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Effects of upadacitinib or adalimumab on pain in rheumatoid arthritis and psoriatic arthritis: results from randomised phase 3 studies.
No full textINTRODUCTION: Patients with rheumatoid (RA) or psoriatic (PsA) arthritis can experience debilitating pain.
METHODS: Post hoc analyses of phase 3, double-blind studies in patients with active disease despite treatment (SELECT-COMPARE, SELECT-PsA 1) assessed the effects of upadacitinib or adalimumab versus placebo on pain in patients with attenuation of inflammation (AoI) versus remaining inflammation at weeks 12 and 24/26 (PsA/RA). Further, a mediation analysis assessed the direct/indirect effect of treatment on pain using the Patient\u27s Global Assessment of pain (PtGA) and 28 tender joint count (TJC28) at weeks 2/12/26 in RA, and weeks 16/24 in PsA.
RESULTS: In patients with RA+AoI, PtGA scores improved more with upadacitinib (least squares mean change, -42.9) versus adalimumab (-34.7 (p\u3c 0.05)) or placebo (-33.1 (p\u3c 0.05)) at week 12 from baseline; improvements were similar across groups by week 26. For PsA+AoI, improvement was greater with upadacitinib (week 12, -2.7; week 24, -3.8) versus placebo (-1.8 (p\u3c 0.05); -2.8 (p\u3c 0.001), respectively) and similar to adalimumab (-2.8, -3.6). For RA, the direct effect on pain was nearly two times greater with upadacitinib versus placebo compared with adalimumab at weeks 12/26. For PsA, total effects on pain (TJC28 improvement) at weeks 16/24 were greater with upadacitinib (2.16 and 2.30) and adalimumab (1.35 and 1.71) versus placebo.
CONCLUSIONS: Upadacitinib effectively reduced pain in active RA and PsA, including in patients with AoI. The greater pain relief observed in RA with upadacitinib versus adalimumab might indicate both direct (relieving non-inflammatory pain) and indirect (suppressing inflammation) effects
Neighborhood matters: Predicting lung cancer screening adherence with explainable AI.
No full textBackground: This study builds a predictive model for lung cancer screening (LCS) adherence using social determinants of health (SDOH) data in high-risk populations. By identifying key factors influencing non-adherence, we seek to improve risk stratification for individuals less likely to complete annual LCS follow-up scans within 15-months.
Methods: We recruited 188 minoritized individuals meeting high-risk smoking pack year criteria who underwent their first low-dose computed tomography (LDCT) scan between 2017 and 2021 at four clinical centers in Los Angeles County. Participants completed an IRB-approved survey assessing demographics, tobacco use, social needs, discrimination, and lung cancer risk perception. Residential address at time of first LDCT was geocoded to match with neighborhood-level SDOH metrics. The data were split into training (N = 145) and testing cohorts (N = 43) by whether individuals received their initial LDCT by June 30, 2021. Electronic medical records were checked for LDCT follow-up within 15 months of initial LCS. Those who underwent the subsequent LDCT within 15 months of the initial LCS were considered adherent. We trained an XGBoost classifier with hyperparameter tuning and performed SHapley Additive exPlanations (SHAP) analysis to interpret model predictions.
Results: The cohort included 69 (37 %) Asian/Pacific Islander, 53 (28 %) Black/African American, and 49 (26 %) Hispanic/Latino participants. The LCS non-adherence rate was 66 %. The XGBoost classifier achieved an AUROC of 0.81 and AUPRC of 0.90, with prediction performance of accuracy = 0.79, recall = 0.78, specificity = 0.81, positive predictive value = 0.88, and negative predictive value = 0.68. SHAP analysis indicated that neighborhood-level SDOH factors, such as school proficiency and poverty levels, were more predictive of non-adherence than individual-level factors like smoking status.
Conclusions: This machine learning approach accurately predicted LCS non-adherence using individual- and neighborhood-level SDOH factors. These findings emphasize the relevance of community-level characteristics in informing LCS adherence interventions and may support the development of regionally tailored strategies to improve adherence in high-risk populations
iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity 2025: Focus on Prevention and Treatment of Cardiometabolic Disease
No full textEndoscopic and intrathecal management of intraventricular fungal infections: a case report of Cladophialophora bantiana and systematic review.
No full textBackground: Intraventricular fungal infections are rare and associated with high morbidity and mortality. Diagnosis is often delayed due to nonspecific clinical and radiological findings, and treatment is complicated by limited cerebrospinal fluid (CSF) penetration of systemic antifungal agents. Neuroendoscopic visualization and intrathecal antifungal therapy have been reported only sporadically, and standardized management strategies are lacking.
Case presentation: We report a 75-year-old male who developed a right temporal lobe abscess caused by Cladophialophora bantiana, confirmed by histopathology, culture, and molecular diagnostics. Despite prolonged systemic antifungal therapy, the patient demonstrated clinical and radiographic progression with intraventricular ventriculitis. Neuroendoscopy enabled direct visualization of pigmented intraventricular fungal lesions, targeted biopsy, ventricular lavage, and placement of an Ommaya reservoir, allowing initiation of intrathecal liposomal amphotericin B with serial CSF drug level monitoring and subsequent radiographic stabilization. To contextualize this case, we performed a systematic literature review of intraventricular fungal infections managed with endoscopic procedures and/or intrathecal or intraventricular antifungal therapy, identifying eleven cases involving Aspergillus spp., Cladophialophora bantiana, Mucorales, and other dematiaceous fungi. Management strategies were highly individualized and typically combined surgical intervention, ventricular access devices, systemic antifungals, and local antifungal administration.
