EClinicalMedicine最新文献

{"title":"From airways to arteries: cardiovascular and kidney risk in chronic obstructive pulmonary disease.","authors":"Inuk Tórsheim, Alexander G Mathioudakis, Pradeesh Sivapalan","doi":"10.1016/j.eclinm.2026.104165","DOIUrl":"10.1016/j.eclinm.2026.104165","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104165"},"PeriodicalIF":12.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection-triggered encephalopathy syndromes: a meta-analysis of clinical characteristics and outcomes in 1946 cases.","authors":"Michael Eyre, Velda X Han, Terrence Thomas, Hiroshi Sakuma, Shekeeb S Mohammad, Hannah F Jones, Takayuki Mori, Go Kawano, Vanessa W Lee, Stephen Malone, Carly Debinski, Hiroya Nishida, Margherita Nosadini, Ming Lim, Russell C Dale","doi":"10.1016/j.eclinm.2026.104163","DOIUrl":"10.1016/j.eclinm.2026.104163","url":null,"abstract":"<p><strong>Background: </strong>Infection-triggered encephalopathy syndromes (ITES) are acute, para-infectious disorders that can cause disability or death. Recognition is increasingly important in viral pandemics, but clinical features and outcomes remain poorly understood.</p><p><strong>Methods: </strong>PubMed search (inception to 6 March 2024) identified studies with published individual patient data (raw data were not collected from authors). The search was updated on 14 May 2026 using the same terms to identify reports and cases published after the data extraction cutoff. Data were extracted by paediatric neurologists using a standardised proforma. Major syndromes included acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), acute necrotising encephalopathy (ANE), acute shock with encephalopathy and multiorgan failure (ASEM), hemiconvulsion-hemiplegia-epilepsy syndrome (HHE), febrile infection-related epilepsy syndrome (FIRES) and mild encephalopathy with reversible splenial lesion (MERS). We performed a pooled analysis of individual-level published data investigating patient characteristics, infections, and clinical outcomes measured by six-month modified Rankin Scale (mRS). Infection-syndrome associations were analysed with chi-square normalised residuals.</p><p><strong>Findings: </strong>1946 patients from 656 studies (by ascending age of onset) included 164 ASEM (median age 0.78 years), 217 AESD (1.3 years), 95 HHE (2 years), 414 ANE (3.4 years), 562 FIRES (9 years), and 422 MERS (9.25 years). An updated search identified 658 cases from 171 studies that could be eligible for inclusion. AESD was linked to human herpesvirus 6 (z = 12.87); ANE with influenza A (z = 11.1), SARS-CoV-2 (z = 9.1) and influenza B (z = 4.3); MERS with rotavirus infection (z = 7.48); and FIRES with absence of microbiological identification (z = 18.2) (all p < 0.001).Neuroimaging was often delayed. Magnetic resonance imaging (MRI) brain restricted diffusion was the commonest finding, typically bilateral (except HHE). Characteristic patterns included thalamic involvement with or without haemorrhagic changes in ANE, corpus callosum involvement in MERS, and subcortical white matter involvement in AESD and HHE. Cerebrospinal fluid pleocytosis occurred mostly in FIRES and MERS, and elevated protein in ANE.Immunotherapy (commonly steroids, immunoglobulin) including biologics (anakinra, tocilizumab) was used most in ANE and FIRES. Acute mortality was 12% (227/1946), highest in ASEM (50%) and ANE (35%). There was good six-month outcome (mRS 0-2) in 52% (95% CI 50-55; 615/1174): MERS 99% (95% CI 97-100; 323/326), AESD 54% (95% CI 44-64; 50/93), FIRES 38% (95% CI 33-44; 120/314), ANE 33% (95% CI 27-38; 88/269), HHE 16% (95% CI 7-32; 5/32), and ASEM 15% (95% CI 9-24; 14/91).</p><p><strong>Interpretation: </strong>ITES showed distinct demographic, clinico-radiological features and outcomes. This largest ITES cohort to date highlights the importance o","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104163"},"PeriodicalIF":12.