Jacques S et al. · Jul 3, 2026
Complement opsonisation contributes to immune clearance of nanopharmaceuticals, but complement activation has some undesirable effects. Herein, we show that tethering the fusion complement receptor 2-complement receptor 1 (CR2-CR1) regulator to cross-linked iron oxide nanoworms via a PEG spacer and copper-free click chemistry overcomes complement opsonisation. Furthermore, CR2-CR1-conjugated nanoworms reduce complement opsonisation of unmodified nanoparticles.
Medicine
Wiering L et al. · Jul 1, 2026
Metabolic dysfunction-associated steatotic liver disease (MASLD), a major public health concern, is influenced by an interplay of genetic, environmental, and lifestyle factors, with socioeconomic factors functioning as important upstream determinants whose roles remain not yet fully understood. This review synthesizes current evidence on how different indicators of socioeconomic status as well as related social determinants of health-income, poverty, food insecurity, health insurance, education, migration, and composite indices-relate to MASLD prevalence, severity, and outcomes across different world regions. Several studies associate these socioeconomic factors with an increased risk of MASLD, illustrating the disease's link with socioeconomic disadvantages. However, socioeconomic factors often lose or attenuate their independent association with MASLD once key downstream determinants-such as diet quality, physical inactivity, and metabolic comorbidities-are considered, supporting a model in which socioeconomic factors mainly shape exposure to metabolic and behavioural risk factors rather than exerting a direct causal effect. Among the factors examined, education and food insecurity demonstrate the most consistent independent associations with MASLD. Notably, the direction of socioeconomic gradients appears to differ by regional income level, with lower SES associated with higher MASLD burden in high-income countries but an inverse pattern in several middle-income settings. Evidence remains largely limited to the United States, Europe, and a small number of Asian cohorts, underscoring the need for more geographically diverse research. This review highlights the association of different socioeconomic factors with MASLD, while also revealing the need for more detailed studies which systematically disentangle individual and area-level social determinants of health, model mediating pathways and incorporate underrepresented regions and paediatric populations. A deeper understanding of how socioeconomic factors and downstream mediators jointly drive MASLD could inform targeted clinical strategies and multi-level policies aimed at mitigating the social gradient in MASLD.
Medicine
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
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
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
Meng X et al. · Jul 1, 2026
Background The lens of the eye is highly radiosensitive, yet personalized shielding during head CT remains challenging due to the lack of a rapid, pre-scan localization method. Purpose To develop and validate a deep learning solution that enables automated, patient-specific eye protection by generating a precise 3D eyeball model directly from a single-view topogram. Methods Our two-stage approach combines an advanced data simulation pipeline-which generates realistic training topograms from digitally reconstructed radiographs (DRRs) using a table-movement-aware model and CycleGAN-based stylization-with a dedicated generative network (EyeGen-Net). The model was trained on 400 synthetic and validated on 100 real clinical samples. Results EyeGen-Net achieved a Dice Similarity Coefficient of 0.79 ± 0.08, a Hausdorff Distance of 5.40 ± 1.57 mm, and an Average Surface Distance of 1.84 ± 0.65 mm against expert segmentations. Crucially, phantom validation demonstrated that the derived 3D model facilitates organ-based tube current modulation (OBTCM), yielding an approximate 30% reduction in lens dose across different scanning modes without compromising diagnostic image quality. Conclusions This work provides a practical, automated pathway for implementing personalized radioprotection in routine head CT, aligning with the ALARA (As Low As Reasonably Achievable) principle.
Medicine
Andersson DF et al. · Jul 1, 2026
Aims Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) may be affected by coronary microvascular dysfunction with reduced stress perfusion. Changes in native T1 and T2 reflect changes in myocardial perfusion; therefore, the aim of our study was to investigate whether non-contrast, adenosine stress native T1 and T2 are affected in patients with previous suspected MINOCA. Methods and results Patients with MINOCA and a normal CMR (n = 15, 59 ± 7 years, 60% female) underwent 1.5T CMR together with age- and sex-matched volunteers. The protocol included native T1, native T2 and quantitative perfusion mapping, at rest and during adenosine stress. Myocardial stress perfusion was globally reduced, both transmurally (2.9 ± 0.9 vs. 3.6 ± 0.7 mL/min/g, p = 0.02) and in the subendocardium (2.64 ± 0.81 vs. 3.47 ± 0.78 ml/min/g, p = 0.008) in patients with MINOCA, with a reduced global ratio of subendocardial-to-transmural stress perfusion (0.921 ± 0.042 vs 0.957 ± 0.039, p = 0.021). However, there were no differences in global transmural rest native T1 or T2, stress native T1 or T2, or ΔT1- or ΔT2 values between patients and volunteers. Overall, transmural myocardial perfusion correlated with native T1 (R 2 = 0.27, p 2 = 0.48, p 2 = 0.15, p Conclusions Native T1- and T2-mapping during adenosine stress, although correlated with quantitative myocardial perfusion, are not alone sufficiently sensitive methods for distinguishing patients with MINOCA and reduced stress perfusion from healthy volunteers.