Conclusion: This case report and systematic review highlight neuroendoscopy as a key diagnostic and therapeutic tool in intraventricular fungal infections and underscore the frequent need for intrathecal antifungal therapy when systemic treatment is insufficient. Management remains interdisciplinary and individualized, emphasizing the importance of detailed reporting to inform future treatment strategies.
Clinical trial number: Not applicable.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12879-026-12638-7
Determining the best discriminatory physical functioning outcome measurement instrument for psoriatic arthritis trials: A meta-epidemiological study.
No full textOBJECTIVES: To empirically compare the discriminant capacities of three outcome measurement instruments for assessment of physical functioning for psoriatic arthritis (PsA): HAQ-DI, SF36-PF and SF36-PCS.
METHODS: We applied a network meta-analysis technique in a sample of randomized trials (RCTs) for PsA. For randomized comparison, we calculated net effect size estimates for each outcome measurement instrument using standardized mean differences (SMDs); positive values indicated a beneficial effect of the intervention compared to the control groups. We analyzed the differences between outcome measurement instruments at the trial level by applying a multiple-treatment meta-analysis to compare the SMDs within and across randomized comparisons for each outcome measurement instrument.
RESULTS: From 42 articles (31 RCTs), 57, 18, and 18 randomized comparisons enabled a direct comparison between HAQ-DI and SF36-PCS (difference in SMDs: 0.057, 95 % confidence interval, CI: 0.003 to 0.110), SF36-PF and SF36-PCS (difference in SMDs: 0.101, 95 % CI: 0.018 to 0.184); and HAQ-DI and SF36-PF (difference in SMDs:0.059, 95 % CI:0.142 to 0.024), respectively. The network meta-analysis technique confirmed that both HAQ-DI and SF36-PF were more responsive to change than SF36-PCS, with differences between SMDs of 0.057 (95 % CI: 0.003 to 0.110) and 0.109 (95 % CI: 0.032 to 0.185), respectively. No difference in discriminatory capacity between HAQ-DI and SF36-PF was noted.
CONCLUSIONS: HAQ-DI and SF-36-PF were equally responsive to change and superior to SF36-PCS in PsA RCTs. We illustrated a new method for quantitative comparison of the performance of different outcome measurement instruments for a particular domain
Impact of non-metropolitan residence on survival for gastric neuroendocrine tumors.
No full textBACKGROUND: Gastric neuroendocrine tumors (NETs) treated at academic centers are associated with improved survival. However, the impact of location of residence remains unclear. Here, we evaluated outcomes based on metropolitan or non-metropolitan residence.
METHODS: The National Cancer Database (NCDB) was accessed to identify adult patients diagnosed with invasive gastric NETs from 2004 to 2019.
RESULTS: Of 14665 gastric NETs patients, 13 % (n = 1933) were from non-metropolitan areas. On multivariable analysis, non-metropolitan residence was associated with reduced survival (HR 1.13, p = 0.007). Patients in non-metropolitan areas had a decreased OS with earlier clinical stages 1-2 (HR 1.40, p = 0.011), with higher grades 3-4 tumors (HR 1.26, p = 0.008), or when undergoing surgical resection (HR 1.19, p = 0.01); survival was equivalent for later stage 3-4 tumors and earlier grades 1-2 tumors.
CONCLUSIONS: Non-metropolitan residence conferred an independent survival disadvantage for all gastric NET patients, especially in early stage or high grade tumors and upon surgical resection. Future research should explore causative factors and possible interventions
Mindfulness Apps to Improve Depression Severity and Family Management in Parents of Children With Medical Complexity: A Pilot Study.
No full textPURPOSE: Parents of children with medical complexity (CMC) frequently experience challenges with family management and depression. The purpose of the study was to provide preliminary feasibility, usage, acceptability, and efficacy data following a trial of mindfulness app use in parents of a CMC.
DESIGN AND METHODS: In this single-arm intervention pilot study, parents were asked to use a mindfulness mobile application (app) for 10-15 min, 4 days a week. Depression severity and family management were measured using the Patient Health Questionnaire-9 and Family Management Measure, respectively, at baseline and 4 weeks later.
RESULTS: A total of 32 parents consented to participate; 28 parents completed all surveys. Self-reported usage data indicate that 8 parents (32%) used the app 4 days a week and 12 parents (50%) used it for at least 10 min/session. The majority rated the app easy to use and would recommend it (n = 26; 92.8%). There was a statistically significant improvement in depression severity and family management scores following app use. Time spent using the app had a strong negative correlation with depression severity scores (p \u3c 0.01), however, the number of days used per week of use was not statistically significant.
PRACTICE IMPLICATIONS: Parents of a CMC are at risk for depression and family management issues. Timely identification of parental mental health is important so interventions can be provided. This pilot study provides promising, preliminary information regarding the feasibility, acceptability, and efficacy of a mindfulness app intervention
