Secondary platelet activation peaks ≈2 hours after intravenous thrombolysis with alteplase. This study evaluated the safety and efficacy of ultra-early tirofiban administration and compared different tirofiban regimens following intravenous thrombolysis in patients with noncardioembolic acute ischemic stroke. This observational study enrolled patients with acute ischemic stroke who received tirofiban within 24 hours following intravenous thrombolysis. Patients were divided into ultra-early (within 2 hours) and early (2-24 hours) groups based on tirofiban initiation time. A secondary analysis was performed based on whether the tirofiban regimen included a bolus dose. The primary outcome was 90-day excellent functional outcome (modified Rankin Scale score 0-1). The safety outcomes included symptomatic intracranial hemorrhage, intracranial hemorrhage, and 3-month all-cause mortality. A total of 472 patients were enrolled, with 214 in the ultra-early tirofiban group and 258 in the early tirofiban group. The ultra-early tirofiban group was associated with 3-month excellent functional outcomes (67.5% versus 53.3%; adjusted odds ratio [aOR], 1.56 [95% CI, 1.01-2.42]). There were no significant differences in intracranial hemorrhage (3.7% versus 1.6%; P=0.18), symptomatic intracranial hemorrhage (0.5% versus 0.4%; P=0.99), or 3-month mortality (1.5% versus 2.5%; P=0.94). Propensity score matching analyses showed consistent outcomes. No significant differences in excellent functional outcomes (61.4% versus 71.0%; aOR, 0.68 [95% CI, 0.36-1.30]) or symptomatic intracranial hemorrhage (0.4% versus 0%; P=0.99) were observed between bolus and maintained groups for prophylactic tirofiban after intravenous thrombolysis. Ultra-early tirofiban administration following recombinant tissue plasminogen activator was associated with excellent functional outcomes without increasing the risk of symptomatic intracranial hemorrhage, intracranial hemorrhage, or mortality. The extra bolus dose did not show superiority over only maintained dose administration.

The effectiveness of Community Treatment Orders (CTO) and the variability with which they are used remains the subject of ongoing debate. To examine the associations between discharge from psychiatric in-patient care on to a CTO in New South Wales (NSW), Australia, and hospital admissions and bed-days in the following 12 months. Retrospective matched case-control study using linked administrative health data from NSW between 1 January 2017 and 31 December 2023. Cases were individuals discharged on to a CTO after their first psychiatric hospital admission during the study period. We attempted to match controls 2:1 on age, gender and hospital discharge within 6 months of each other. Data were from the NSW Mental Health Ambulatory and Admitted Patient Data Collections. There were 5506 individuals discharged on to CTOs and 9761 matched controls. Discharge on to a CTO did not affect the odds of hospital readmissions in the following 12 months (adjusted odds ratio (ORadj) = 1.06, 95% CI 0.97-1.14) though was associated with significantly greater bed-days (log βadj = 0.12, 95% CI 0.08-0.17, p < 0.0001). Individuals with a principal diagnosis of non-affective psychosis who were discharged on to a CTO had significantly lower odds of hospital readmissions in the following 12 months (ORadj = 0.67, 95% CI 0.59-0.77). Discharge on to a CTO did not significantly affect hospital readmissions across the full sample, but did significantly lower the odds for individuals with non-affective psychosis. This suggests that targeted use of CTOs in specific populations (e.g., non-affective psychosis) warrants greater consideration, as the benefit of their use otherwise - especially from a human rights point of view - is unclear. Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).