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of referral strategies for patients with suspected axial spondyloarthritis: a systematic review with meta-analysis.","authors":"Daniel Feller, Roel Wingbermühle, Bart Koes, Sofia Ramiro, Alessandro Chiarotto","doi":"10.1016/j.eclinm.2026.104167","DOIUrl":"10.1016/j.eclinm.2026.104167","url":null,"abstract":"<p><strong>Background: </strong>Axial spondyloarthritis (axSpA) is a clinically important but often under-recognized condition, with substantial diagnostic delay. Structured referral strategies have been proposed to facilitate earlier identification of suspected cases; however, their diagnostic accuracy has not been comprehensively compared. We therefore conducted a systematic review to synthesize the diagnostic accuracy of referral strategies for identifying axSpA in patients with chronic back pain.</p><p><strong>Methods: </strong>We performed a systematic review of observational studies evaluating referral strategies for suspected axSpA. The review protocol was prospectively registered in PROSPERO (CRD42025634153). MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL Plus were searched from inception to December 2025. Study selection, data extraction using the \"Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies\" (CHARMS), risk of bias assessment using the \"Prediction model Risk Of Bias Assessment Tool + Artificial Intelligence\" (PROBAST+AI), and certainty of evidence rating using an adapted \"Grading of Recommendations Assessment, Development and Evaluation\" (GRADE) approach were conducted by two independent reviewers.</p><p><strong>Findings: </strong>Twenty-four studies evaluating 40 referral strategies were included. Risk of bias was high across all strategies, resulting in low to very low certainty of evidence for most performance metrics. Meta-analysis was feasible for nine referral strategies. Statistically significant pooled likelihood ratios were observed for the negative likelihood ratio (LR-) of the ASAS referral criteria (0.18, 95% CI 0.04-0.81), and for both the positive and negative LRs of the Braun 2-step alternative strategy (LR+ 2.02, 95% CI 1.47-2.76; LR- 0.38, 95% CI 0.19-0.75), CaFaSpA ≥1 (LR+ 1.64, 95% CI 1.04-2.59; LR- 0.43, 95% CI 0.21-0.87), and RADAR 2/3 (LR+ 2.76, 95% CI 2.13-3.59; LR- 0.60, 95% CI 0.51-0.71). These results did not meet thresholds (e.g., LR+ >10, LR- <0.10) for strong diagnostic accuracy.</p><p><strong>Interpretation: </strong>Current referral strategies for axSpA have limited diagnostic impact and are supported by low to very low-certainty evidence. Future research should prioritize the development of new referral strategies, particularly for primary care settings.</p><p><strong>Funding: </strong>No specific funding was received for this work.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104167"},"PeriodicalIF":12.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: a systematic review and diagnostic test accuracy meta-analysis\".","authors":"Juliana Trujillo-Gomez, Sofía Tsokani, Catalina Arango-Ferreira, Santiago Atehortua-Muñoz, María José Jimenez-Villegas, Carolina Serrano-Tabares, Areti-Angeliki Veroniki, Ivan D Florez","doi":"10.1016/j.eclinm.2026.104160","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104160","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.eclinm.2026.104097.][This corrects the article DOI: 10.1016/j.eclinm.2026.104157.][This corrects the article DOI: 10.1016/j.eclinm.2022.101275.].</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104160"},"PeriodicalIF":12.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heatwaves and health system resilience in Europe.","authors":"eClinicalMedicine","doi":"10.1016/j.eclinm.2026.104168","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104168","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"98 ","pages":"104168"},"PeriodicalIF":12.