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176 papers

Glucagon-Like Peptide-1 Agonist vs. Placebo and Pulmonary Decline After Open-Heart Surgery: A Substudy of the GLORIOUS Randomised Clinical Trial.

Mikkelsen AD et al. · Jul 1, 2026

Background Postoperative pulmonary decline is an established complication of open-heart surgery extending beyond the immediate postoperative phase. Inflammation-mediated lung damage and ischaemia-reperfusion injury secondary to extracorporeal circulation is a proposed pathophysiological driver. GLP-1 receptor agonists (GLP-1RA) have emerged as promising protective agents in this setting. Aim Investigate whether infusion of the GLP-1RA, exenatide during cardiopulmonary bypass and weaning thereof, can mitigate the decline in diffusing capacity and ventilatory performance 3 months postoperative, compared to placebo. Methods In this predefined explorative substudy of the randomised, clinical GLORIOUS trial, 878 adult patients undergoing non-emergent coronary artery bypass grafting (CABG) and/or surgical aortic valve replacement (SAVR) were randomised to a continuous infusion of the GLP-1RA, exenatide or placebo during cardiopulmonary bypass, extending into the early postoperative period. Diffusing capacity of the lung for carbon monoxide (DLCO) and ventilatory performance (FEV 1 /FVC) were measured preoperatively and 3 months postoperatively. Results Median DLCO (% predicted corrected) declined from 80% preoperative to 72% 3 months postoperative, corresponding to a -7.7 percentage point (pp) difference (95% CI 6.2 to 9.1; p 1 /FVC declined from 0.75 preoperative to 0.73 postoperative, corresponding to a -1.6 difference (95% CI 1.0 to 2.1; p 0.3). Findings were consistent across subgroup analyses. Conclusion While both diffusing capacity and ventilatory performance exhibited a mild-to-moderate decline 3 months after open-heart surgery, the GLP-1RA exenatide did not mitigate this decline compared with placebo. Editorial comment Pulmonary dysfunction is one of the most common complications to open-heart surgery. The present study confirms a decline in diffusing capacity of the lung for carbon monoxide (DLCO) and in ventilatory performance measured as FEV 1 /FVC at 3 months postoperatively compared to preoperative measurements. Infusion of GLP-1 receptor antagonist during cardiopulmonary bypass and weaning did not mitigate the pulmonary decline compared to placebo.

Medicine

Preliminary Outcomes of a Brief Values-Guided Self-Management Intervention to Improve Glucose Levels Among Emerging Adults With Type 1 Diabetes and Above-Recommended HbA1c: A Pilot Study.

Styles SE et al. · Jul 1, 2026

Introduction A minority of young adults with type 1 diabetes achieve > 70% time in range (TIR; 70-180 mg/dL [3.9-10 mmol/L]), as recommended. Self-management goals based on self-chosen values (whatever is most important to an individual) may motivate engagement in self-management tasks that could improve TIR. This study explored the acceptability, feasibility, and potential outcomes of values-guided self-management. Methods A single-arm quasi-experimental pilot study was conducted with 14 participants aged 18-25 years and HbA 1c ≥ 58 mmol/mol (7.5%). The intervention consisted of a single 1:1 session ( Results Fourteen participants received the intervention. The intervention was acceptable and feasible to implement. The mean change (95% CI) between pre- and post-intervention TIR was an increase of 2.2 (-1.2, 5.7) percentage points, mostly through a decrease in time above range. The standardized mean change (95% CI) in progress towards valued living was 0.72 (0.27, 1.16) with small improvements in diabetes-specific acceptance and carrying out valued actions. Conclusions A brief values-guided self-management intervention shows promise to improve time in range among emerging adults with type 1 diabetes and above recommended HbA 1c . Further investigation of values-guided self-management is warranted. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12620000200987; https://www.anzctr.org.au/ACTRN12620000200987.aspx).

Medicine

Sustaining Breastmilk Expression and Direct Feeding at Breast for Very Low Birth Infants: A Qualitative Exploration of Parental Perspectives.

