Publications by Year: 2026

BACKGROUND: Premature birth is the leading cause of neonatal morbidity and mortality. Understanding perceptions, beliefs and attitudes towards preterm births, and how these factors influence care provision at health facilities and at home is crucial for improving preterm newborns' health outcomes.

METHODS: We conducted an exploratory qualitative study at Batu and Meki communities in the East Shewa Zone of Oromia Region, Ethiopia. We conducted in-depth interviews (n=81) and focus group discussions (n=8) using semistructured guides. The study participants included women who had preterm births, family members, community members, healthcare workers and expert stakeholders. We audio-recorded, transcribed the interviews and coded the transcripts. We employed the socioecological model to present perceptions, beliefs and attitudes towards preterm birth at individual, interpersonal, organisational and societal levels.

FINDINGS: Giving birth to a preterm newborn is often associated with fear, stress, unhappiness, concern and worry. At the individual level, preterm newborns' mothers often feel guilt and self-blame. Families tend to keep preterm birth a secret due to perceptions of 'incompleteness'. At the interpersonal level, preterm newborns are often stigmatised and families are disappointed by mothers who give birth prematurely. However, some believe that preterm newborns are accepted within the community. At the organisational level, healthcare providers find the causes of preterm birth unpredictable, they do not consider preterm births prevalent, and consider some of them as abortion. There is also a common belief that preterm infants have a low survival rate, leading to the deprioritisation of their care. At the societal level, some believe preterm births are caused by divine will as punishment for sins committed by the mother, while others think they occur naturally. Preterm newborn's death is often not acknowledged as true loss and families are discouraged from grieving.

CONCLUSIONS: Our study found that the beliefs, perceptions and attitudes surrounding preterm birth, held by families, communities, healthcare providers and society at large, influence the care that preterm newborn-mother dyads receive both at home and within health facilities. Addressing these requires a multifaceted approach targeted at deeply ingrained attitudes and perceptions.

BACKGROUND: Clozapine is highly effective for treatment-resistant schizophrenia but has been associated with an increased risk of agranulocytosis. As a result, until 2025, the Food and Drug Administration required patients receiving clozapine to undergo regular blood testing to monitor for neutropenia as part of a Risk Evaluation and Mitigation Strategy (REMS) programme.

OBJECTIVE: This study sought to compare the risk of neutropenia-related hospitalisations between clozapine and olanzapine initiators.

METHODS: The study cohort was nested in claims data from Medicaid and two commercial health insurance databases and consisted of adults initiating clozapine or olanzapine who had a recorded diagnosis of schizophrenia or schizoaffective disorder and ≥1 dispensing of a different antipsychotic in the 6 months before initiation. Propensity score matching (1:1) was used to mitigate confounding. The primary outcome was hospitalisation with a neutropenia diagnosis in the primary position. Both as-treated and intention-to-treat analyses were implemented.

FINDINGS: After propensity score matching, there were 16 873 initiators in each group. At 6 months postinitiation, there were 12 neutropenia-related hospitalisations among the clozapine cohort (incidence rate: 2.21 per 1000 person-years; 95% CI 1.25 to 3.89) and <11 among the olanzapine cohort (0.18; 95% CI 0.03 to 1.29), corresponding to an incidence rate ratio (IRR) of 12.18 (95% CI 1.58 to 93.71). The IRRs were 5.77 (95% CI 1.29 to 25.76) at 1 year, 5.50 (95% CI 1.23 to 24.55) at 2 years and 5.40 (95% CI 1.21 to 24.13) at 3 years postinitiation. Associations remained but were attenuated in intention-to-treat analyses.

CONCLUSIONS: Clozapine initiators had an elevated risk of neutropenia-related hospitalisation, especially during the first 6 months of treatment, although the absolute risk was low.

CLINICAL IMPLICATIONS: Despite removal of the REMS programme, it is important for prescribers to monitor patients for neutropenia after initiating clozapine.

The burden of sepsis is poorly understood, but it is estimated that nearly 50 million cases of sepsis occur annually, accounting for nearly 20% of all deaths globally. Modern techniques to capture sepsis epidemiology are limited, particularly when applied to lower-middle income countries where the burden of sepsis is highest. We need more robust data sets, surveillance infrastructure, and integrated research to better assess the prevalence of this syndrome, identify vulnerable populations, and develop policy interventions to effectively mitigate the impact of sepsis globally.