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of lipidomic and polygenic risk scores within contemporary clinical cardiovascular risk assessment pathways: a multi-cohort development and validation study.","authors":"Aleksandar Dakic, Jingqin Wu, Tingting Wang, Thomas G Meikle, Kevin Huynh, Changyu Yi, Habtamu B Beyene, Agus Salim, Michelle Cinel, Nat Mellett, Thy Duong, Alexandra N Faulkner, Matilda van Buuren-Milne, Anjali Bhagwat, Jonathan E Shaw, Dianna J Magliano, Gerald F Watts, Joseph Hung, Jennie Hui, John P Beilby, John Blangero, Eric K Moses, Melissa C Southey, Roger L Milne, Allison M Hodge, John J McNeil, Paul Lacaze, Chenglong Yu, Rory Wolfe, Jean Yh Yang, Stuart M Grieve, Clara K Chow, Stephen T Vernon, Michael P Gray, Gemma A Figtree, Jedidiah I Morton, Paul Scuffham, Mark Woodward, Lisa Kalman, Ellie Paige, Melinda J Carrington, Michael Inouye, Corey Giles, Peter J Meikle","doi":"10.1016/j.eclinm.2026.104159","DOIUrl":"10.1016/j.eclinm.2026.104159","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Guideline-recommended clinical risk scores such as AusCVDRisk underestimate cardiovascular disease (CVD) risk in a substantial proportion of individuals who later experience events, with up to 65% initially classified as low or intermediate risk. This limitation is most consequential in the intermediate-risk group, where treatment decisions are uncertain and additional risk refinement could alter management. Circulating lipid species and inherited genetic variation capture complementary molecular aspects of atherosclerotic risk that are not fully reflected by conventional clinical variables, but are not routinely incorporated into primary-care risk assessment. We investigated whether selective integration of lipidomic and genomic risk signals into AusCVDRisk improves 5-year CVD prediction and reclassification, with a focus on individuals at intermediate clinical risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A lipidomic score comprising 689 lipid species measured by liquid chromatography-tandem mass spectrometry was derived using regularised Cox regression in 8082 participants from the Australian Diabetes, Obesity and Lifestyle Study (1999-2000). A genome-wide coronary artery disease polygenic score (PGS002048; 762,124 variants) was optimised in 3328 participants from the Busselton Health Study (1994-95). Each score was adjusted for AusCVDRisk predictors to isolate independent effects and incorporated into Cox models retaining the AusCVDRisk linear predictor as a fixed offset, generating lipidomic-enhanced (L.CVDRisk), genomic-enhanced (G.CVDRisk), and combined (LG.CVDRisk) scores. Internal and external validation was performed across five Australian cohorts totalling 13,521 adults without baseline CVD. Discrimination (Harrell's concordance index; C-statistic), calibration, categorical net reclassification improvement (NRI), and decision-curve analyses were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;LG.CVDRisk showed modest gains in discrimination compared with AusCVDRisk (pooled ΔC among intermediate-risk individuals 0.071, 95% CI 0.033-0.109; overall 0.012, 95% CI 0.000-0.024). Risk classification improved substantially (pooled NRI in the intermediate-risk group 0.305, 95% CI 0.212-0.397; overall 0.080, 95% CI 0.031-0.129), with net event and non-event reclassification of 38.2% (95% CI 29.3-47.0%) and -6.8% (95% CI -9.3 to -4.2%) among intermediate-risk individuals. Decision-curve analysis showed the greatest net benefit when molecular profiling was selectively applied to individuals with intermediate AusCVDRisk (5-&lt;10%). In a coronary imaging cohort, LG.CVDRisk reclassified 17 (41%) of 41 intermediate-risk individuals with extensive coronary calcification into the high-risk category.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Selective augmentation of an established clinical risk algorithm with lipidomic and genomic information improves cardiovascular risk stratification among individuals at intermediate baseline risk. This ","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104159"},"PeriodicalIF":12.