Publications by Year: 2026

INTRODUCTION: Inflammatory bowel disease (IBD) commonly affects young women and frequently overlaps with peak reproductive years. Despite this overlap, there remains limited data on the safety and efficacy of IBD treatments during pregnancy and lactation, and many gastroenterology trainees report limited exposure to managing pregnant patients with IBD. Optimal management of IBD in pregnancy ideally starts before conception, with a goal of at least 3 months of steroid-free remission. The preconception period is critical for patient education and therapeutic optimization for patients with IBD. Optimized management during pregnancy and lactation is necessary to prevent adverse maternal and fetal outcomes.

AREAS COVERED: In this review, we discuss latest evidence on the safety and efficacy of available IBD therapies during conception, pregnancy, and lactation. Medications discussed include 5-aminosalicylates, biologic therapies, calcineurin inhibitors, Janus kinase inhibitors, corticosteroids, immunomodulators, and sphingosine 1-phosphate receptor modulators.

EXPERT OPINION: While most IBD therapies can be safely continued during pregnancy and lactation. Patient education during the preconception period is critical for maintenance of remission during pregnancy and postpartum. Evidence-based research and representation of pregnant patients with IBD in future studies are necessary to address existing knowledge gaps to optimize maternal and neonatal outcomes.

BACKGROUND: Surgical intervention, particularly sentinel lymph node and lymph node dissection, is essential in managing melanoma, targeting locoregional disease. Our aim was to elucidate risk factors for postoperative lymphatic complications in melanoma patients undergoing lymph node surgery in Peru.

METHODS: A retrospective cohort study was conducted, reviewing records of melanoma patients who underwent lymphatic surgery at the Instituto Nacional de Enfermedades Neoplásicas from 2010 to 2019. Descriptive statistics and logistic regression analyses were performed to identify predictors of lymphatic complications.

RESULTS: The study included 699 melanoma patients (mean age 60.70 y, 51.4% women). Most patients were Hispanic (99.3%) and from Lima (52.8%), with lower extremity involvement being common. Surgical interventions included wide local excision (56.9%), sentinel lymph node surgery (67%), and lymph node dissection (32.3%). Complications at the site of lymph node dissection included wound dehiscence (1.6%), infection (6.2%), lymphoceles (5.7%), and lymphedema (2.7%). Multivariate analysis identified lymphatic invasion (odds ratio [OR] = 2.601, 95% confidence interval [CI]: 1.232-5.491) and positive lymph node pathology (OR = 2.066, 95% CI: 1.034-4.127) as risk factors, whereas primary lesion location in the upper extremity (OR = 0.055, 95% CI: 0.007-0.408) and trunk (OR = 0.106, 95% CI: 0.014-0.818) were protective factors.

CONCLUSIONS: Key risk factors for postoperative lymphatic complications in melanoma patients undergoing lymph node surgery include lower extremity involvement, lymph node dissections, lymphatic invasion, and positive lymph nodes. Understanding these risk factors can help clinicians optimize management strategies to reduce postoperative lymphatic complications.

Transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) is a powerful technique for investigating human cortical circuits. However, characterizing TMS-evoked potentials (TEPs) at the group level typically relies on grand averaging across stimulus repetitions (trials) and subjects-an approach that assumes a level of spatial and temporal consistency that is often lacking in TEPs. Here, we introduce an adaptation of Group Task-Related Component Analysis (gTRCA), a novel multivariate signal decomposition method, to automatically extract TEP components that are maximally reproducible across both trials and subjects. Following the validation of a new permutation-based statistical test for gTRCA using simulated data, the method was applied to two independent TMS-EEG datasets, in which stimulation was targeted to the primary motor cortex (M1) in cohorts of 16 and 22 healthy participants. We found that gTRCA reliably identified TEP components that were reproducible at the group level. Notably, the main gTRCA component captured the key spatial, temporal, and spectral features of motor TEPs, remained robust despite reduced number of stimuli and participants, and was consistent across different recordings. These findings demonstrate that gTRCA affords a more reliable characterization of TEPs at the group level, thereby facilitating the translation of TMS-EEG research into clinical practice.

Mold bloodstream infections are rare but highly fatal, especially with Lomentospora prolificans and Scedosporium spp. Among 84 episodes over 20 years, the 30-day mortality rate was 38%. Cancer, intensive care unit admission, and healthcare-onset infection were linked to increased mortality rates, highlighting the need for early detection and better management strategies.

BACKGROUND: Transcutaneous afferent patterned stimulation (TAPS) is a non-invasive, wrist-worn neurostimulation therapy that has demonstrated acute and short-term lasting tremor reduction in patients with essential tremor (ET). However, the longer-term improvement in underlying tremor severity from consistent use of TAPS has not been fully explored.

