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The Association Between Retinal Nerve Fibre Layer Loss and Forceps Trauma During Surgery for Idiopathic Full Thickness Macular Hole
Full text link\ua9 2026 Raimondi et al. Purpose: This study investigated the relationship between forceps trauma during internal limiting membrane (ILM) peeling and its effects on focal and overall retinal nerve fibre layer (RNFL) loss and their impact on central visual fields following macular hole surgery. Methods: We conducted a post hoc analysis of ILM peeling surgeries for idiopathic full thickness macular hole collected previously as part of a prospective study. This included video analysis to assess the position of ILM pick-up points (PUPs), associated retinal hemorrhages, and the overall duration of ILM peeling. Subsequently, we correlated these findings with multimodal imaging as well as visual field data at 3 weeks and 6 months postoperatively. Results: The analysis encompassed a total of 43 eyes of 43 patients, with 213 PUPs performed by four experienced surgeons. The median peeling time was 263 seconds and the median number of PUPs per case was 5.6. PUPs were found to be associated with hemorrhages and subacute nerve fibre layer swelling (SANFL) lesions in approximately 20% of cases overall. Although PUPs, especially those linked with SANFL lesions and hemorrhages, were associated with focal RNFL defects, most defects were in the outer temporal sector of the macula and unrelated to PUPs. There were 192 focal RNFL defects observed but only 16% were associated with PUPs. PUPs in the inner and temporal sectors of the macula, and the severity of a DONFL appearance, demonstrated a significant correlation with peripapillary RNFL loss on multivariate analysis. No correlation between central visual field improvement and any of the anatomical changes was found. Conclusion: Whilst forceps trauma can result in SANFL lesions and focal RNFL loss, over 80% of focal RNFL defects observed after ILM peeling are not associated with PUPs and may be more associated with the act of ILM avulsion from the underlying retina during peeling
Multivariate moment indeterminateness: Separating functions and bounded point evaluations
No full text\ua9 2026 The Author(s). The publishing rights in this article are licensed to the London Mathematical Society under an exclusive licence.The discrete data encoded in the power moments of a positive measure, fast decaying at infinity on Euclidean space, are incomplete for recovery, leading to the concept of moment indeterminateness. On the other hand, classical integral transforms (Fourier-Laplace, Fantappi\ue8, Poisson) of such measures are complete, often invertible via an effective inverse operation. The gap between the two non-uniqueness/uniqueness phenomena is manifest in the dual picture, when trying to extend the measure, regarded as a positive linear functional, from the polynomial algebra to the full space of continuous functions. This point of view was advocated by Marcel Riesz a century ago, in the single real variable setting. Notable advances in functional analysis have their root in Riesz\u27s celebrated four notes devoted to the moment problem. A key technical ingredient being there the monotone approximation by polynomials of kernels of integral transforms. With inherent new obstacles, we reappraise in the context of several real variables M. Riesz\u27s variational principle. The result is an array of necessary and sufficient moment indeterminateness criteria, some raising real algebra questions, as well as others involving intriguing analytic problems, all gravitating around the concept of moment separating function
Burden of chronic respiratory disease in Asia, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
No full text\ua9 2026 Elsevier LtdBackground: Chronic respiratory diseases are an important global issue, particularly in Asia, where burden patterns vary widely across countries. With more than half the world\u27s population living in Asia, understanding the national and regional burden of chronic respiratory diseases is essential; however, research on this area remains inadequate. We aimed to investigate the burden of chronic respiratory diseases in Asia at national and regional levels, and to identify key risk factors. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study 2023 provides estimates for assessing the burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis. We focused on 34 countries in Asia, encompassing the high-income Asia Pacific region and central, east, south, and southeast Asia. Estimates for age-standardised prevalence and disability-adjusted life-year (DALY) rates per 100 000 population, including 95% uncertainty intervals (UIs), were extracted by location, sex, year, and Socio-demographic Index (SDI). The average annual percentage change was calculated and presented as a percentage with 95% CIs. Estimates of modifiable attributable risk factors for DALYs and mortality were also included. Findings: In Asia, the age-standardised prevalence and DALY rates for chronic respiratory diseases generally declined from 1990 to 2023; however, the trend varied substantially by disease and country. In 2023, the age-standardised prevalence rate of COPD was highest in south Asia (3044\ub718 [95% UI 2748\ub767–3303\ub704] per 100 000 population), while the age-standardised asthma prevalence rate was highest in the high-income Asia Pacific region (4870\ub724 [4046\ub770–5962\ub778] per 100 000 population) and southeast Asia (4778\ub718 [3970\ub725–5735\ub761] per 100 000 population). Despite southeast Asia and the high-income Asia Pacific region having a similar age-standardised asthma prevalence rate, southeast Asia had a higher age-standardised DALY rate (508\ub767 [95% UI 394\ub789–669\ub792] per 100 000 population) compared with the high-income Asia Pacific region (204\ub740 [129\ub723–290\ub741] per 100 000 population). A decrease in the age-standardised DALY rate for chronic respiratory diseases was observed with increasing SDI, contrasting with its prevalence patterns. Age-standardised DALY rates of COPD decreased in all Asian countries except for Georgia (average annual percentage change 1\ub737 [95% CI 1\ub726–1\ub748]) and Kazakhstan (0\ub773 [0\ub755–0\ub793]), and age-standardised DALY rates of asthma decreased in all countries. Smoking and ambient particulate matter pollution were identified as leading attributable risk factors for chronic respiratory diseases across Asia. Household air pollution from solid fuels was a regionally pronounced risk factor for chronic respiratory diseases, particularly in south Asia (age-standardised DALY rate 657\ub758 [95% UI 485\ub704–880\ub745] per 100 000 population). Although smoking was a major risk factor in males, ambient particulate matter pollution and secondhand smoke emerged as important attributable risk factors for chronic respiratory diseases in females. Interpretation: Countries with lower SDI had markedly higher DALY rates, highlighting the need to address socioeconomic and health-care inequities. Household air pollution from solid fuels continues to impose a substantial but preventable burden in south Asia, calling for clean energy adoption and improved ventilation. Funding: Gates Foundation
Clinical and cost-effectiveness of eculizumab withdrawal in atypical haemolytic uraemic syndrome: the SETS aHUS multi-centre, open-label, prospective and single-arm study
Full text linkBackground: Atypical haemolytic uraemic syndrome is a rare disease (incidence: 0.4 cases per million per year) which, without treatment, is associated with high morbidity and mortality. Eculizumab, a monoclonal complement inhibitor, is an effective treatment but the optimal way to use this high-cost medication (\ua3360,000 per year for an adult) has not been established. Objective: Establish the safety of eculizumab withdrawal and the effectiveness of a monitoring protocol to detect disease relapse and reintroduction of treatment if relapse occurs. Setting: Fifteen hospitals in the United Kingdom. Design: SETS aHUS is a multicentre, open label, prospective, single arm study of the safety and impact of eculizumab withdrawal in patients with atypical haemolytic uraemic syndrome using Bayes single arm analysis with a health economic analysis and qualitative study. Participants: Patients over 2 years of age with atypical haemolytic uraemic syndrome who were receiving eculizumab therapy for at least 6 months. Two study arms are described with 28 participants recruited to the withdrawal arm and 11 additional participants recruited to the standard of care arm of the study. Intervention: Withdrawal of eculizumab treatment and replacement with monitoring to assess disease activity with reintroduction of treatment if relapse occurs. Main outcome measures: The primary outcome measure was to determine the safety of eculizumab withdrawal in patients with atypical haemolytic uraemic syndrome during the 2-year study period. Patients met a primary outcome of \u27safety event occurred\u27 if there was a permanent reduction in estimated glomerular filtration rate or requirement for renal replacement therapy or significant extra-renal manifestation of disease. The health economic analysis compared the cost and health outcomes on and off eculizumab treatment. The qualitative study explored the experiences of patients on living with atypical