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced-frequency bictegravir, emtricitabine, and tenofovir alafenamide in virologically suppressed adults with HIV: a single-centre randomised phase 2 pilot trial in Spain.","authors":"Iván Chivite, Elisa Moraga, Abiu Sempere, Sònia Vicens-Artés, Pilar Callau, Cristina Rovira, Carmen Hurtado, Amedeo De Nicoló, Alejandro Sánchez-Molina, Berta Torres, Jordi Blanch, José Alcamí, José Luis Blanco, Antonio D'Avolio, Sonsoles Sánchez-Palomino, Elisa De Lazzari, Esteban Martínez","doi":"10.1016/j.eclinm.2026.104158","DOIUrl":"10.1016/j.eclinm.2026.104158","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Reduced-frequency oral antiretroviral therapy may lessen treatment burden, but the exposure thresholds required to maintain virological suppression and the role of the HIV reservoir remain undefined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;BETAF-RED was a 48-week, single-centre, randomised, open-label, controlled phase 2 pilot trial conducted at Hospital Clínic, Barcelona, Spain. Eligible participants were adults aged 18 years or older with HIV-1 RNA &lt;50 copies per mL for at least 6 months while receiving once-daily bictegravir, emtricitabine, and tenofovir alafenamide. Key eligibility criteria included stable clinical condition and CD4 count &gt;350 cells per μL; key exclusions included previous virological failure or documented resistance to study drugs, active hepatitis B or C infection, and conditions judged to jeopardise adherence. Participants were assigned 1:1:1:1 to receive the oral fixed-dose single-tablet regimen bictegravir, emtricitabine, and tenofovir alafenamide 50/200/25 mg once daily, three times weekly, twice weekly, or once weekly for 48 weeks. The primary endpoint was maintenance of HIV-1 RNA &lt;50 copies per mL (virological success) at weeks 12 and 48, assessed by Food and Drug Administration Snapshot in the intention-to-treat exposed population, defined as all randomised participants receiving study drug, and in the prespecified on-treatment analysis. Secondary outcomes were virological failure and no virological data. Safety analyses included all participants who received at least one dose of study drug. This was not a non-inferiority study, and no non-inferiority margin was specified. ClinicalTrials.gov, NCT05602506.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between November 7, 2022, and July 3, 2023, 40 participants were enrolled; 39 received study medication. In the intention-to-treat exposed Food and Drug Administration Snapshot analysis, virological success was observed at week 12 in 9/9, 9/10, 10/10, and 8/10 participants in the once-daily, three-times-weekly, twice-weekly, and once-weekly arms, respectively. At week 48, virological success was observed in 8/9, 9/10, 9/10, and 7/10 participants in the once-daily, three-times-weekly, twice-weekly, and once-weekly arms, respectively. At week 12, virological failure and no virological data were observed in 0/9 and 0/9, respectively, in the once-daily arm; 1/10 and 0/10, respectively, in the three-times-weekly arm; 0/10 and 0/10, respectively, in the twice-weekly arm; and 2/10 and 0/10, respectively, in the once-weekly arm. At week 48, virological failure and no virological data were observed in 0/9 and 1/9, respectively, in the once-daily arm; 1/10 and 0/10, respectively, in the three-times-weekly arm; 0/10 and 1/10, respectively, in the twice-weekly arm; and 2/10 and 1/10, respectively, in the once-weekly arm. In the prespecified on-treatment analysis, virological success was observed in 36/37 participants at week 12 and in all 33 participants remaining on thei","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104158"},"PeriodicalIF":12.8,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification, validation, and prediction of longitudinal recovery phenotypes in degenerative cervical myelopathy: analysis of prospective cohorts and a randomised controlled trial.","authors":"Karlo M Pedro, Mohammed Ali Alvi, Christopher Lozano, Vishwathsen Karthikeyan, Alex B Bak, Benjamin M Davies, James S Harrop, Jetan H Badhiwala, Jefferson R Wilson, Wendy Lou, Zihang Lu, Kevin E Thorpe, Michael G Fehlings","doi":"10.1016/j.eclinm.2026.104162","DOIUrl":"10.1016/j.eclinm.2026.104162","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Symptom evolution in degenerative cervical myelopathy (DCM) is traditionally characterized by severity of neurological deficit. A recent expert consensus challenged this view, proposing that DCM fluctuates across neurological, functional and health-related quality of life measures. We examined whether joint changes across these three domains define distinct recovery patterns in a