Noonan M et al. · Jul 1, 2026

In Ireland, while most women express milk for their preterm very low birthweight (VLBW) infants, only a few are discharged home exclusively receiving mothers' own milk, and even fewer are engaged in direct feeding at breast (DFAB). This is in the context of Ireland having one of the lowest breastfeeding initiation and sustenance rates in the world. This qualitative descriptive study aimed to explore parents' experiences and perspectives on sustaining breastmilk expression and DFAB for VLBW infants. Semi-structured interviews were conducted with nine mothers and three partners, and the data were analysed using Braun and Clarkes' (2022) framework for reflexive thematic analysis. The themes developed were: (1) Sustaining breastmilk expression for preterm infants; (2) Navigating the transition to DFAB; and (3) The emotional Journey of feeding a VLBW infant. Supportive conditions for sustained milk expression included access to equipment, skin-to-skin contact, and both practical and emotional support from partners and healthcare professionals. Key influences on the transition to DFAB encompassed infant-related challenges, health system factors and the role of partner involvement. Scheduled support from lactation consultants, midwives and nurses in both hospital and community settings, who have undertaken specialised training on supporting women to breastfeed a VLBW infant is recommended to facilitate the transition to DFAB. Participants identified strategies that could be integrated into a 'DFAB care pathway' to provide a structured and consistent evidence-based approach to support women, their premature infants and families.

Medicine

Epidemiology of chronic dialysis treatment among children and adolescents in a capital of Northeastern Brazil.

Medeiros IS et al. · Jul 1, 2026

Introduction Information about the clinical and epidemiological profile of children and adolescents undergoing chronic dialysis in Brazil is limited. Objective To describe the clinical and epidemiological characteristics of the pediatric population undergoing chronic outpatient dialysis treatment in a capital city in Northeastern Brazil. Methods This is a descriptive, observational, and retrospective study whose population consisted of all children and adolescents undergoing chronic outpatient dialysis treatment in São Luís, capital of the state of Maranhão, Brazil, in 2023. Results Thirty-two children and adolescents with chronic kidney disease (CKD) were undergoing dialysis treatment during this period, the majority (56.25%) being male. The mean age was 11.31 years (± 3.56). Regarding ethnicity, non-white individuals predominated (71.9%). The renal replacement therapy (RRT) modality was exclusively hemodialysis (HD), and the most commonly used vascular access at the end of the follow-up period was arteriovenous fistula (AVF) (56.2%). Regarding the underlying disease, 35% had an unknown etiology. There were nine transplants during the period, all from deceased donors. At that time, there was virtually universal access to erythropoiesis-stimulating agents and drugs for the prevention and treatment of bone mineral metabolic disorders. Conclusion The high rate of unknown underlying disease and the exclusive use of HD as the RRT modality, rather than peritoneal dialysis, reflect diagnostic, therapeutic, and structural challenges. This scenario highlights the need for better planning of public policies aimed at managing pediatric CKD in the region.

Medicine

The T Cell Receptor: Molecular Sensor, Therapeutic Mediator and Probabilistic Driver of Adaptive Immunity.

Schober K. · Jul 1, 2026

Advances in high-throughput sequencing, single-cell profiling, and genome engineering have transformed the study of T cell receptors (TCRs), enabling the identification and functional interrogation of antigen-specific repertoires at an unprecedented scale. This review discusses how recent methodological developments-including high-dimensional TCR discovery strategies, physiological receptor engineering, and longitudinal in vivo analyses-have reshaped our understanding of TCR-driven immune responses. Recruitment into immune responses originates from diverse naïve precursor pools and results in polyclonal populations in which multiple clonotypes contribute to antigen recognition. Within such populations, receptor properties, such as TCR avidity, influence the likelihood of recruitment, expansion, and persistence. However, the impact of these parameters depends strongly on biological context, including antigen availability, cellular competition, and tissue environment. Physiological engineering approaches, such as orthotopic TCR replacement, now enable causal interrogation of receptor function while preserving endogenous regulatory control. Together with advances in spatial and longitudinal profiling of human immune responses, these approaches allow increasingly precise analyses of connections between TCR identity and T cell fate. Integrating insights across antigen discovery, receptor engineering, and in vivo dynamics suggests that TCR biology is shaped by the interplay of receptor sequence, regulatory context, and tissue environment across time. Understanding these relationships will be essential for interpreting immune responses and for guiding the rational design of T cell-based immunotherapies.