FKBP5 (FK506-binding protein 51, protein), encoded by the FKBP5 (gene, human), is a glucocorticoid receptor-regulating cochaperone. FKBP5 has been suggested as a mediator between stress, vascular morbidity, and neuropsychiatric complications. In this translational proof-of-concept study, we investigated the impact of FKBP5 on stroke outcome in mice and men. Fkbp5 (gene, mouse) knockout and wild-type mice were subjected to transient brain ischemia. Lesion volume was assessed at 48 hours after stroke using magnetic resonance imaging. Circulating corticosterone level and adrenal gland weight were determined at 72 hours. Observational data from the Prospective Cohort with Incident Stroke Berlin were used to explore associations between FKBP5 gene variants and functional outcome after 1 year. Poor functional outcome at 1 year was defined as a modified Rankin Scale score of 0 to 1 versus 2 to 6. Risk allele ACT from a predefined FKBP5 haplotype (rs9296158, rs3800373, rs1360780) versus non-ACT was used as the exposure variable. Logistic regression analyses were performed and adjusted for potential confounders. Fkbp5 knockout mice showed reduced corticosterone levels and adrenal weights, together with smaller infarct lesions at 48 hours. Four hundred thirty-three patients with available FKBP5 haplotype were included in the Berlin stroke cohort. FKBP5 risk haplotype ACT, which was present in 204 patients, was associated with poor functional outcome at 1 year (adjusted odds ratio, 1.7 [95% CI, 1.02-2.7]). Loss of Fkbp5 leads to improved outcome in experimental stroke. In addition, the FKBP5 risk haplotype, indicative of increased FKBP5 expression, was associated with poor functional outcome following stroke.

Anemia has emerged as a risk factor for cerebral venous thrombosis (CVT) and has been associated with poorer outcomes. A specific association has been observed with microcytic anemia, most commonly caused by iron deficiency anemia (IDA). However, detailed data on the clinical, radiological, and therapeutic profile of CVT in patients with IDA remain limited. We analyzed consecutive patients with CVT and moderate or severe IDA from the prospective Lariboisière Hospital cohort with CVT (1998-2023). Patients with other types of anemia were excluded. Clinical, neuroimaging, treatment, and outcome data were compared with those of patients with CVT without anemia. Among 616 patients with CVT, 64 (10.4%) had moderate or severe IDA. Most were women (96.9%), with chronic gynecological bleeding (eg, fibroids, adenomyosis) as the predominant cause. All received anticoagulation. Additional treatments included iron supplementation, blood transfusion, gynecological surgery, and gonadotropin-releasing hormone analogs. Compared with patients without anemia (n=502), those with IDA more frequently presented with focal neurological deficits and parenchymal lesions (54.7% versus 35.3%, P=0.0025), particularly venous infarctions (32.8% versus 14.5%, P=0.0002). Despite more severe initial presentations, 1-year functional outcomes did not significantly differ between groups (adjusted odds ratio for excellent outcome associated with IDA, 0.60 [95% CI, 0.23-1.52]). IDA is a prevalent comorbidity in CVT, affecting predominantly young women with benign, treatable causes of IDA. Although associated with more severe initial findings, long-term outcomes did not differ from those of patients without IDA. Appropriate recognition and specific management of IDA should be considered in patients with CVT.

Background and Objectives: Emergency physicians practice in high-pressure environments and face occupational stressors that may affect their mental health. This study was designed to evaluate the prevalence of depression among emergency physicians in South Korea and examined environmental, sociolegal, and individual factors associated with depressive symptoms in the post-pandemic period. Materials and Methods: This nationwide cross-sectional study analyzed data from the 2025 Korean Emergency Physician Survey. Screening positive for depressive symptoms was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10, indicating moderate-to-severe depressive symptom severity. Measures included the PHQ-9, the Korean Epworth Sleepiness Scale (KESS), and the Adult APGAR, a brief self-administered instrument assessing overall wellness. Multivariable logistic regression was performed to identify factors associated with depression after adjusting for demographic, clinical, and work-related variables. Results: Of the 1050 physicians who responded (response rate: 37.5%), 743 emergency physicians completed the PHQ-9 section (completion rate: 70.8%; mean age, 43.2 ± 7.78 years; 86.5% male), and 111 (14.9%) screened positive for depressive symptoms. Objective workload indicators, including total work hours and number of night shifts, did not differ between physicians with and without depression. However, emergency physicians screening positive for depression reported higher perceived burdens related to staffing shortages and patient-related stressors. Protective factors included being married (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08–0.58), longer sleep duration (AOR, 0.65; 95% CI, 0.50–0.86), better sleep quality (AOR, 0.45; 95% CI, 0.27–0.74), fixed mealtimes (AOR, 0.60; 95% CI, 0.39–0.93), and higher Adult APGAR scores (AOR, 0.72; 95% CI, 0.60–0.86). Factors associated with increased odds of depression included a history of cancer (AOR, 14.63, 95% CI, 2.53–84.61), current alcohol consumption (AOR, 2.54, 95% CI, 1.14–5.68), daytime sleepiness (AOR, 1.17; 95% CI, 1.04–1.31), and more frequent verbal abuse during the previous 12 months (AOR, 1.25; 95% CI, 1.08–1.44). Conclusions: Depression was prevalent and was associated with perceived work burden, sleep health, lifestyle regularity, and psychosocial factors. Interventions should address sleep quality, workplace safety, and social support.

