, which captured weekday and weekend sleep duration, weighted average sleep duration, and restless sleep. We used Cox proportional hazards models and multinomial logistic regression models to estimate associations between sleep and prostate cancer incidence and aggressiveness. RESULTS: During follow-up (median 10.9 years), 1345 men developed prostate cancer. Shorter sleep duration (< 6 h), in comparison to...

PFKM governs metabolic shifts throughout skeletal muscle differentiation

Mon, 18 May 2026 00:00:00 +0000

Metabolism is known to influence cell identity, but the underlying mechanisms remain unclear. Here we reveal spatiotemporal dynamics of phosphofructokinase 1 (PFK1), a key glycolytic enzyme, within the skeletal muscle lineage. The expression of PFKM (the muscle isoform of PFK1) is low in muscle stem cells and increases during differentiation. Mechanistically, Wnt signalling rapidly induces lysosomal degradation of PFKM through a methyl arginine degron motif, which gets selectively methylated by the protein arginine methyltransferase (PRMT1) and delivered to lysosomes through microautophagy. PFKM degradation shifts glucose metabolism from glycolysis to the pentose phosphate pathway. PFKM overexpression increases glycolysis and promotes differentiation into terminally differentiated myofibres. On the other hand, PFKM knockdown blunts differentiation, which can be rescued by supplementation with the downstream glycolytic intermediate 3-phosphoglycerate. In sum, our findings highlight...

Improving Primary Healthcare for Elderly Patients: How Chronic Disease Management Intensity Makes a Difference

Wed, 6 May 2026 00:00:00 +0000

Background: Since 2009, China has implemented a chronic disease management program within primary healthcare (PHC) institutions in response to challenges posed by an aging population. However, the effectiveness of the program has been reported as mixed, likely due to variations in PHC physicians’ efforts and the support they received from the health system and community. This multi-sector engagement was conceptualized as management intensity in this study, and its impact on the program’s effectiveness was evaluated. Methods: This study analyzed 60 885 patients under the chronic disease management program in Yuhuan, Zhejiang province, as of 2023. Management intensity, the primary predictor, was quantified by township-level residual measured based on patients’ length of follow-up after eliminating patient demographics. This approach removed the portion of follow-up length attributable to individual characteristics, leaving the residual serving as a purified exposure variable for...

Dissemination, adaptation, and uptake of patient-facing materials to improve care coordination in primary care

Wed, 6 May 2026 00:00:00 +0000

Objective: We sought to improve patients' experience of care coordination by promoting the uptake of patient-facing tools with evidence of sustained use in Veterans Affairs (VA) primary care clinics. We disseminated tools, adapted and improved tools in response to feedback, and tracked real-world uptake. Methods: We conducted outreach to leadership and frontline providers at local, regional, and national levels. We collaborated with frontline providers and veteran patients using human-centered design approaches to guide tool adaptation. We assessed dissemination and real-world uptake through website analytics and QR code tracking. Results: Tools included paper pamphlets that explained care processes, provided contact information, and answered frequently asked questions. Feedback resulted in use of larger fonts; pictures and colors; less dense text; and QR codes. Discussions led to development of new tools addressing current challenges coordinating care with VA-paid community providers....

p21+TREM2+ senescent macrophages fuel inflammaging and metabolic dysfunction-associated steatotic liver disease

Wed, 6 May 2026 00:00:00 +0000

Cellular senescence drives chronic sterile inflammation during aging via the senescence-associated secretory phenotype, yet the senescent cell types responsible are poorly defined. Macrophages share multiple features of senescence, including inflammatory secretion, yet whether macrophages can adopt a senescent state remains unclear. Here we identify p21⁺Trem2⁺ senescent macrophages as a major source of inflammaging, using primary mouse and human macrophage models of DNA damage and cholesterol-induced senescence characterized by multi-omic profiling. We found that senescent macrophages exhibit a distinctive p21-TREM2 expression profile and senescence-associated secretory phenotype, driven in part by type I interferon signaling via cytosolic mitochondrial DNA. We also found that senescent macrophage accumulation occurs in aging, metabolic dysfunction-associated steatotic liver disease mouse livers, and is enriched in human cirrhotic liver tissue. Finally, senolytic treatment targeting...

An Innovative Approach to Enhanced Care Management for High-Need Pediatric Medicaid Members: Retrospective Cohort Study.

Mon, 27 Apr 2026 00:00:00 +0000

Background

The California Advancing and Innovating Medi-Cal (CalAIM) initiative supports Enhanced Care Management (ECM) for high-need pediatric populations but published evidence of the impact of ECM in pediatric populations is lacking.