Medicine

Audience Interpretation of Risks in Health Promotion Campaigns About Underage Drinking: Qualitative Interviews With Parents of Adolescents.

Nguyen HV. · Jul 1, 2026

Issue addressed Underage alcohol use has been linked to risks of physical, mental, and social harms to young people. Despite the known risks, research shows that parents may choose to supply alcohol to their children on occasions for various reasons. This has prompted several health promotional campaigns aimed at parents to discourage the practice of parental supply of alcohol, but there has been little evidence of how the messages are received by the target audiences, i.e., parents of adolescents. Methods Grounded in the existing literature on alcohol-related harms, social dimensions and communication of risks, the current paper conducted a qualitative analysis of interviews with parents of adolescents to understand their interpretation of risks in a series of Australian health promotion campaigns that addressed underage drinking. Result The study demonstrated how target audiences brought in their own lived experiences and social worldviews to interpret and internalise messaging about risks in ways that are nuanced and situational. Conclusions The findings demonstrated how parents' lived experiences and worldviews influenced their interpretation and alignment with the health promotion messages about parental supply of alcohol. While the ways the parents negotiated with the health promotion messages may not be scientifically-grounded, it was not always due to unawareness of risks but based upon strategies and assessment of risks in situational contexts. SO WHAT?: Understanding of how lived experiences inform interpretation of health promotion campaigns has implications for more effective alcohol-related risk communication aimed at behaviour change to reduce alcohol-related harms among young people.

Medicine

Assessment of Ocular Surface Pathogen Susceptibility to Ultraviolet-C (UVC) Light Treatment With a Novel Prototype Device-An In Vitro Study.

Williams OJ et al. · Jul 1, 2026

Purpose Assess in vitro efficacy of a device emitting 265 nm UVC light against bacteria isolated from veterinary infectious keratitis. Methods Twenty-seven clinically-derived bacterial isolates: Staphylococcus pseudintermedius (n = 10; including n = 2 methicillin-resistant Staphylococcus pseudintermedius [MRSP]), Staphylococcus aureus (n = 1), Streptococcus canis (n = 4), Escherichia coli (n = 4, including n = 2 multidrug-resistant isolates), Pseudomonas aeruginosa (n = 7) and Serratia marcescens. (n = 1), and three type culture strains (n = 1 E. coli, S. aureus, S. pseudintermedius) were lawn cultured. Prototype UVC device (2.50 mW/cm 2 intensity, 23 mm diameter beam) provided triplicate exposures at 1, 2, 3, and 5 s, and plates incubated (37°C, 16-20 h). All experiments were performed in duplicate (n = 6 treatment zones per timepoint, per isolate). Absence of growth in all exposed areas at any time demonstrated complete UVC inhibition; presence of growth was categorized as Results UVC inhibition was complete in 11/30 isolates at ≤ 5 s exposure. Partial efficacy was seen in 18/19 remaining isolates at 5 s; ≥ 33% zones demonstrated absence of bacterial growth. Efficacy against MDR-MRSP and MDR-E. coli was comparable to susceptible counterparts. All P. aeruginosa were completely inhibited at ≤ 5 s; the S. marcescens isolate was least susceptible with ≥ 10 bacterial colonies within 50% zones after 5 s. Conclusion Five seconds of UVC exposure is sufficient to markedly reduce growth of most bacterial species, including MDR-isolates and completely inhibit P. aeruginosa in vitro. These findings support further controlled in vivo safety and efficacy studies of UVC as an adjunct to topical antibiotics in companion animal infectious keratitis.

Medicine

Evolving SPECT-CT technology.

Willowson KP et al. · Jul 1, 2026

Both hardware and software developments have seen single photon emission CT (SPECT)/X-ray CT technology grow at a rapid rate. Such growth has been fuelled by the need for clinical applications and has provided inspiration for clinical developments, particularly with the expanding role of theranostics. Developments such as whole-body quantitative reconstructions, digital detectors, and recent multidetector 3D geometry have allowed SPECT to become comparable to PET on a number of fronts, with a particularly powerful role in biodistribution and dosimetry studies for both planning and evaluating radionuclide therapy. Whilst there remain fundamental challenges for SPECT such the limited spatial resolution and sensitivity, the unique opportunity to image long-lived radioisotopes and simultaneous multi-tracer studies, together with easily accessible equipment, makes SPECT/CT a valuable clinical asset. This review discusses developments in SPECT/CT technology and their clinical impact.