Disparities in early intervention (EI) use are well documented. We sought to determine the effects of family navigation (FN) on EI services use and child development among low-income, racially diverse children with suspected developmental delays. We conducted a randomized controlled trial at 6 pediatric practices in a large urban community. Children who were aged younger than 30 months, had a gestational age of more than 35weeks, had parents who spoke English or Spanish, and were referred to Part C EI were eligible. Children were randomized to FN or usual care and followed for 12 months. The main outcome measures were multidisciplinary evaluation (MDE) and EI service initiation and duration obtained from county EI program administrative files and Bayley-3 developmental scores. We examined differences among groups using intention-to-treat logistic and Cox regression models. We randomized 358 eligible children and followed 305 (85%) for 12 months. Children were predominantly Black with family incomes of less than $55 000. Overall, 257 (72%) completed an MDE, and 195 (54%) initiated services. Children who received FN had greater odds of MDE completion (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) and greater EI service initiation (64.4% vs 54.7%; P = .02) than children who received usual care. The average duration of EI services and Bayley-3 scores did not differ among groups. We found that an FN program improved EI referral completion and services initiation but not EI duration or child development among a population of predominantly low-income urban Black children. Implementation of FN programs in similar minoritized communities may reduce disparities in access to EI services.

Routine childhood vaccination rates declined nationwide among children born during 2020-2021 compared with prior birth cohorts. We identified sociodemographic risk factors associated with incomplete 7-vaccine series among children born during widespread health care disruptions due to the COVID-19 pandemic. We retrieved childhood vaccination data from Louisiana's Immunization Information System for children born from March 1, 2020, through July 1, 2021, to identify completion status of the 7-vaccine series by age 24 months. After geocoding home addresses, we used regression analyses and machine-learning models to identify social vulnerability factors at the individual and census-tract levels that were associated with 1 or more missing vaccine doses. Children residing a greater distance from the vaccinating facility (adjusted odds ratio [AOR] = 1.12; 95% CI, 1.05-1.19; P = .002) and in a census tract with a larger low-income population than the statewide median (AOR = 1.14; 95% CI, 1.05-1.23; P = .006) had significantly higher odds of being 1 dose short of 7-vaccine series completion by age 24 months. Similarly, children residing in areas with a larger low-income (AOR = 1.18. 95% CI, 1.14-1.23; P < .001) and non-White (AOR = 1.07; 95% CI, 1.02-1.11; P = .04) population than the statewide median had higher odds of missing multiple doses of the 7-vaccine series by age 24 months. We need further research to identify and implement best practices that help socially vulnerable communities retain access to routine health care, such as childhood immunizations, during future public health emergencies.