Microcirculatory dysfunction plays a central role in sepsis pathophysiology and is associated with poor clinical outcomes. While advances in bedside tools and biomarkers offer potential for identifying microcirculatory dysfunction, most therapies targeting the microcirculation have not translated into improved clinical outcomes. Future advances likely lie in precision medicine approaches that employ microcirculatory measurements to guide individualized resuscitation strategies. This article highlights current evidence on the physiology, assessment, and therapeutic approaches to microvascular dysfunction in sepsis, underscoring the need for precision medicine strategies and further research into patient subgroups that may benefit from microcirculation directed interventions.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive form of acute leukemia. BPDCN has a strong predilection for the skin and poses diagnostic challenges with clinical and histologic features that overlap with other conditions. BPDCN shows recurrent myeloid-associated mutations, complex chromosomal aberrancies, and copy-number changes with chromosomal losses involving tumor suppressors and cell cycle regulators. In patients with cutaneous BPDCN, the bone marrow frequently harbors mutationally related myeloid clones/neoplasms; BPDCN transforms from underlying premalignant hematopoietic clones with acquisition of additional progression events, and often occurs in association with ultraviolet damage in sun-exposed sites.

Anaplastic lymphoma kinase (ALK) rearrangements have emerged as a defining molecular alteration across a wide spectrum of cutaneous mesenchymal and melanocytic neoplasms with diverse clinical, histologic, immunophenotypic, and biologic features. This article describes several distinct ALK-rearranged cutaneous neoplasms: epithelioid fibrous histiocytoma, superficial ALK-rearranged myxoid spindle cell neoplasm, nonneural granular cell tumor, Spitz melanocytic neoplasms, and other emerging entities. ALK overexpression by immunohistochemistry and confirmatory molecular testing, when necessary, plays a critical diagnostic role. The expanding spectrum of ALK-rearranged cutaneous tumors underscores the value of an integrated diagnostic approach to ensure accurate diagnosis and guide clinical management.

OBJECTIVE: To synthesize magnetic resonance imaging (MRI) features and their reported diagnostic performance that differentiate benign from malignant soft-tissue tumors in alignment with the 2020 World Health Organization classification.

MATERIALS AND METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials were searched through July 2024. Eligible studies reported MRI feature frequencies or diagnostic accuracy for common soft-tissue tumor subtypes. Reviews, case reports, duplicates, non-English publications, and studies outside the scope were excluded. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

RESULTS: Seventy-six studies met inclusion criteria. In lipomatous tumors, homogeneous fat signal and thin septa supported lipoma, whereas thick or nodular septa and enhancement favored atypical or well-differentiated liposarcoma. Myxofibrosarcoma often demonstrated an infiltrative fascial "tail." Vascular lesions included angioleiomyoma with a reticular T2 pattern and glomus tumor with marked T2 hyperintensity and avid enhancement. In peripheral nerve sheath tumors, lower apparent diffusion coefficient values and peritumoral edema favored malignancy. Heterogeneity in imaging protocols precluded meta-analysis; results were summarized descriptively by subtype.

CONCLUSION: Consolidated MRI patterns-such as septal morphology in lipomatous tumors, the fascial tail in myxofibrosarcoma, characteristic T2 patterns in vascular lesions, and diffusion and edema cues in nerve sheath tumors-support differentiation of benign and malignant entities, enhance reader confidence, and inform biopsy and management. Standardized prospective studies are needed to validate these thresholds and improve generalizability.

BACKGROUND AND OBJECTIVES: Alzheimer's disease and related dementias (ADRDs) are prevalent conditions that are stressful and elevate emotional distress in couples after diagnosis. Without treatment, emotional distress may become chronic and negatively affect couples' quality of life. We report results from an NIH Stage 1A open pilot of Resilient Together for Dementia (RT-ADRD), a novel, dyadic, skills-based intervention aimed at preventing chronic emotional distress in couples early after diagnosis. We describe results from our mixed-methods single arm feasibility study, including preliminary feasibility and acceptability of the intervention, and qualitative feedback from exit interviews. We also present exploratory analyses for change in outcomes and mechanisms of action.

METHODS: Six couples (N = 12 individuals) were recruited within six months of ADRD diagnosis by their diagnosing providers. Participants completed baseline assessments, participated in weekly RT-ADRD sessions together, then completed post-intervention assessments and one 60-min exit interview together.