METHODS: We conducted a retrospective analysis of the multicenter PROSPECT trial, which evaluated twice-daily TAPS use over three months in patients with ET. Underlying tremor improvement was assessed by comparing pre-stimulation tremor severity at baseline with pre-stimulation tremor severity at 1- and 3-month follow-up visits. Tremor severity was measured using the Bain & Findley Activities of Daily Living (BF-ADL) scale and the Tremor Research Group's Essential Tremor Rating Assessment Scale (TETRAS). Responders were defined as patients demonstrating at least a 1-point improvement on any qualifying task.

RESULTS: Among 192 patients with available data, pre-stimulation BF-ADL scores improved significantly by 2.0 points at 1 month and 2.7 points at 3 months compared with baseline (p < 0.001). Pre-stimulation TETRAS scores also showed significant improvements at both time points (p < 0.001). Measurements at 1 and 3 months were made an average of 16.2 hours after the prior stimulation session. Over 80% of patients met responder criteria for underlying tremor improvement on BF-ADL and TETRAS at both follow-up visits. Improvements were observed even among patients using TAPS approximately once daily.

CONCLUSIONS: Consistent use of TAPS was associated with significant improvement in underlying tremor severity in patients with essential tremor. These findings suggest that regular TAPS use may confer sustained therapeutic benefit.

INTRODUCTION: The glucagon-like peptide-1 receptor agonist semaglutide may impact neuroinflammation and reduce neurodegeneration. We present baseline characteristics of participants enrolled in the evoke (NCT04777396) and evoke+ (NCT04777409) trials, referred to as "evoke (+)" hereafter.

METHODS: Evoke (+) are two ongoing global, multicenter, randomized, double-blind, parallel-group, placebo-controlled phase 3 trials investigating semaglutide in participants with early-stage symptomatic Alzheimer's disease (AD) with confirmed amyloid positivity (by positron emission tomography or cerebrospinal fluid testing). Inclusion criteria are the same for both trials, except that by design, evoke+ also includes participants with significant small vessel pathology. Both trials include a 12-week screening phase before randomization (1:1) to receive oral semaglutide titrated to 14 mg or placebo for 156 weeks. Baseline data were summarized and analyzed descriptively. Additionally, data were pooled and assessed by five main geographical regions.

RESULTS: Evoke (+) recruited 9996 participants from 566 sites in 40 countries. The mean (standard deviation) age of participants was 71.8 (7.1) and 72.6 (7.1) years in evoke and evoke+, respectively; more participants were female than male (female: 53.0% and 51.9%, respectively) and most had a Clinical Dementia Rating (CDR) global score of 0.5 (72.8% and 71.4%; CDR global score of 1: 26.5% and 27.6%). Both trial populations had similar demographics, and clinical and cognitive baseline characteristics, except that 2.8% of participants in evoke+ had magnetic resonance imaging-documented significant small vessel pathology as per protocol inclusion criteria. Regional-level data demonstrated some differences in AD treatment characteristics, including cholinesterase inhibitor use of 41.7% in North America versus 61.6% in Asia.

DISCUSSION: Evoke (+) are the only large-scale, phase 3 trials investigating the longer-term efficacy and safety of semaglutide in early AD as a potential disease-modifying treatment. The baseline characteristics from evoke (+) reflect a varied, global population with early-stage symptomatic AD. Primary readouts are expected in the second half of 2025.

HIGHLIGHTS: evoke and evoke+ are the only large-scale randomized controlled trials (RCTs) investigating the longer-term efficacy and safety of semaglutide in early AD.Baseline characteristics reflect a varied, global population.The trials' primary readouts are expected in the second half of 2025.

BACKGROUND: People with HIV (PWH) are at higher risk of myocardial fibrosis and subsequent heart failure (HF) compared to people without HIV (PWOH). Mechanisms underlying this risk and its specificity to PWH are unclear.

METHODS: We measured 2594 proteins in plasma obtained concurrently with cardiovascular magnetic resonance imaging among 342 PWH and PWOH. We estimated associations with HIV serostatus and myocardial fibrosis (elevated extracellular volume fraction, ECV ≥30% among women, ≥28% among men) using multivariable regression. Among an independent community-based cohort, we estimated associations between the identified signature and time to incident HF.

RESULTS: Participants were age 55±6 years, 25% female, 61% PWH (88% on antiretroviral therapy, 74% undetectable HIV RNA), and 52% had elevated ECV. We identified 39 proteins and one cluster of 42 proteins that were higher among PWH vs. PWOH and positively associated with elevated ECV, independent of risk factors (FDR<0.05). Among an independent cohort of 3223 PWOH (age 68±9 years; 52% female; 118 incident HF cases over 9.8±1.4 years), we found this protein cluster and 34 of 39 individual proteins were associated with time to incident HF. This signature was statistically enriched for T cell activation, TNF signaling, ephrin signaling, and tissue maintenance and repair.

CONCLUSION: We identified an HIV-related proteomic signature associated with myocardial fibrosis regardless of HIV serostatus and that predicted incident HF among the general population. Our results identify several novel associations related to specific immune processes that may contribute to risk of myocardial fibrosis and subsequent HF among both PWH and PWOH.