Peer support is an effective strategy to promote self-management behaviors and improve well-being in those with cardiometabolic disease, including type 2 diabetes mellitus (T2DM). There is limited knowledge about stakeholder perceptions regarding peer support programs in low- and middle-income countries (LMICs). The study assessed stakeholders' awareness and understanding of peer support initiatives for T2DM, and explored their perceived barriers and readiness for implementation. A cross-sectional, self-administered online survey with branching logic was distributed to stakeholders across macro- (health policy), meso (tertiary hospital), and micro (community) levels of LMIC healthcare systems from June 1 to December 15, 2023. Quantitative data were analyzed descriptively; qualitative data underwent thematic content analysis. A total of 69 respondents from 25 LMICs participated in the survey. Due to branching logic and response attrition, 53 surveys (77%) had complete responses. Most respondents were medical doctors (n = 35, 50.7%) and a large proportion worked in tertiary hospitals (n = 27, 39.1%). Thirty-nine respondents (56.5%) were aware of peer support; among the 38 respondents with complete data, 29 (76%) reported active involvement in T2DM peer support initiatives. Of 15 responses to open-ended questionnaires regarding barriers to T2DM peer support, 9 (60%) cited concerns about limited resources and lack of funding. Local leadership (mean ± standard deviation: 3.4 ± 1.2), resource allocation (2.7 ± 1.4), and sustainability planning (2.7 ± 1.4) showed the highest perceived readiness on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Stakeholders in LMICs demonstrate awareness and active involvement in T2DM peer support programs. While limited resources and funding remain significant barriers, local leadership, resource allocation, and sustainability planning showed the highest perceived readiness, indicating promising foundations for implementation. Strengthening these areas through targeted support could facilitate the expansion and sustainability of peer support initiatives in resource-constrained settings.
Publications by Year: 2026
2026
KEY POINTS: In a large longitudinal study of predialysis CKD, plasma fibroblast growth factor 23 was stable in most of the children when modeled as linear trajectories over time Children with rapidly rising fibroblast growth factor 23 trajectories exhibited lower eGFR, higher serum phosphorus, proteinuria, and anemia compared with those with stable levels Longitudinal fibroblast growth factor 23 monitoring provides a powerful, independent predictor of kidney disease progression in children with CKD.
BACKGROUND: In children and adults, plasma fibroblast growth factor 23 (FGF23) concentrations increase early in CKD and associate with disease progression and adverse cardiovascular outcomes. However, longitudinal changes in FGF23 in children with progressive CKD are not well characterized.
METHODS: We measured c -terminal FGF23 biannually and eGFR in 543 children with CKD stages 2-4 enrolled in the CKD in children study. All participants had 2-3 FGF23 measurements. We used a linear mixed model to estimate the average percent change in FGF23 and eGFR over time for the overall cohort and latent group-based trajectory modeling to identify populations with distinct patterns of change in FGF23 concentration, eGFR, and phosphorus z -score. We used Cox proportional hazards model to examine the risk of progression to kidney failure according to FGF23 trajectory group.
RESULTS: At study enrollment, the median age was 12 years and eGFR 52 ml/min per 1.73 m 2 . In univariate models with repeated measures, FGF23 increased by a mean of 3.7% annually, and eGFR decreased by 3.8% annually over a median observation period of 4 years. We identified three distinct FGF23 trajectories: stable in 64% of participants (FGF23 slope 0% per year); slowly rising in 30% (slope 6% per year) and rapidly rising in 6% (slope 39% per year). Membership in the faster-rising trajectory groups was associated with lower eGFR, higher serum phosphorus, greater proteinuria, and anemia. With subsequent median 4.9 years of follow-up, the risk of kidney failure was 1.7-fold higher (95% confidence interval, 1.09 to 2.67) in the slowly rising and 8-fold higher (95% confidence interval, 2.41 to 23.56) in the rapidly rising FGF23 trajectory group compared with the stable trajectory group, in fully adjusted analyses. Phosphorus z -score trajectories did not associate with progression to kidney failure in adjusted models.
CONCLUSION: By characterizing longitudinal changes in FGF23 in children with CKD, we find that FGF23 was stable in most children. Membership in the faster-rising FGF23 trajectory groups associates with increased risk of progression to kidney failure. Future studies are needed to investigate whether FGF23 is a modifiable cause or a consequence of CKD progression in children with CKD.