Objective

We evaluated a novel multidisciplinary care model (Pair Team) for delivering ECM services, focusing on implementation and early outcomes for children and adolescents enrolled in Californias Medicaid program (Medi-Cal).

Methods

We conducted a retrospective, observational cohort study of Medi-Cal-enrolled children and adolescents who enrolled in Pair Teams program between July 2022 and November 2024. Program engagement, health care engagement, and depressive symptoms were assessed using program data, electronic health records, and prescription data.

Results

The main cohort included 1294 enrollees with 12 months of follow-up data (mean age 8.9 years, 50.3% (651/1294) female, 81.8% (1058/1294) experiencing homelessness)....

Cost-Effectiveness of Medical Therapy for Heart Failure With Mildly Reduced and Preserved Ejection Fraction

Thu, 23 Apr 2026 00:00:00 +0000

BACKGROUND: Three medications are now guideline-recommended treatments for heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), however, the cost-effectiveness of these agents in combination has yet to be established. OBJECTIVES: The purpose of this study was to determine the cost-effectiveness of mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium glucose co-transporter 2 inhibitors (SGLT2is) in individuals with HFmrEF/HFpEF. METHODS: Using a 3-state Markov model, we performed a cost-effectiveness study using simulated cohorts of 1,000 patients with HFmrEF and HFpEF. Treatment with 1-, 2-, and 3-drug combinations was modeled. Based on a United States health care sector perspective, outcome data was used to calculate incremental cost-effectiveness ratios (ICERs) in 2023 United States dollars based on a 30-year time horizon. RESULTS: Treatment with MRA, MRA+SGLT2i, and MRA+SGLT2i+ARNI therapy resulted...

2025 ACC/AHA Clinical Practice Guidelines Core Principles and Development Process A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Thu, 23 Apr 2026 00:00:00 +0000

2025 ACC/AHA Clinical Practice Guidelines Core Principles and Development Process A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

NATIONAL COSTS FOR CARDIOVASCULAR-RELATED HOSPITALIZATIONS AND INPATIENT PROCEDURES IN THE UNITED STATES, 2016-2021

Thu, 23 Apr 2026 00:00:00 +0000

NATIONAL COSTS FOR CARDIOVASCULAR-RELATED HOSPITALIZATIONS AND INPATIENT PROCEDURES IN THE UNITED STATES, 2016-2021

PREDICTORS FOR PATIENTS UNDERSTANDING REASON FOR HOSPITALIZATION

Thu, 23 Apr 2026 00:00:00 +0000

PREDICTORS FOR PATIENTS UNDERSTANDING REASON FOR HOSPITALIZATION

Perceived Inadequate Neighborhood Food Shopping and Cardiovascular Disease Risk: The Multi-Ethnic Study of Atherosclerosis.

Wed, 22 Apr 2026 00:00:00 +0000

BACKGROUND: Individuals with access to healthy food have healthier diets, improved cardiometabolic risk profiles, and decreased cardiovascular disease (CVD). However, previous studies have focused on the neighborhood food environment as distance to and density of food retailers. Our study examines the association between an individual's perceived adequacy of neighborhood food shopping and incident CVD. METHODS: We analyzed data from 6814 participants in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals aged 45 to 84 who were enrolled in the study between 2000 and 2002 and followed longitudinally. Cox proportional hazards models estimated hazard ratios (HRs) for incident CVD, adjusting for sociodemographic, behavioral, and cardiovascular risk factor covariates. RESULTS: Approximately 20% of participants reported inadequate neighborhood food shopping, with higher prevalence among Black and Hispanic participants, lower income, or educational...

Cardiogenic Shock from Chronic Immune Checkpoint Inhibitor Associated Myocarditis Causing Predominant Right Ventricular Failure

Wed, 22 Apr 2026 00:00:00 +0000

Cardiogenic Shock from Chronic Immune Checkpoint Inhibitor Associated Myocarditis Causing Predominant Right Ventricular Failure

Exploring Self-Employment and Cardiovascular Disease Risk among Hispanic Women.