Abstract Background Numerous studies have explored age‐related heterogeneity in primary Sjögren's disease (SjD); however, the links between clinical phenotypes and underlying immunophenotypes across age groups remain insufficiently defined. Because primary SjD onset is typically gradual and retrospectively uncertain, diagnostic age—corresponding to the time of confirmed disease identification and clinical management—serves as a more practical and reproducible measure for age‐related analysis. Methods We retrospectively analyzed 5778 primary SjD patients from Peking University People's Hospital diagnosed between January 2018 and December 2022, stratifying them by diagnostic age (&lt;45 years vs. ≥45 years). Multivariable logistic regression, adjusted for confounders and with false discovery rate correction, was used to identify age‐dependent associations. Results In unadjusted analyses, early‐diagnosed patients exhibited a distinct clinical phenotype and more active humoral immunity. Subsequent multivariable adjustment, controlling for sex, smoking, comorbidities, and inflammatory/hematologic markers, confirmed early diagnosis (&lt;45 years) as an independent risk factor for interstitial lung disease (adjusted odds ratio [OR] = 1.98, 95% confidence interval [CI]: 1.09–3.60) and hypergammaglobulinemia (adjusted OR = 3.80, 95% CI: 2.91–4.99). Immunophenotyping further revealed a reconstituted T cell landscape characterized by CD4⁺ lymphopenia (median difference: −70 cells/μL; 95% CI: −109 to −30), CD8⁺ expansion (+33 cells/μL; 95% CI: +8 cells/μL to +75 cells/μL), and a skewed CD4⁺ subset balance featuring elevated Treg (9.76% vs. 8.57%) and naïve Th cells (34.90% vs. 26.30%) but reduced Teff cells (88.93% vs. 90.30%; all p &lt; 0.01). Conclusions This study defines the core phenotype of early‐diagnosed primary SjD by hypergammaglobulinemia and interstitial lung disease risk, unveiling its distinct T cell basis. These results highlight age‐specific immune mechanisms and suggest the need for personalized monitoring and individualized immune regulation strategies in clinical management.

Cluster separation outperforms other metrics in validating multimorbidity patterns: Statistical simulation study.

The effects of different concentrations of isotonic contrast agents on the quality of hepatic and portal vein imaging and their impact on patients' renal function remain unclear. This study aimed to assess whether lower concentrations of iodixanol yield high-quality imaging by comparing hepatic and portal vein imaging quality and evaluating renal function following dual-energy CT (DECT) scans. Patients were randomly assigned to receive either iodixanol at 270 mgI/mL (iodixanol 270 group, n = 50) or 320 mgI/mL (iodixanol 320 group, n = 50) and underwent DECT with energy-spectrum reconstruction. Quantitative and qualitative image quality parameters, as well as changes in renal function before and after scanning, were compared between the 2 groups. Significant differences were observed in the contrast-to-noise ratio, signal-to-noise ratio of the main portal vein, and the computed tomography value of the hepatic vein between the 2 groups (P < .05). These parameters were superior in the iodixanol 320 group compared to the iodixanol 270 group. Qualitative evaluation scores for the portal and hepatic veins in the iodixanol 320 group were significantly higher than those in the iodixanol 270 group (P < .05). Postcontrast acute kidney injury incidence was higher in the iodixanol 320 group than in the iodixanol 270 group (20.5% vs 2.1%, P < .05), and this association remained significant after multivariable adjustment (adjusted odds ratio = 13.70, P = .002). With a fixed injection protocol, iodixanol 320 mgI/mL yielded higher venous enhancement, whereas iodixanol 270 mgI/mL provided diagnostically acceptable portal/hepatic venous image quality on DECT with a lower iodine load. After adjustment, 320 mgI/mL was associated with higher odds of postcontrast acute kidney injury; this safety signal requires confirmation in larger iodine-matched studies.

ABSTRACT Based on a three-level meta-analysis of 55 studies (188 effect sizes; N = 40,924), emotional reactions were positively associated with information sharing (r = 0.32). Moderator analyses revealed stronger associations for positive (r = 0.46) than negative (r = 0.25) emotions, interpersonal (r = 0.39) than media (r = 0.24) channels, and sharing behavior (r = 0.35) than intention (r = 0.28). The strength of association varied by topic, with larger estimates for multi-topic (r = 0.56) and commercial content (r = 0.45). This meta-analysis offers a cross-study test of Emotional Broadcaster Theory and identifies boundary conditions shaping the relationship between emotional reactions and information sharing.