clinic-based cohort of adult patients with DCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Cohorts analysed were the Cervical Spondylotic Myelopathy-North America (CSM-NA, 2005-2007, N = 278), CSM-International (CSM-I, 2007-2011, N = 479) and the CSM-PROTECT Trial (2012-2017, N = 290). All participants were symptomatic adult DCM patients who underwent surgical treatment and completed at least three longitudinal assessments. Bayesian consensus clustering (BCC) was used to simultaneously model one-year changes in the modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), and health-related quality of life (SF-36 Score). The optimal number of trajectory clusters was selected using maximum mean adjusted adherence. Multivariable logistic regression examined association between trajectory classes and achievement of minimal clinically important difference (MCID) across outcomes with internal validation performed using 100 bootstrap resamples.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The final analytical cohort consisted of 1047 patients diagnosed with DCM. The mean age was 56.8 years, and 60.7% were male. The mean symptom duration was 29.8 months, and most patients exhibited involvement of two spinal levels. Joint modelling of multiple longitudinal outcomes resulted in three distinct patient groups. Trajectory 1 (n = 177, 17%) was characterised by minimal postoperative improvement with persistently low neurological function and health-related quality-of-life scores. Trajectory 2 (n = 524, 50%) demonstrated the greatest reductions in neck pain disability. Trajectory 3 (n = 346, 33%) exhibited global recovery, with substantial improvements across neurological, functional, and quality-of-life domains. Trajectory 3 patients had markedly higher odds of achieving MCID in neurological function (odds ratio [OR] 10.90, 95% CI 6.15-19.32), physical quality of life (OR 7.32, 95% CI 3.53-15.22), and disability (OR 3.02, 95% CI 1.85-4.93) compared to patients in Trajectory 1. BCC-derived models reduced clustering uncertainty and improved model discrimination beyond conventional outcome predictors. Predictors of global recovery included an anterior surgical approach (OR 3.55, 95% CI 1.21-10.37) and higher baseline frailty (OR 1.42, 95% CI 1.14-1.76).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;We provide evidence that outcomes in DCM follow three distinct, multidimensional trajectories that are not captured by neurological severity alone. Simultaneous assessment of neurological, functional, and health-related quality-of-life outcomes is both valid and informat","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104162"},"PeriodicalIF":12.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global cardiovascular-kidney-liver-metabolic burden from 1990 to 2023.","authors":"Jayanth Jayabaskaran, Haryo Raden Himan, Srinithy Nagarajan, Bryan Chong, Yiming Chen, Ernest En-Rae Tan, Carel Le Roux, Muhammad Shahzeb Khan, Anurag Mehta, Mark D Muthiah, Jiong-Wei Wang, Xiao-Dong Zhou, Ming-Hua Zheng, Lijing L Yan, A Mark Richards, Mamas A Mamas, Derek Hausenloy, Gregory Lip, Mark Y Chan, Arun J Sanyal, George A Mensah, Laurence S Sperling, Nicholas Ws Chew","doi":"10.1016/j.eclinm.2026.104155","DOIUrl":"10.1016/j.eclinm.2026.104155","url":null,"abstract":"<p><strong>Background: </strong>The cardiovascular-kidney-liver-metabolic (CKLM) framework represents the multi-organ interplay of systemic metabolic disorders that drive the global burden of cardiovascular diseases (CVD).</p><p><strong>Methods: </strong>This study is a descriptive epidemiological analysis of the Global Burden of Disease Study 2023 that examines the trends in mortality and disability-adjusted life years (DALYs) associated with atherosclerotic CVD, chronic kidney disease (CKD), type 2 diabetes (T2D), obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), from 1990 to 2023, across 204 countries and territories. Epidemiological trends were stratified by age, sex, region, and sociodemographic index (SDI).