Apolipoprotein E (APOE) ε4 is the strongest genetic risk factor for Alzheimer's disease (AD). However, it is known that other pathways independent of APOE also play a role in AD. Disentangling APOE-dependent and independent effects is instrumental for understanding the biology of AD. We conducted an APOE-stratified multi-omic analysis in multiple large datasets to identify AD-associated plasma proteins and metabolites. More than 64% of the identified proteins were not found in non-APOE stratified studies, and 17% of the proteins showed APOE-specific trends. Mitochondrial dysfunction was associated in AD independently of APOE and was accompanied by disruptions in glucose and lipid metabolism and cell death and increased in inflammatory signaling activation. Lipid upregulation was found in AD cases when compared with controls with the same APOE genotype, indicating that additional factors beyond APOE affect lipid regulation and AD risk. These findings may be informative in guiding the development of effective medications for AD.
OBJECTIVES: To evaluate the feasibility, safety, and technical performance of robot-assisted CT-guided cryoablation for pulmonary metastases.
MATERIALS AND METHODS: A single-centre IDEAL stage 2a prospective development study of 26 participants (median age 62 years, IQR 47-71; 14 men) who underwent 30 procedures targeting 37 lung metastases using a robotic navigation system. Median tumour diameter was 9.8 mm (IQR 5.1-12.8). All procedures were performed under general anaesthesia with high-frequency jet ventilation. Feasibility, safety, and technical performance (targeting accuracy, manipulations, radiation dose) were recorded.
RESULTS: Robotic guidance was successfully completed without conversion in 35/37 tumours (95%). One major complication occurred (3%, CTCAE grade 3 pneumothorax requiring 4 days of drainage); all others were grade 1-2. Pneumothoraces were managed by observation (n = 7) or prophylactic intraprocedural chest drain insertion (n = 11). No bronchopleural fistulas were observed. Median hospital stay was 1 night (IQR 1-2). A total of 54 cryoprobes were used. Median Euclidean targeting error on first insertion was 6.1 mm (IQR 2.9-9.7) and lateral error 4.2 mm (IQR 2.2-6.5). The median number of manipulations per probe was 1 (IQR 0-2.5), with one-third requiring no adjustment. Once integrated into the workflow, the "chopstick" technique was frequently applied, supporting conformal ablation. Median total procedure time was 66.5 min (IQR 56.6-92.8). Twelve-month local tumour progression-free survival was 97%.
CONCLUSION: Robot-assisted CT-guided cryoablation of pulmonary metastases was feasible, safe, and accurate, achieving high targeting precision with minimal cryoprobe manipulation. These findings support evaluation in prospective comparative trials.
KEY POINTS: Question Robotic-assisted CT-guided cryoablation of lung metastases is feasible and safe, achieving high targeting accuracy and minimal probe manipulation, even in anatomically challenging cases. Findings Robotic trajectory planning supported complex multiprobe configurations. Procedural refinements-including patient positioning, probe selection, and adoption of "chopstick" configurations-were introduced to address bleeding risk and optimise energy delivery. Clinical relevance Robot-assisted navigation is particularly advantageous in cryoablation, enabling minimal manipulations and accurate probe placement despite the often-necessary complex trajectories.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent hepatic pathology worldwide, with significant potential for progression to cirrhosis and ultimately end-stage liver disease. Accordingly, a wide range of preclinical models have been developed to better understand the disease mechanisms and progression as well as to accelerate drug discovery. These include in vitro, ex vivo, and in vivo models, which offer unique advantages yet differ in terms of disease driver, species used, and biological complexity-ranging from benchtop cellular systems to whole organs and organisms. In this review, we provide a comprehensive overview of the technologies currently used for the study of MASLD, with a focus on how standardization of disease progression across models may aid therapeutic development.
Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NSAID-ERD) is a heterogeneous condition characterized by chronic eosinophilic airway inflammation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma whose symptoms are aggravated after ingestion of aspirin and other NSAIDs. As a unique treatment, aspirin treatment after desensitization (ATAD) has been in use for several years after showing the inhibitory effect on CRS symptoms and nasal polyp growth as well as severe asthma. However, in recent years, biologics have also shown to cause a decrease in polyp size as well as associated outcomes such as quality of life. In this manuscript, considerations on choosing the best treatment of NSAID-ERD are laid out based on current literature.
BACKGROUND: The antithrombotic strategies for symptomatic intracranial atherosclerotic stenosis (sICAS) remains challenging. Dual pathway inhibition (DPI) has demonstrated clinical benefit in coronary and peripheral artery disease.