Do clinical and perinatal outcomes of dichorionic diamniotic (DCDA) twin pregnancies differ between single embryo transfer (SET) and double embryo transfer (DET) in human medically assisted reproduction (MAR)? In DCDA twin pregnancies, SET was associated with a significantly higher incidence of complete miscarriage and a lower rate of twin live births than DET. While DET has historically been the major contributor to dizygotic DCDA twins, the global adoption of SET has markedly reduced such cases. However, monozygotic twinning (MZT) occurs more frequently after MAR, especially in blastocyst transfer cycles, and the prognosis of monozygotic DCDA twins remains poorly understood. This single-center retrospective cohort study analyzed 206 clinical multiple pregnancies achieved between January 2014 and December 2024, following 4658 fresh and 15872 frozen-warmed embryo transfer cycles. Only cycles using autologous oocytes were included. Clinical and perinatal outcomes of DCDA twin pregnancies derived from SET and DET were compared. To account for baseline differences between SET and DET groups, an exploratory multivariable logistic regression analysis was performed for clinical outcomes. Statistical analyses were performed using the Mann-Whitney U-test and Fisher's exact test, with P < 0.05 considered significant. When comparing the clinical course of DCDA twin pregnancies, the incidence of two gestational sacs and two fetal heartbeats was significantly higher in the DET group than in the SET group (98.0% vs 47.2%, P < 0.0001; 63.5% vs 25.5%, P < 0.0001) (two fetal heartbeats: adjusted odds ratios [aOR], 0.276; 95% CI, 0.108-0.706; P < 0.007). Twin live birth occurred in 53.1% of DET-derived DCDA twins and 17.6% of SET-derived DCDA twins (P < 0.0001) (aOR, 0.324; 95% CI, 0.121-0.867; P = 0.025), whereas complete miscarriage was more frequent after SET (49.0% vs 17.7%, P < 0.0001) (aOR, 9.140; 95% CI, 3.030-27.600; P < 0.0001). Perinatal outcomes, including gestational age, birth weight, and congenital anomaly rates, did not differ significantly between groups. The number of monozygotic cases was limited, and zygosity could not be genetically confirmed. Some same-sex DCDA twins may have been dizygotic in origin. These findings highlight that DCDA twin pregnancies should not be regarded as a uniform clinical entity in MAR. Even within the same chorionicity category, early outcomes differ significantly between monozygotic twins after SET and dizygotic twins after DET. Although SET remains the optimal strategy to prevent multiple pregnancies, further studies should aim to identify embryos at higher risk of post-transfer splitting and to refine preventive criteria for MZT. There is no funding for this study. N/A.

Among patients who have a penicillin allergy label (a history of any reaction to penicillin in their medical records), many cataract surgeries are performed yearly. Less than 1% of these patients have a true allergy to penicillin. The evidence supports limited concern regarding cephalosporin cross-reactivity; however, the guidance for surgeons regarding antibiotic selection in these patients remains unclear. To examine rates of perioperative antibiotic selection after penicillin allergy label reclassification vs before reclassification. Quality improvement study including 1905 patients identified with a penicillin allergy label undergoing cataract surgery between May 30, 2020, and May 30, 2025, at a large tertiary eye care center in the US. This analysis was conducted from June 2025 to December 2025. Policy intervention for surgeons performing cataract surgery that featured enhanced pharmacy collaboration and guidance, suppression of automated electronic medical record alerts for cephalosporin cross-reactivity, and reclassification of the allergy in the medical record. The policy intervention date was set as November 30, 2022. Patient receipt of intracameral antibiotics (1.0 mg/0.1 mL of cefuroxime or 0.5 mg/0.1 mL of moxifloxacin), topical antibiotics (eg, erythromycin or moxifloxacin), or no prophylaxis. Perioperative antibiotic selection rates were measured for all patients undergoing cataract surgery. Among the 1905 patients with a penicillin allergy label in their medical record, 3077 cataract surgeries (some patients underwent >1 cataract surgery) were performed by 51 surgeons. In an unadjusted time series analysis, the mean rate of cefuroxime use was 80.0% (95% CI, 74.5%-84.7%) after the policy intervention date, which was far above the expected use rate of 3.3% (95% CI, 2.0%-4.4%) (P = .001). After adjustment, the mean rate of cefuroxime use was 71% (95% CI, 62%-79%) after the policy intervention date compared with a mean rate of 2% (95% CI, 1%-3%) before the intervention. The adjusted odds ratio was 0.37 (95% CI, 0.27-0.52; P < .001) for cefuroxime use after the policy intervention date in patients with high-risk allergies (such as a history of anaphylaxis or angioedema) noted in the medical record and prior to review by a pharmacist. Evidence-based antibiotic selection policies for patients with a penicillin allergy label may enhance appropriate use of intracameral cefuroxime in cataract surgery. The rapid increase in cefuroxime use after the policy intervention date suggests surgeons may benefit from education and pharmacy support.