Medicine
Hanin Z et al. · Jul 1, 2026
Background Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in patients with diabetes mellitus (DM). Early detection remains difficult, but essential for timely management. In this study, we assessed Peroxidasin (PXDN) gene expression as a biomarker for early detection of DN and for reflection of oxidative stress status. We also compared PXDN and Nuclear factor-κB (NF-κB) expression levels in DN patients, aiming to identify a reliable diagnostic biomarker. Methods This prospective cross-sectional study included 40 patients with T2DM with and without nephropathy, and 20 matched healthy controls. PXDN mRNA expression was quantified by real-time polymerase chain reaction (qRT-PCR). Biochemical analyses of malondialdehyde (MDA) and total antioxidant capacity (TAC) were also done to assess the oxidative stress status. Laboratory parameters, including glycated haemoglobin, urinary albumin-to-creatinine ratio, estimated glomerular filtration rate, and microalbuminuria, were measured and correlated with gene expression levels and the oxidative stress status. Results PXDN mRNA expression was significantly upregulated in patients with DN compared to diabetic cases without nephropathy and control subjects. MDA levels were significantly elevated in both diabetic groups relative to controls, but no significant difference was found between DN and DM without renal impairment. TAC was significantly lower in DN cases compared to DM and controls. The NF-κB gene was upregulated in both diabetic groups compared to control subjects, but no significant difference was found between DN and DM without nephropathy. Furthermore, PXDN expression did not correlate with MDA, TAC, or NF-κB levels. Receiver operating characteristic (ROC) analysis identified PXDN as a highly specific and sensitive marker for DN, outperforming conventional oxidative stress biomarkers in distinguishing DN from both diabetic and healthy individuals. Conclusion PXDN is significantly upregulated in DN and may serve as a sensitive and specific molecular marker for early detection of nephropathy compared to NF-κB.
Medicine
Bauler S et al. · Jul 1, 2026
Iron-deficiency anemia is the most common micronutrient deficiency and a leading cause of disability-adjusted life years among adolescent girls and young women (AGYW) globally. Although multiple micronutrient supplementation (MMS) provides a broader range of micronutrients than iron-folic acid supplementation (IFAS) prior to conception, the acceptability of MMS and home-based supplementation strategies remains underexplored. We assessed the acceptability of MMS, IFAS, and a contextualized nutrition curriculum delivered via school clubs in a two-arm cluster-randomized trial across three rural secondary schools in Monapo District, Mozambique. Fourteen teachers (clusters) were randomized to deliver either weekly school-based IFAS or daily home-based MMS. A total of 492 AGYW aged 13-20 years were enrolled (240 IFAS; 252 MMS); both arms received the same nutrition curriculum. Participants in both arms reported increased energy, improved appetite, and relief from menstrual symptoms. IFAS was significantly more acceptable than MMS for smell, and some participants perceived the once-weekly IFAS regimen as less burdensome than daily MMS. Some AGYW also reported that male peers perceived MMS as birth control, or assumed the girls were pregnant, due to the image of a pregnant woman on the pill bottle. Ratings of the nutrition curriculum and teachers' facilitation were positive in both arms. Participants generally preferred the regimen they were assigned, and family support facilitated adherence. These findings suggest home-based supplementation may be a feasible and acceptable strategy for reaching in-school and out-of-school AGYW in Mozambique. Including boys in future interventions and redesigning the MMS label could help reduce misconceptions and enhance acceptability.
Medicine
Dora K et al. · Jul 1, 2026
Objectives Resistance exercise enhances executive function (EF) more effectively at moderate or higher intensities than at low intensity resistance exercise (LRE), probably with increased neural activity and lactate production to meet brain energy demands. Given that LRE remains widely applicable with less perceived exertion, and electrical muscle stimulation (EMS) increases lactate production and neural activation, we investigated whether combining LRE with EMS (LRE-EMS) effectively enhances EF, without increasing perceived exertion. Design A crossover randomized study. Methods Seventeen young men participated in a crossover randomized study to assess the cognitive effects of LRE alone, EMS alone, and LRE-EMS. The LRE protocol involved knee extensions at 40% one-repetition maximum for 4 sets of 10 repetitions. During the EMS condition, the participants remained seated for 260 s to match the duration of the other conditions, with EMS applied to the lower limb muscles. Subjective perceptions of exertion and fatigue during exercise were recorded. Results IC and lactate were measured at baseline, immediately postexercise, and 15 min postexercise. The LRE condition did not significantly increase IC (p = 0.100), whereas LRE-EMS resulted in significant IC improvements immediately and 15 min postexercise (both p Conclusions Perceived exertion and fatigue were greater with LRE-EMS compared with LRE and EMS. These findings suggest that LRE combined with EMS and EMS alone are effective strategies for cognitive improvement, but increased perceived exertion still exists.
Medicine