AIMS: This study aimed to evaluate the efficacy of DPI with low-dose rivaroxaban plus antiplatelet therapy (APT) compared with APT alone on recurrent stroke with sICAS.
METHODS: This prospective cohort study included patients with sICAS identified from the Ischemic Cerebrovascular Disease Database of the First Affiliated Hospital of Zhengzhou University between January 2019 to August 2023. Low-dose rivaroxaban was prescribed off-label to patients in the DPI group. The outcomes were ischemic stroke, transient ischemic attack (TIA), acute coronary syndrome (ACS), all-cause death and cardio-cerebrovascular death within 1 year of discharge. Cox regression with inverse probability of treatment weighting (IPTW) was applied to compare outcomes between the DPI and APT groups. The win-ratio method was used to assess the major adverse cardiovascular events (MACE), prioritized in the order of all-cause death, recurrent ischemic stroke or TIA, and ACS.
RESULTS: Among the 1217 patients with sICAS, 131 (10.8%) received DPI therapy. The recurrence rate of ischemic stroke was lower in the DPI group compared to the APT group (8/131 [6.1%] vs 136/1086 [12.5%]). DPI significantly reduced the risk of ischemic stroke recurrence (HR = 0.46, 95% CI: 0.23-0.94, p = 0.034) and the incidence of MACE (HR = 0.53, 95% CI: 0.29-0.97, p = 0.041) during the 1-year follow-up, consistent with the IPTW-based cohort (HR = 0.35, 95% CI: 0.16-0.76, p = 0.008; HR = 0.43, 95% CI: 0.22-0.83, p = 0.012). The win-ratio analysis of MACE favored DPI therapy (win ratio = 2.34, 95% CI: 1.41-3.90, p = 0.001). Symptomatic intracranial hemorrhage, fatal bleeding, and hospitalization for gastrointestinal bleeding were infrequent in this cohort.
CONCLUSIONS: DPI therapy may be associated with a lower risk of recurrent stroke compared with antiplatelet therapy alone in patients with sICAS. These findings warrant further investigation through large-scale randomized controlled trials.
Women's health remains inadequately served due to the historical predominance of males as the biological reference in medical research, leading to persistent sex-based gaps in the understanding, diagnosis, and management of disease. As healthcare moves toward decentralization, e.g., through the collection of person-generated health data, point-of-care diagnostics, and wearable devices, there is a critical need for tools tailored to women's unique conditions and presentations. Ultrasound technologies, recognized for their versatility and safety, have evolved from imaging to multifunctional platforms, with growing roles in diagnosis and therapy. Diagnostic ultrasound non-invasively assesses anatomical features and functional information, and therapeutic ultrasound can perform targeted interventions, including neuromodulation, immunomodulation, thermal ablation, and drug delivery. By exploring the fundamental physical principles of ultrasound, including acoustic streaming, cavitation, and thermal interactions, and linking these mechanisms to cellular and tissue responses, this review highlights the capability of ultrasound to address female-specific health disparities, especially in conditions that are undertreated or differentially expressed in women. Advancements in ultrasound technologies could significantly enhance clinical outcomes and improve the quality of life for women affected by conditions currently underserved by traditional medical interventions.
Preventable readmissions represent a significant opportunity to improve quality and reduce healthcare costs, with approximately 26% of Medicare medicine readmissions considered preventable. However, evidence on the effectiveness of post-discharge interventions at scale remains mixed, and implementing evidence-based practices consistently across large, diverse health systems is a challenge. To address these concerns, the Mass General Brigham Population Health Services Organization (MGB PHSO) developed and implemented a novel, multidisciplinary, system-wide post-discharge intervention aimed at reducing 30-day readmissions within its Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO). It was hypothesized that standardizing delivery through a high-fidelity workflow would reduce readmissions. A standardized, multidisciplinary program was created involving: (1) a coordinator conducting chart review and obtaining records; (2) a pharmacist performing medication reconciliation; and (3) a registered nurse completing a post-discharge assessment. A prospective cohort study was conducted comparing the outcomes of patients at pilot intervention sites with those of a propensity-matched control group. The intervention cohort showed a directional reduction in 30-day readmission rates compared to the matched controls (13.5% vs. 16.3%, P = 0.07) but no significant difference in 30-day emergency department presentations. The intervention group also had a significantly higher rate of 14-day follow-up appointments (70.0% vs. 65.3%, P = 0.025). These findings support the effectiveness of a centralized, standardized post-discharge strategy for reducing readmissions within an ACO setting. This study demonstrates that structured, system-level interventions can improve care transitions and outcomes in value-based care models.