Postoperative urinary retention (POUR) is a common complication, but its incidence and risk factors after thyroidectomy are not well-defined. We investigated the incidence of POUR after thyroidectomy and its risk factors. We conducted a retrospective review of 511 consecutive patients who underwent thyroidectomy by a single surgeon. POUR was defined as the inability to void within 6h of the last preoperative void performed immediately prior to transfer to the operating room, with bladder volume >500mL requiring catheterization. Univariable and multivariable logistic regressions were performed separately for male and female. Among 511 patients (368 females, 143 males; mean age 49.6years), 412 (80.6%) underwent lobectomy, 71 (13.9%) total thyroidectomy without lateral neck dissection, and 28 (5.5%) total thyroidectomy with lateral neck dissection. Surgical access was open in 333 (65.2%), transoral robotic in 158 (30.9%), and transoral endoscopic in 20 (3.9%). Overall, 68 patients (13.3%) developed POUR. In males, independent predictors were benign prostatic hyperplasia (BPH) (adjusted odds ratio [aOR] 7.890; 95% confidence interval [CI], 1.814-34.318; p=0.006) and body mass index (BMI)<25kg/m2 (aOR 0.245; 95% CI, 0.066-0.909; p=0.036; reference ≥25kg/m2). In females, age ≥50years (aOR 2.417; 95% CI, 1.273-4.588; p=0.007), BMI <25kg/m2 (aOR 0.465; 95% CI, 0.228-0.947; p=0.035; reference ≥25kg/m2), and operative time ≥60min (aOR 1.939; 95% CI, 1.014-3.709; p=0.045). Surgical approach, extent of surgery, pathology, and postoperative opioid use were not independently associated with POUR in either sex. POUR occurred in 13.3% of thyroidectomy patients. Sex-stratified analysis showed BPH and lower BMI as key risks in males, whereas older age, lower BMI, and longer operative time were significant in females. Recognizing these factors may support targeted perioperative screening and postoperative monitoring to reduce retention-related delays and complications.

Pulmonary hypertension (PH) and sensitization adversely affect heart transplant outcomes. Although left ventricular assist devices may reduce PH, they can increase sensitization. We examined the impact of sensitization on heart transplant outcomes in left ventricular assist device-bridged patients and whether precapillary PH modifies this effect. Adults bridged to heart transplant with an left ventricular assist device between 2005 and 2020 were identified from the United Network for Organ Sharing database. Patients with available panel-reactive antibody (PRA) and hemodynamic data were included. Associations between PRA and survival and treated rejection were analyzed. Among 2469 patients, 1053 had precapillary PH (pulmonary vascular resistance [PVR] >2 Wood units [WU]) and 1416 had PVR ≤2 WU. Elevated PRA (>10%) occurred in 566 patients (24.8% with PVR >2 WU; 21.5% with PVR ≤2 WU). Overall, PRA >10% was associated with increased mortality (adjusted hazard ratio [aHR], 1.28 [95% CI, 1.04-1.58], P=0.022), driven by patients with PVR >2 WU (aHR, 1.82 [95% CI, 1.34-2.50], P<0.001), with no association in those with PVR ≤2 WU (aHR, 0.99 [95% CI, 0.47-1.32], P=0.92). PRA >10% was also associated with treated rejection overall (adjusted odds ratio [aOR], 1.41 [95% CI, 1.09-1.82], P=0.008), confined to the PVR >2 WU group (aOR, 1.87 [95% CI, 1.26-2.76], P=0.002) and absent in the PVR ≤2 WU group (aOR, 1.13 [95% CI, 0.80-1.59], P=0.49). Elevated PRA predicts worse outcomes in LVAD-bridged transplant recepients with precapillary PH, but not in those without precapillary PH.