haemolytic uraemic syndrome and eculizumab treatment, views on withdrawing from treatment and the proposed monitoring plan. Results: One of 28 patients (3.6%) who withdrew from treatment met a primary outcome. Based on the pre-study analysis plan, withdrawal from treatment is not associated with a greater risk to patients compared to remaining on treatment. Of 17 patients with an abnormality in complement regulation, 4 relapsed. Of 11 patients with no abnormality in complement regulation, 0 relapsed. It was possible, by monitoring and rapid patient access, to reintroduce eculizumab treatment when relapse was identified. Most patients welcomed the opportunity to withdraw from treatment but identified concerns about monitoring and the risk of relapse, informed by initial experience at presentation. Withdrawing a patient from treatment saves \ua34.2M in healthcare costs (80 years time horizon). Limitations: Reflecting the low prevalence, participant numbers are low, particularly in the standard of care group. Conclusions: Withdrawal of eculizumab treatment with monitoring of disease activity exhibited a favourable safety profile compared to continuation of eculizumab, was acceptable to patients and carers and is associated with significant cost savings. Future work: More real-world data should be generated by continued assessment of patients after treatment withdrawal including risk of relapse, renal outcomes, real-world economic analysis and a better understanding of communicating change to patients and carers. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/130/94.Overall, 24 patients remained off eculizumab during their 2 years of trial participation. Four patients relapsed and eculizumab treatment was re-started. One patient’s kidney function fell, but overall withdrawing eculizumab had a similar safety profile as staying on treatment. The cause of atypical haemolytic uraemic syndrome predicted relapse. The quality of life of patients who withdrew from eculizumab is expected to increase, with minimal impact on life expectancy. We estimated that there would be a saving of \ua34,188,361 per patient who withdrew from treatment. In the interviews at the beginning of the trial, participants said that eculizumab treatment was disruptive to work and school. Eculizumab side-effects were also a problem. The decision not to withdraw from eculizumab was based upon concerns about the possibility of relapse. At the end of the trial, participants said that the extreme tiredness and other symptoms associated with eculizumab were no longer present with less disruption to their daily lives. Anxiety was an issue, but this became less over time. Knowing they could restart eculizumab immediately was reassuring. The following future research is important: (1) Can eculizumab be withdrawn again in patients who have relapsed? (2) What are the factors influencing risk of relapse? (3) What is the most effective way to manage patients short and long-term after withdrawal of eculizumab? It will be critical to identify what resources are required to implement new ways to manage atypical haemolytic uraemic syndrome
Co-creating an antenatal care information resource in Arabic with re-settled migrant mothers
Full text link2026 Lie and Claisse.Introduction: Arabic-speaking women newly settled in the UK have different experiences of healthcare in their original countries which influence their engagement with the NHS. Like other migrant women, they are often unaccustomed to the way health services work. Language, religious and cultural barriers, as well as the lack of family and community supports contribute to inequalities in health and wellbeing outcomes during pregnancy and childbirth. Materials and methods: To address their needs, the ERicar2 project aimed to produce a co-created antenatal care community information resource with a group of these women. Ten participatory workshops over eleven weeks were conducted to listen to the women\u27s stories of their pregnancy journeys, explore publicly available resources, and work together to produce a prototype of an information resource tailored to their community needs. Results: The qualitative findings from the workshops uncovered their experiences of miscarriage, their health seeking behavior, the role of religious belief and digital media, and the importance to them of their reproductive rights. The messages that they had for a newly arrived Arabic speaking woman were incorporated in a letter illustrated with their drawings, addressed to a fictional character “Dila” and containing QR codes to internet sites for pregnancy support. The letter was digitally animated and recorded in English and Arabic by volunteers among the research participants. The ERicar2 online resource is available for use by UK health providers and Arabic-speaking communities. Discussion: Engagement with migrant mothers through participatory co-creative workshops (ERicar) is a model that can be replicated. In a safe community space, women sharing their pregnancy journeys have led to mutual support and research insights for maternal healthcare. Employing bricolage and iterative co-creation methods, women have been able to contribute to an antenatal resource tailored to the needs of an expectant mother recently resettled in the UK
