Publications by Year: 2026

Microbiota exist virtually on every surface of the human body and plays a vital role in maintaining human health. As a significant public health issue, infertility poses a great risk to the physical and mental health of the couple and their future quality of life. Over the past decade, intensive research on the microbiota of the reproductive tract has led to the identification of microbiota in the vagina, uterus, cervix, and male testes that play a vital role in maintaining a normal pregnancy. Additionally, dysbiosis of the gut microbiota has been linked to infertility. This review summarizes the mechanisms by which dysbiosis of the reproductive tract and gut microbiota triggers infertility, focusing on dysbiosis of bacterial ecological ratios, microbiota-mediated imbalance of the immune system, inflammatory responses, and effects on signaling pathways. In addition, we discuss the significant capacity of gender-specific microbiota for diagnosis, prognosis, and treatment of infertility-associated reproductive disorders, respectively. Finally, we extensively analyze therapeutic strategies targeting the microbiota to prevent or treat infertility, laying the foundation for future customized precision medicine.

INTRODUCTION: Diagnostic overshadowing, a type of cognitive bias, happens when a pre-existing medical condition overshadows the evaluation of other potential diagnoses. This study aimed to explore diagnostic overshadowing in trauma due to the impact of substance and alcohol use disorder (SUD) on time to diagnosis and management in patients with blunt splenic injury.

METHODS: The 2017-2020 American College of Surgeons Trauma Quality Improvement Project database was used to identify patients ≥18 y with blunt splenic injury who underwent splenectomy. Patients were stratified into those with and without SUD. Delayed diagnosis (time to abdominal computed tomography scan >1 h) and delayed splenectomy (>2 h) were defined using median-based thresholds to measure distributional shifts in care timeliness between groups. Multivariable logistic regression examined the impact of SUD on delayed diagnosis, delayed splenectomy, and outcomes (e.g., mortality, postoperative complications). A sensitivity analysis was conducted by excluding patients with a positive alcohol screen on admission.

RESULTS: Nine thousand two hundred thirty-seven patients were included: 1739 (19%) SUD and 7498 (81%) non-SUD. The median time to splenectomy was 2.4 h (interquartile range = 1.2-7.1) in SUD patients compared with 2 h (interquartile range = 1.1-4.9) in non-SUD patients (P < 0.001). On multivariable analyses, SUD patients were more likely to experience delayed diagnosis (adjusted odds ratio [aOR] = 1.13, 95% confidence interval [CI] = 1.04-1.23), delayed splenectomy (aOR = 1.25, 95% CI = 1.09-1.42), and composite complications (aOR = 1.14, 95% CI = 1.01-1.31) compared with non-SUD patients. After excluding intoxicated patients, those with SUD were still more likely to have delayed diagnosis and management, with a greater risk of delayed splenectomy compared with the overall cohort.

CONCLUSIONS: Diagnostic overshadowing, exemplified in blunt splenic injury patients with SUD, can be measured and can negatively impact patient care. Further studies are needed to explore the prevalence and impact of diagnostic overshadowing in trauma patients.

BACKGROUND: Over the past decade, lung cancer management has been reshaped by advances in early detection, treatment, and prevention. Prevention now extends beyond tobacco control to include recognition of non-tobacco risk factors, screening, and incidental nodule programs. Yet progress in primary prevention remains uneven, with marked regional disparities. Smoking prevalence continues to decline and measures to reduce particulate matter exposure are expanding, but the overall global impact remains inconsistent.

PATIENTS AND METHODS: This article draws upon the discussions and expert recommendations presented at the New York Lung Cancer Foundation Summit 2025, integrating perspectives on prevention, screening, therapeutic innovation, and health system challenges across diverse health care settings.

RESULTS: Screening programs, now active in >40 countries, achieve lower false-positive rates and earlier-stage diagnoses, although lung cancer incidence is rising among individuals who never used any tobacco products in some regions. Therapeutic innovations-including perioperative immunotherapy, targeted treatments for oncogene-driven non-small-cell lung cancer, and antibody-drug conjugates (ADCs)-have markedly improved survival outcomes. Persistent challenges include refining patient selection, sequencing multimodal therapies, managing toxicity, and understanding mechanisms of resistance. Systemic barriers such as unequal progress in tobacco and vaping prevention, limited screening uptake, delayed molecular testing, and restricted access to multidisciplinary care continue to blunt these gains. Ongoing research on novel immunotherapies, ADCs, and bispecific antibodies aims to overcome therapeutic resistance. In small-cell lung cancer, consolidation immunotherapy and delta-like ligand 3-targeted approaches have improved outcomes and are redefining treatment paradigms. Persistent disparities in access and trial participation underscore the need for more equitable study designs, stronger international collaboration, and clearer communication with the public.

CONCLUSIONS: This article summarizes current advances and strategic priorities in lung cancer research and care, reflecting the discussions and recommendations of the New York Lung Cancer Foundation Summit 2025.