For patients with left-sided metastatic colorectal cancer (mCRC), the recommended first-line treatment is anti-epidermal growth factor receptor (anti-EGFR) antibodies, such as cetuximab or panitumumab, plus doublet chemotherapy. However, the differences in outcomes between cetuximab and panitumumab remain unknown. Clinical data of patients with left-sided all RAS or KRAS wild-type mCRC who received cetuximab or panitumumab plus doublet chemotherapy were retrospectively collected from 24 institutions in Japan. The patients were divided into two groups: the cetuximab and panitumumab groups. Overall survival (OS), progression-free survival (PFS), and response rate (RR) were compared between the two groups. A total of 233 patients were enrolled: 87 (37.3%) in the cetuximab group and 146 (62.7%) in the panitumumab group. Median OS, PFS, and RR of the cetuximab and panitumumab groups were 26.6months (95% confidence interval [CI], 19.7-33.4) versus 31.8months (95% CI, 25.7-37.9), 9.7months (95% CI, 6.9-12.5) versus 12.4months (11.1-13.7), and 57.8% versus 71.0%, respectively. In multivariate analysis, OS and RR were significantly better in the panitumumab group than in the cetuximab group (adjusted hazard ratio 0.69, 95% CI 0.50-0.99, p = 0.04; adjusted odds ratio 2.00, 95% CI 1.07-3.73, p = 0.03) and PFS was similar between the two groups (adjusted hazard ratio 0.75, 95% CI 0.55-1.01, p = 0.05). As a first-line treatment for patients with left-sided all RAS or KRAS wild-type mCRC, panitumumab plus doublet chemotherapy may be suggested better efficacy outcomes than cetuximab plus doublet chemotherapy.

Abstract Background: Individuals with chronic disease must comprehend their diagnosis (sense) and gain control over the ailment (grip on disease). However, HIV-AIDS is different due to stigma and discrimination. Yet, persons living with HIV, with a robust sense of grip on disease (SoGoD), can lead satisfying lives. This study aimed to assess the SoGoD status and its associates, and then elicit the perspective of the stakeholders. Materials and Methods: This mixed-method study was conducted among People Living with HIVs (PLHIVs) visiting a tertiary care hospital in Kolkata, India, from November 2023 to January 2024. The quantitative strand of the study was conducted among 120 PLHIVs on antiretroviral therapy (ART), and then the qualitative strand was conducted by in-depth interviews (IDIs) with study participants and key informant interviews (KIIs) with healthcare personnel. SPSS software was utilized for quantitative data analysis, and factors associated with the SoGoD were analyzed using logistic regression models. Qualitative data were analyzed thematically. Results: Among the study participants, 34% have a dynamic grip. Illiteracy (adjusted odds ratio [aOR] = 7.22, 95% confidence interval [CI] = 1.94–10.97), current marriage (aOR = 4.44, 95% CI = 1.61–12.27), no history of substance use (aOR = 2.79, 95% CI = 1.99–7.85), and lesser stigma and discrimination (aOR = 5.41, 95% CI = 1.96–7.86) were significantly associated with dynamic grip. Self-care, family and community support, and integrated institutional care were identified as major ways to enhance disease grip. Conclusion: Since HIV is a heavily stigmatized disease, measures such as early family engagement and counseling, and comprehensive and adaptable institutional care should be undertaken to improve their disease grip.