RESULTS: RT-ADRD exceeded all a-priori feasibility and acceptability benchmarks (> 70%). Feedback from exit interviews suggested that participants had favorable impressions of the program and found the skills useful and relevant. Participants also offered perspectives on barriers and facilitators of engagement and program enhancement. In exploratory analyses, persons living with dementia exhibited significant reductions in perceived stress at post-intervention (p < .05; Cohens d > 0.8). Both persons living with dementia and their care partners exhibited statistically significant improvements in positive dyadic interactions measured by the Dyadic Relationship Scale (ps < .05); Cohens ds > 0.8).

CONCLUSIONS: RT-ADRD shows promise as a feasible and acceptable dyadic intervention delivered early after diagnosis. Results support a future NIH Stage 1B trial of RT-ADRD to establish definitive feasibility markers of both intervention and control before formal efficacy testing.

TRIAL REGISTRATION: This open pilot was registered on ClinicalTrials.gov (NCT06421545) on 05/20/2024.

BACKGROUND: Complex tibial plateau fractures continue to pose a significant challenge for surgeons. In recent years, the widespread use of CT imaging has led to new insights leading to novel classifications that facilitate 360° stabilization techniques. Visualization in 3D has improved both fracture reduction and surgical outcomes. This study investigated whether preoperative planning of complex tibial plateau fracture fixation via finite element modeling (FEM) could enhance the fixation performance achieved by experienced surgeons and potentially improve outcomes for less experienced surgeons.

METHODS: In twelve left cadaveric fresh-frozen human knees with intact soft tissue reproducible Schatzker type IV fractures with lateral depression were created. The samples were paired on the basis of bone mineral density and then randomly allocated into two groups. Six senior surgeons with extensive experience in the operative treatment of tibial plateau fractures performed two procedures: one using standard preoperative planning and one using FEM-optimized fixation planning. All fractures were stabilized with a medial locking plate and supplemental single screws when needed. The operation time, radiation dose and implant usage were documented. Surgeon mental workload was measured by the NASA task load index. Finally, the samples were biomechanically tested over four quasistatic load ramps from 10 to 200 N, followed by a cyclic sinusoidal load with increasing load level until failure. Failure was defined as either ≥ 5° varus/valgus malalignment or a vertical impression of the condyles ≥ 3 mm. The initial stiffness and load to failure were assessed via a 3D motion tracking system. Statistical analysis was conducted using Student's t-tests.

RESULTS: No significant differences were observed in terms of operative time or intraoperative radiation exposure. However, the NASA-TLX mental demand test revealed a statistically significant advantage for the FEM-planned group (33 ± 12.4 vs. 49 ± 8.6 (p = 0.043)), indicating a reduced cognitive load. Additionally, the FEM group exhibited superior biomechanical performance, with a higher load to failure of 1050 ± 535 N vs. 442 ± 226 N (p = 0.041).

CONCLUSION: This biomechanical feasibility study demonstrated that FEM-based preoperative planning is feasible and easy to implement for complex tibial plateau fractures. This planning supports specialized surgeons in challenging operations and can improve the stability of osteosynthesis.

Pulsed field ablation (PFA) has proven to be a safe and effective non-thermal ablation modality for the treatment of atrial fibrillation (AF), but little outcome data beyond 1 year have been reported. Here we present results from the ADVENT-LTO study, which provides extended follow-up of the ADVENT trial, the first randomized trial comparing PFA with conventional thermal ablation. In ADVENT-LTO, 364 patients with paroxysmal AF (183 PFA, 181 thermal; 237 men, 127 women) participated and were followed for 1,332 ± 147 days. For the primary endpoint of 4-year treatment success, PFA demonstrated preserved effectiveness compared to thermal ablation (72.8% PFA, 64.3% thermal; P = 0.12). Moreover, there was a trend favoring PFA as compared to thermal ablation for the prespecified outcome of freedom from hospital-based arrhythmia intervention (85.6% PFA, 78.6% thermal; hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.38-1.05), including fewer repeat ablations (10.4% PFA, 17.7% thermal; P = 0.04) as well as a trend favoring PFA as compared to thermal ablation for the prespecified outcome of progression to persistent AF (2.6% PFA, 4.6% thermal; HR = 0.55, 95% CI: 0.16-1.88). Taken together, these data demonstrate that the favorable outcomes of PFA are maintained over the course of 4 years. Coupled with the safety advantages of PFA over thermal ablation, these long-term data support widespread adoption of PFA for the treatment of AF. ClinicalTrials.gov registration: NCT06526546 .