Muscle weakness after immobilization often exceeds that explained by loss of muscle mass alone, suggesting a role for neuromuscular synaptic changes. To quantify these adaptations, we developed a composite transcriptomic Neuromuscular Junction (NMJ) Remodeling Score and evaluated its behavior relative to classical atrophy pathways during short-term unloading. We analyzed vastus lateralis RNA sequencing data from adults undergoing 10 days of unilateral lower-limb suspension followed by a 21-day recovery, generating NMJ and atrophy scores for 15 and 10 genes, respectively. Transcriptome-wide testing across more than twenty thousand genes identified a broad pattern of metabolic suppression. The NMJ score showed a large effect increase during unloading and partial normalization with recovery, while the atrophy score rose more strongly and reversed during recovery. The two scores demonstrated weak correlation, consistent with distinct biological processes. Individual NMJ-related genes displayed coordinated regulation, including marked upregulation of several acetylcholine receptor subunits and modest downregulation of muscle signaling kinase (MuSK), reflecting a denervation-like transcriptional pattern. Directional replication in a 60-day bed rest cohort supported generalizability across disuse conditions. Together, these findings indicate that limb unloading elicits measurable transcriptomic remodeling at the NMJ that is only partially aligned with atrophy signaling, providing a framework for investigating neural contributions to immobilization-induced weakness.

BackgroundDialectical Behavior Therapy's (DBT) original biosocial theory and subsequent iterations as a transactional model suggest that invalidating social and family environments can contribute to emotion dysregulation and patterns of self-invalidation that may lead to suicidal and non-suicidal self-injurious behaviors over time. To our knowledge, no studies have examined the relationship between parental and self-invalidation on suicidality in a treatment setting or longitudinally over the course of treatment from pre-to post-treatment. This study examined the relationship between youth-reported parental invalidation, self-invalidation, and suicidality over the course of treatment in a comprehensive DBT partial hospitalization program (PHP).MethodsTwo hundred sixty-four adolescents and young adults admitted to a four-week comprehensive DBT PHP that incorporated family, individual, and skills group therapy components. All patients completed surveys evaluating perceived parental-invalidation, self-invalidation, and suicidality pre- and post-treatment.ResultsPatients reported significant decreases on all outcome measures: perceived mother and father invalidation, self-invalidation, and suicidality after 4 weeks. Changes (reductions) in both self-invalidation and mother invalidation were significant predictors of reduced suicidality.ConclusionComprehensive DBT is a viable treatment option for decreasing invalidation and suicidality in four weeks. These findings emphasize the importance of parent involvement in improving treatment outcomes for adolescents and young adults.

To report on the relationship between neuroinflammation and chronic pain, especially in the pediatric population. Pediatric chronic pain is prevalent, affecting about 20% of the population. Neuroinflammation is now recognized as a putative contributing factor to the development and maintenance of chronic pain. Strides have been made in understanding neuroinflammatory processes in the context of pain, as research begins to unravel the involvement of glial cells (e.g., microglia, astrocytes), pro-inflammatory markers (e.g., interleukins, Tumor Necrosis Factor-alpha [TNF-α]), and metabolic pathways (e.g., oxidative stress). In children, the vulnerability of a developing nervous system, life stressors (e.g., adjustment periods/transitions, social stress, family dynamics) and hormonal changes can further impact neuroinflammation and promote pain. Investigating this complex web of factors that contribute to pediatric pain has implications for both clinical practice and research. This review aims to summarize recent literature on the role of neuroinflammation in pediatric chronic pain, highlighting novel insights and areas for future clinical exploration. Targeting neuroinflammation shows promise for advancing pediatric chronic pain management, but pediatric-specific studies remain quite limited, and urgently needed.

Social determinants of health (SDOH) are crucial in shaping liver health outcomes, yet comprehensive assessments that span key SDOH domains are lacking. To address this knowledge gap, we developed a Social Determinants Disadvantage Score (SDDS) and examined its association with major adverse liver conditions. We conducted a cross-sectional analysis of 117,783 participants from the All of Us Research Program. The SDDS was systematically constructed using validated questionnaires covering economic stability, education, healthcare access and quality, neighborhood and built environment, and social and community context. Each question was scored on a 0 (most advantage) to 1 (most disadvantage) scale. Total SDDS was calculated as the mean of all questions, ranging from 0 to 1. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of SDDS with total and individual adverse liver conditions, including steatotic liver disease (SLD), metabolic dysfunction-associated steatohepatitis (MASH), alcoholic liver disease (ALD), cirrhosis, hepatocellular carcinoma (HCC), chronic hepatitis B virus (HBV), chronic hepatitis C virus (HCV), and hepatic failure based on the Electronic Health Record. Higher SDDS was associated with a higher risk of adverse liver conditions. The highest SDDS quintile (most disadvantaged) compared to the lowest SDDS quintile had an OR = 1.67 (95% CI: 1.55-1.79) for total adverse liver condition risk after adjusting for age, sex, race, and other covariates. Similar associations were observed for individual liver conditions. Per 10% higher SDDS, the adjusted OR (95% CI) was 1.25 (1.22-1.29) for SLD, 1.27 (1.19-1.35) for MASH, 1.15 (0.99-1.34) for ALD, 1.31 (1.25-1.39) for cirrhosis, 1.35 (1.15-1.59) for HCC, 1.24 (1.14-1.35) for HBV infection, 1.40 (1.33-1.48) for HCV infection, and 1.35 (1.21-1.50) for hepatic failure. Consistent associations were found for disadvantages in individual SDOH domains, score excluding missingness, and score with selected factors. The SDDS provides a comprehensive, validated tool for assessing SDOH and their associations with liver health. Our findings highlight significant associations between social disadvantage and the prevalence of adverse liver conditions, emphasizing the need for future longitudinal studies to inform targeted interventions.