Medicine

COVID-19 Mortality in Swedish Intensive Care Units: A Multicenter Survival Analysis.

Forsberg G et al. · Jul 1, 2026

Background Mortality among critically ill COVID-19 patients has varied globally. In Sweden, geographic differences in mortality have also been observed. The current study aimed to determine whether mortality differences persist after adjusting for differences in case-mix, and to identify potential independent factors contributing to regional variations in mortality. Methods We conducted a multicenter cohort study including adult patients admitted to seven hospital ICUs across three Swedish healthcare counties between March 1, 2020 and July 31, 2021. These ICUs include one university hospital, three county hospitals and three local hospitals, and cover the intensive care infrastructure for approximately one million inhabitants. Patients were assigned to the hospital of initial ICU admission, even if transferred later during the course. Patient characteristics, disease severity, respiratory support, and treatments were registered. Primary outcome was 90-day mortality. A mixed-effects Cox proportional hazards model was used. Results Seven hundred and forty seven patients were included. The unadjusted 90-day mortality varied significantly, with the highest rate at 30%, and the lowest at 8.5% (p Conclusion Among patients admitted to ICU due to COVID-19, we observed a difference in mortality related to the hospital of first ICU admission. This difference persisted after adjustment for calendar time, baseline confounders, and healthcare county. Potential explanations are lacking within the current study. Future studies should focus on comprehensive evaluation of both organizational and contextual determinants of mortality. Editorial comment This analysis from 3 Swedish counties (7 hospitals) for COVID ICU cases presents factors and relations to mortality risk, including factors for first admission to university-larger-, or smaller hospital. An association was observed for higher risk if the first ICU admission was in a smaller hospital, though recognizing that this is a dataset coming from a small set of hospitals.

Medicine

A Systematic Review and Expert Evaluation of Perioperative SGLT2 Inhibitor-Associated Ketoacidosis Case Reports.

Snel LIP et al. · Jul 1, 2026

Introduction The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in the perioperative setting may lead to SGLT2i-associated postoperative ketoacidosis (SAPKA) in patients with type 2 diabetes (T2D). Therefore, cessation of this drug is recommended before surgery. We aimed to study reported cases to assess the causality of SGLT2i, identify common characteristics, potential risk factors, treatment and outcomes of SAPKA. Methods We conducted a systematic literature search to identify case reports of patients with metabolic acidosis and the presence of ketones who used SGLT2i in the perioperative setting. Case reports were summarised for common characteristics, assessed for quality and distributed to a panel of diabetes experts, who evaluated the likelihood of SAPKA using a questionnaire. Results Ninety-three papers containing 128 case reports fulfilled the inclusion criteria. The expert panel found SAPKA to be 'likely' in 53 (41%), 'possible' in 38 (30%) and 'unlikely' in 27 (21%) cases; 10 cases (8%) could not be validated due to insufficient data or implausible timing. SAPKA was therefore considered likely or possible in 71% (91/128) of cases. Common factors identified in the SAPKA reports included a diagnosis of T2D mellitus (n = 115), impaired perioperative intake (n = 30) and insufficient insulin supplementation (n = 10). Treatment with insulin was effective, and ketoacidosis resolved in all surviving patients, although significant morbidity, including ICU admission, was reported in a substantial proportion of cases. Discussion Confirming a SAPKA diagnosis is challenging due to the variable reporting quality and numerous confounding factors present during the perioperative period. Clinicians should remain aware of SAPKA given the increasing prevalence of SGLT2i use. Focusing on early recognition and treatment represents a potential alternative strategy to routine preoperative SGLT2i discontinuation, though this requires further prospective evaluation. Editorial comment This systematic review presents an overview and discussion of the many, to date, case reports of ketoacidosis thought to be associated with perioperative SGLT2 inhibitor treatment.

Medicine