High Incidence of Mandibular Osteoradionecrosis After Radiotherapy for Oral Cavity: Time for Rebalancing Risks and Benefits
No full textCrown Copyright \ua9 2026 Published by Elsevier Ltd on behalf of The Royal College of Radiologists. All rights are reserved, including those for text and data mining, AI training, and similar technologies.Aims: Limited evidence exists on the incidence of osteoradionecrosis (ORN) specifically for oral cavity (OC) cancer alone. The primary objective of this study was to determine the incidence of ORN for each subsite of the OC. The secondary objective was to analyse the risk factors for ORN development. Materials and methods: Between 2010 and 2021, a total of 2517 head and neck cancer patients underwent radical or adjuvant radiotherapy (RT) at our centre. Of these, 254 patients with an OC primary cancer were identified and were included in this analysis. Results: Of the 254 patients, ORN developed in 57 patients (22.4%). Subsite analysis showed the following incidence: floor of mouth 21/64 (32.8%), retromolar trigone 11/46 (23.9%), lower gum 8/25 (32.0%), tongue 14/109 (12.8%) and buccal mucosa 3/10 (30.0%).In univariable analysis, any surgical intervention involving the mandible as well as dental extraction after RT were identified as significant risk factors for ORN development (P < .05). In multivariable analysis, dental extraction after RT (P < .001), rim resection as a part of the primary treatment (P = .027), and ipsilateral neck irradiation (P = .045) were confirmed as significant risk factors. Conclusion: This study, focusing exclusively on ORN of the OC, has revealed unexpectedly high rates of ORN at 22.4%, with certain subsites such as floor of mouth having an incidence of 32.8%. The authors recommend that postoperative RT for OC cancers should be carefully evaluated, weighing the potential benefits against the possible risks of morbidity
Better reporting is better science: Community-defined minimal reporting requirements for light microscopy
No full text\ua9 2026 Montero Llopis et al.Incomplete reporting of microscopy methods undermines transparency, reproducibility, and data reuse. Despite recent initiatives, comprehensive, broadly endorsed, and accessible reporting guidelines are still lacking. Here, we present a bare minimal microscopy reporting requirements checklist that integrates human- and machine-readable input to provide clear, actionable guidance for researchers, reviewers, and publishers and to advance community standards in microscopy
Finding Solutions to Addressing Inequalities in Dementia Diagnosis and Care: Recommendations From a Country-Wide Consultation
Full text link\ua9 2026 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.Background: Accessing a diagnosis and receiving adequate care and support for dementia can often be subject to various inequalities. Personal-, community-, and infrastructure-level factors can contribute to and often intersect in causing unequal health and care outcomes. With a paucity of evidence to inform solutions for dementia inequalities, the aim of this public consultation exercise was to explore potential solutions to inequalities in dementia diagnosis and care with different dementia stakeholders. Methods: Utilising a future workshop approach, we conducted 11 in-person and remote consultation workshops to discuss experienced barriers of accessing diagnosis and care; discuss an ideal-world scenario where no barriers exist; and solutions to reach more equitable dementia diagnosis and care with people with dementia, unpaid carers, health and social care professionals, and third sector representatives. Discussions were synthesised by the research team and one public consultation group and mapped against the Dementia Inequalities model. Results: A total of 131 different stakeholders in dementia attended 11 workshops across England. Solutions were identified across three layers of inequalities, with the majority of solutions proposed on a community and infrastructure level. Examples included link workers, a social care career pathway, Community Champions, adequate home equipment, and digital training. Some solutions require Governmental input, such as creating career pathways in the social care workforce, similar to the NHS, to train and maintain good paid carers, as well as a cross-UK national dementia strategy raising the priority of dementia and required changes. Conclusions: Dementia inequalities could be addressed via diverse and holistic approaches. With limited evidence to date on the impact of some of the proposed solutions, future research needs to build on these recommendations and design and test suitable interventions