ABSTRACT Previous literature links emotional dysregulation (ED) to HIV acquisition risk and intimate partner violence (IPV) perpetration. This study assessed the relationship between ED, HIV acquisition risk, and IPV perpetration cross-sectionally and longitudinally among men (18–30 years) in urban informal settlements and rural areas in KwaZulu-Natal, South Africa. Data were drawn from 163 young men enrolled in a pilot randomized controlled trial of Stepping Stones and Creating Futures Plus (SSCF+). Regression models were used to examine baseline and longitudinal associations. Informed by previous findings that SSCF+ reduced ED among men with elevated depressive symptoms, we assessed whether the intervention modified ED – HIV/IPV associations in this subgroup using ED × intervention interaction terms among participants with elevated depressive symptoms (n = 56). Cross-sectionally, ED was associated with multiple sexual partners, alcohol use and drug use. Longitudinally, only alcohol abuse remained significantly associated with ED (adjusted odds ratio [aOR] 1.06, 95% CI 1.02–1.11). ED increased the risk of emotional and combined IPV perpetration cross-sectionally, and longitudinally ED was associated with physical (aOR 1.07, 95% CI 1.02–1.13), emotional (aOR 1.06, 95% CI 1.02–1.11), sexual (aOR 1.05, 95% CI 1.01–1.10), and combined IPV perpetration (adjusted beta coefficient [aβ] 0.16, 95% CI 0.03–0.34). Among men with elevated depressive symptoms, combined IPV perpetration increased with ED in the control group but remained relatively flat in the intervention group. Addressing ED within IPV and HIV prevention programming may be an important strategy for reducing men’s IPV perpetration and HIV risk.

Background Superspreading persons (SSPs) drive marked heterogeneity in SARS-CoV-2 transmission, yet quantitative evidence on their determinants in community settings remains limited. Objectives To quantify the impact of SSPs and identify demographic, virologic, and contextual correlates of superspreading in Gangwon Province, Korea. Methods We analysed province-wide epidemiological investigation records for laboratory-confirmed COVID-19 from 21 February 2020 to 31 January 2022. Transmission networks linking index and secondary cases were reconstructed. Superspreaders were prespecified as individuals generating ≥7 secondary infections. Offspring counts were modelled with a negative binomial distribution; multivariable logistic regression estimated adjusted odds ratios for age, vaccination, symptoms at diagnosis, PCR cycle-threshold (Ct), occupation, exposure setting, and viral variant based on specimen date. Results Among 15,300 community-acquired cases, offspring counts followed a negative binomial distribution(κ = 0.36). Most cases generated ≤6 secondaries, whereas 164 cases (1.1%) met the superspreader criterion and accounted for 1,571 downstream infections (11.3%). Higher odds of superspreading were observed among ages 0–19 (aOR 1.86) and 40–59 (1.84), the unvaccinated (1.64), those symptomatic at diagnosis (2.13), individuals with Ct <16.0 (2.54) or 16.0–23.9 (2.15), white-collar workers (1.68), same-facility exposures (2.39), and cases with an unknown source of infection (3.91). Superspreading odds also varied across variant-dominant periods inferred from specimen dates, although confidence intervals included unity. Conclusion SARS-CoV-2 transmission in Gangwon was highly overdispersed, with a small minority of cases responsible for a disproportionate share of spread. Targeted vaccination, rapid isolation of symptomatic or low-Ct index cases, and strengthened controls in high-risk workplaces and shared facilities may help blunt future superspreading.

Area-based deprivation indices have been linked to hypertension and diabetes outcomes, but limited information exists about their relative performance. We compared 2 area-based deprivation measures (Area Deprivation Index and Yost Index) as risk factors for hypertension and diabetes control. This cohort study identified adults with hypertension or diabetes in a 19-county region of Southeast Minnesota covered by the Rochester Epidemiology Project. The deprivation indices were operationalized as quintiles for state and national ranks. We assessed agreement using the weighted kappa statistic. We used modified Poisson regression to evaluate associations of the deprivation indices with blood pressure or diabetes control in 2022. We compared relative model fit using the area under the receiver operating characteristic curve. We identified 67 386 individuals with hypertension and 30 435 with diabetes. There was moderate to substantial agreement between indices, but the agreement was higher for the state rank (weighted kappa 0.68 for both cohorts) than the national rank (0.54 for both). Although the indices were not associated with hypertension control, greater deprivation was associated with worse diabetes control for the Yost Index (relative risk [RR], 1.21 [95% CI, 1.07-1.38]) and Area Deprivation Index (RR, 1.39 [95% CI, 1.12-1.73]) national ranks. The full-model area under the receiver operating characteristic curve was similar across indices but differed across cohorts with worse fit for hypertension (0.53 for both) than diabetes (0.63 for both). Two common area-based deprivation indices had similar strength of association with diabetes control, suggesting that either index would be appropriate for researching and developing interventions for diabetes control.