</p><p><strong>Findings: </strong>In 2023, the global CKLM burden contributed to 626.7 million DALYs, with an age-standardized DALY rate of 6944.3 per 100,000 population. Atherosclerotic CVD was the largest contributor to the CKLM burden (3924.2 [95% Uncertainty Interval {UI}: 3666.9-4181.4]), followed by obesity (1500.0 [95% UI: 730.4-2206.5]), T2D (956.7 [95% UI: 794.4-1142.4]), CKD (523.8 [95% UI: 468.0-590.1]), and MASLD (39.6 [95% UI: 31.2-49.9]). From 1990 to 2023, CKLM-related age-standardized DALYs fell 24.4%, primarily driven by improvements in atherosclerotic CVD (41.5% decrease), while rapid increases were seen in T2D (37.5% increase) and obesity (23.3% increase). Disparities in CKLM burden exist across SDI, geography, and age-sex categories.</p><p><strong>Interpretation: </strong>Improvements in the global CKLM burden, driven by gains in CVD prevention, are offset by the rising burden of upstream CKLM drivers including obesity, T2D, CKD and MASLD. Population-focused strategies for prevention need to target shared risk factors driving the CKLM syndemic to achieve the greatest reduction in overall morbidity and mortality.</p><p><strong>Funding: </strong>This research was supported by the NMRC Research Transition Award and the CSDU Clinician-Scientist Grant.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104155"},"PeriodicalIF":12.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short, animated storytelling social contact videos reduce addiction stigma in the UK, USA, and South Africa: a randomised controlled trial of 13,397 participants.","authors":"Maya Adam, Julia K Rohr, Merlin Greuel, Misha Seeff, Elizabeth Margulis, Jennifer Gates, Maxwell Klapow, Shuyan Liu, Doron Amsalem, Till Bärnighausen","doi":"10.1016/j.eclinm.2026.104129","DOIUrl":"10.1016/j.eclinm.2026.104129","url":null,"abstract":"<p><strong>Background: </strong>Societal stigma towards people with addiction fuels exclusion, undermines social support, and inhibits help-seeking. We evaluated a wordless, short animated storytelling (SAS) social contact video in three countries.</p><p><strong>Methods: </strong>We conducted a three-arm, online randomised controlled trial in the UK, USA, and South Africa. Adults aged 18-49 years were recruited via Prolific Academic between July 10th and July 24th, 2025, and randomly assigned (1:1:1) to a 2 min 40 s SAS video with soundtrack, the same video without soundtrack, or an informational control delivered within the online survey platform. The primary outcome was stigma towards people with addiction, measured using the 18-item Attribution Questionnaire (AQ-18) immediately post-exposure (T1) and two weeks later (T2). Secondary outcomes were optimism (Brief García Interactive Optimism Scale), hopefulness and attitudes of warmth towards people with addiction. Analyses included all participants who completed the relevant assessment and met attention-check criteria. Effects were estimated as ratios of means with robust standard errors and country fixed effects. The trial was registered with ClinicalTrials.gov (NCT06705205; Nov 22, 2024).</p><p><strong>Findings: </strong>Between July 10th and July 24th, 2025, 13,500 participants were recruited; 13,397 (99%) completed T1 and 92% completed T2. Compared with control, mean stigma scores were 9% lower at T1 in the soundtrack group (ratio of means 0·91; 95% CI 0·90-0·93) and 6% lower in the no-soundtrack group (0·94; 0·93-0·95). At T2, stigma remained 4% lower with soundtrack (0·96; 0·95-0·97) and 2% lower without soundtrack (0·98; 0·97-0·99). Secondary outcomes improved at T1 in both intervention groups; at T2, warmth remained higher with attenuation.</p><p><strong>Interpretation: </strong>Single exposure to a wordless SAS social contact intervention reduced addiction stigma across three countries, with greater and more durable effects when accompanied by soundtrack. Our findings support integrating SAS social contact interventions into population-level addiction stigma reduction campaigns.</p><p><strong>Funding: </strong>Heidelberg Institute for Global Health, Heidelberg University Hospital, Germany. No specific grant number was assigned.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"99 ","pages":"104129"},"PeriodicalIF":12.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}