Dynamic Hydrogen Injection in Integrated Electricity-Gas Systems: A PDEs-Embedded Flexible Operation Strategy
No full text\ua9 2010-2012 IEEE.Integrated electricity-gas systems (IEGS) with hydrogen injection has emerged as a crucial pathway to decarbonize energy systems. By coordinating the flexibility of the gas system and hydrogen blending, the accommodation of large-scale renewable energy integrated in power systems can be further improved. However, the time-varying nature of dynamic hydrogen injection, influenced by stochastic renewable energy, can lead to fluctuations in gas concentrations in the gas network, threatening the secure operation of IEGS. This paper focuses on the low-carbon flexible operation strategy for IEGS with dynamic hydrogen injection. First, a flexible operation strategy of hydrogen-mixed gas turbine is developed with a detailed correlation characterization of carbon emission, combustion thermoldynamics, and chemical reaction kinetics under dynamic hydrogen ratios. Second, an optimal IEGS dispatch strategy is formulated in which the joint dynamics of the system component and the gas flow is captured to accurately track the time-varying concentrations of hydrogen in the gas network. Third, a set of discretized partial differential equations (PDEs) is utilized to model mixed gas flows, leading to a PDEs-constrained optimization model. Finally, Taylor series expansions for PDE linearization and McCormick envelope for bilinear terms are employed, enabling tractable algebraic representations. A sequential linear programming (SLP) algorithm with adaptive penalty factors is developed to drive relaxation tightening more efficiently. Numerical results on a 24-bus-20-node system and a practical 197-bus-171-node system in Northwest China illustrate the effectiveness of the proposed model
Neuroimaging and Pathology Biomarkers in Parkinson\u27s Disease and Parkinsonism
Full text link\ua9 2026 by the authors. The “Neuroimaging and Pathology Biomarkers in Parkinson’s Disease” course held on 12–13 September 2025 in Milan, Italy, convened an international faculty to review state-of-the-art biomarkers spanning neurotransmitter dysfunction, protein pathology and clinical translation. Here, we synthesize the four themed sessions and highlights convergent messages for diagnosis, stratification and trial design. The first session focused on neuroimaging markers of neurotransmitter dysfunction, highlighting how positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) provided complementary insights into dopaminergic, noradrenergic, cholinergic and serotonergic dysfunction. The second session addressed in vivo imaging of protein pathology, presenting recent advances in PET ligands targeting α-synuclein, progress in four-repeat tau imaging for progressive supranuclear palsy and corticobasal syndromes, and the prognostic relevance of amyloid imaging in the context of mixed pathologies. Imaging of neuroinflammation captures inflammatory processes in vivo and helps study pathophysiological effects. The third session bridged pathology and disease mechanisms, covering the biology of α-synuclein and emerging therapeutic strategies, the clinical potential of seed amplification assays and skin biopsy, the impact of co-pathologies on disease expression, and the “brain-first” versus “body-first” model of pathological spread. Finally, the fourth session addressed disease progression and clinical translation, focusing on imaging predictors of phenoconversion from prodromal to clinically overt stages of synucleinopathies, concepts of neural reserve and compensation, imaging correlates of cognitive impairment, and MRI approaches for atypical parkinsonism. Biomarker-informed pharmacological, infusion-based, and surgical strategies, including network-guided and adaptive deep brain stimulation, were discussed as examples of how multimodal biomarkers may inform personalized management. Across all sessions, the need for harmonization, longitudinal validation, and pathology-confirmed outcome measures was consistently emphasized as essential for advancing biomarker qualification in multicentre research and clinical practice