Wed, 22 Apr 2026 00:00:00 +0000

Objective: Examine the association between self-employment, cardiovascular disease (CVD) risk factors, and health outcomes among Hispanic women. Methods: This observational study was conducted with data from the Behavioral Risk Factor Surveillance System (2003-2022) and a pooled cross-sectional study design to evaluate the association of self-employment with risk factors for CVD. The statistical models were weighted linear probability models that were adjusted for demographics, language, family structure, socioeconomic status, and health insurance. Results: Of the 165,609 working Hispanic women in the study, roughly 13% (20,946) were self-employed. Relative to working for wages or salary, self-employment was associated with a significant mean (95% confidence interval) decline in the predicted probability of reporting diabetes (-1.69% [-2.3%, -1.0%]), hypertension (-3.25% [-4.7%, -1.9%]), obesity (-5.92% [-7.5%, -4.7%]), binge drinking (-1.98% [-3.3%, -0.77%]), and poor health...

“It’s being uncomfortable for who you are, because I think HIV is part of me … ”: psychosocial adaptation and treatment engagement among GBMSM older and younger than 30 years engaged in a coping and disclosure skills intervention in the Eastern Cape, South Africa

Wed, 22 Apr 2026 00:00:00 +0000

Despite expanded antiretroviral therapy access since 2006 in South Africa, gay, bisexual and men who have sex with men (GBMSM) living with HIV face challenges navigating status-sharing risks with limited skills. Stigma, isolation and generational disparities further shape adherence and psychosocial needs across age groups. The Speaking Out and Allying Relationships (SOAR) intervention was designed to strengthen coping and disclosure skills with partners and family members, providing an opportunity to examine how younger and older GBMSM navigate HIV treatment, stigma and social networks. Between April and June 2024, participants completed in-depth interviews addressing intervention experiences, treatment motivators, social support and community perceptions. Guided by Social Cognitive Theory, Erikson's psychosocial development theory and the illness identity framework, systematic coding and comparative analysis explored living with HIV across two generations of GBMSM. Twenty-one...

‘I have a child i need to live for’: a qualitative study of parenthood and the TB experience in South Africa

Wed, 22 Apr 2026 00:00:00 +0000

Existing research highlights TB's economic and social stigma burdens and impacts behavior in households, but virtually unexplored is the dynamics of TB and parenthood. This qualitative study examines the interplay between TB diagnosis and treatment, and parenting experiences, focusing on the intersections of individual agency, societal expectations, and access to resources. From March 2021 to January 2022, we conducted in-depth interviews with 98 TB patients in Buffalo City, South Africa, including 44 mothers and 54 fathers. Guided by the Network-Individual-Resource (NIR) model, we applied layered coding, memoing, and causal mapping to analyze experiences through the lens of agency and societal expectations. Mothers reported primary caregiving responsibilities, drawing motivation from their children, and relying on multigenerational family support for childcare and treatment-adherence. Children frequently provided emotional and practical care, such as cooking and medication reminders....

Prevention and management of peptide receptor radionuclide therapy-induced hypertensive crisis in a patient with metastatic pheochromocytoma

Wed, 22 Apr 2026 00:00:00 +0000

Background/Objective: While peptide receptor radionuclide therapy (PRRT) with lutetium-177 DOTATATE has been increasingly used for metastatic pheochromocytoma management, PRRT-induced hypertensive crisis has been documented in prior reports. A case is reported here to demonstrate the prevention and management of PRRT-induced hypertensive crisis. Case Report A 75-year-old male developed PRRT-induced hypertensive crisis. He had known progressive metastatic pheochromocytoma. Despite scheduled daily alpha and beta blockade, he developed symptomatic hypertensive crisis shortly after completion of lutetium-177 DOTATATE infusion in the first two treatments, which was managed with as-needed oral alpha blockade. Additional alpha blocker was given right before the initiation of lutetium-177 DOTATATE infusion in the third and fourth treatments. Hypertensive crisis still occurred in the third but not in the fourth treatment. He required the 5th treatment due to tumor progression but he developed...

Which Adverse and Positive Childhood Experiences are most Strongly Associated with Young Peoples’ Arrests and Convictions?

Wed, 22 Apr 2026 00:00:00 +0000

Adverse childhood experiences (ACEs) are associated with young people’s criminal legal system involvement, but the extent to which distinct types of ACEs and positive childhood experiences (PCEs) differentially relate to arrests and convictions for youth is unknown. We identified childhood exposures that remain independently associated with arrests and convictions by age 26 among a broad set of ACEs and PCEs. We conducted a cross-sectional analysis of data from two components of the nationally representative Panel Study of Income Dynamics. We examined the occurrence and number of arrests and convictions by age 26 and constructed ACE- and PCE-type indicator variables and overall scores. Weighted, covariate-adjusted logistic and negative binomial regression models estimated associations between ACE types and arrests and conviction outcomes, controlling for PCE score. Similarly, we estimated PCE-type outcome associations controlling for ACE score. Finally, we examined sex differences...

Joint Biochemical and Genetic Prostate Cancer Risk Stratification

Fri, 17 Apr 2026 00:00:00 +0000

PURPOSE: Overdiagnosis of prostate cancer (PC) through PSA testing at short intervals remains common. While baseline serum PSA abundance < 1 ng/mL warrants infrequent screening, it is critical to foster advanced diagnostic practices for men with baseline serum PSA ≥ 1 ng/mL, who are at higher risk for clinically significant disease. We investigated whether common germline variants could enhance screening recommendations in men with PSA ≥ 1 ng/mL. MATERIALS AND METHODS: Polygenic hazard scores (PHS) for the risk of PC diagnosis (PHS290) were computed in a diverse, matched, prospective cohort of 310 men with baseline PSA ≥ 1 ng/mL with or without PC. Regression models were used to predict PC clinical risk groups with PHS290, while incorporating clinical covariates and an existing 5-year risk calculator score. RESULTS: PHS290 stratified individuals with PSA ≥ 1 ng/mL into risk groups and identified men with intermediate-risk and high-risk PC. Adding PHS290 to our model for predicting...

Advancing precision health discovery in a genetically diverse health system

Fri, 17 Apr 2026 00:00:00 +0000

Linking genetic data with electronic health records in hospital biobanks promises to advance precision medicine, but limited ancestral diversity constrains discovery and generalizability. We analyzed 93,936 participants from the UCLA ATLAS Community Health Initiative to inform disease prevalence and genetic risk across five continental and 36 fine-scale ancestry groups. We discovered numerous unreported gene-phenotype associations, including FN3K with intestinal disaccharidase deficiency in Europeans and admixed Americans. Polygenic scores (PGS) robustly predicted common diseases, with effects markedly diminished in non-Europeans. Furthermore, we reduced the pronounced European bias in curated clinical variants using computational predictors, uncovering unreported disease-gene associations, including ANKZF1 and peripheral vascular disease in African Americans. Longitudinal data revealed that semaglutide efficacy varies across ancestries, is associated with PGS for type 2 diabetes,...

Activating transcription factor-4 promotes mineralization in vascular smooth muscle cells

Wed, 15 Apr 2026 00:00:00 +0000

Emerging evidence indicates that upregulation of the ER stress-induced pro-osteogenic transcription factor ATF4 plays an important role in vascular calcification, a common complication in patients with aging, diabetes, and chronic kidney disease (CKD). In this study, we demonstrated the pathophysiological role of ATF4 in vascular calcification using global Atf4 KO, smooth muscle cell-specific (SMC-specific) Atf4 KO, and transgenic (TG) mouse models. Reduced expression of ATF4 in global ATF4-haplodeficient and SMC-specific Atf4 KO mice reduced medial and atherosclerotic calcification under normal kidney and CKD conditions. In contrast, increased expression of ATF4 in SMC-specific Atf4 TG mice caused severe medial and atherosclerotic calcification. We further demonstrated that ATF4 transcriptionally upregulates the expression of type III sodium-dependent phosphate cotransporters (PiT1 and PiT2) by interacting with C/EBPβ. These results demonstrate that...

A microbiome quantitative trait locus in SLC39A8 modulates disease severity in synucleinopathy-induced models of Parkinsons disease.

Wed, 15 Apr 2026 00:00:00 +0000

Parkinsons disease (PD) is a progressive neurodegenerative disorder characterized by motor deficits, dopaminergic neuron loss, and α-synuclein (α-syn) aggregation. While rare mutations underlie familial PD, around 85% of cases are idiopathic. Emerging evidence implicates common genetic variants and the gut microbiome in PD risk, but their interaction has not been studied. We previously demonstrated that the PD-protective SLC39A8 variant rs13107325 (human A391T, corresponding to A393T in mouse) is associated with microbial compositional shifts in humans and reshapes the microbiome in SLC39A8 A393T knock-in mice. Here, we test whether this SNP modifies PD phenotypes in two α-synucleinopathy mouse models. In the human α-synuclein overexpression model, A393T carrier mice show reduced motor deficits, consistent with a protective role. However, in the α-synuclein preformed fibril (PFF) injection model, A393T carriers exhibit worsened motor deficits, increased dopaminergic terminal loss,...

Multilineage Potential of Cells From the Artery Wall