medRxiv : the preprint server for health sciences最新文献

{"title":"Trends in transitions in cigarette and electronic nicotine vapor product use in the Rutgers Omnibus Study, 2022-2026.","authors":"Olivia K Roberts, Michelle T Bover Manderski, Nishi J Gonsalves, Jihyoun Jeon, Rafael Meza, Cristine D Delnevo, Andrew F Brouwer","doi":"10.64898/2026.09.28.26364207","DOIUrl":"10.64898/2026.09.28.26364207","url":null,"abstract":"<p><strong>Introduction: </strong>Monitoring transitions in cigarette and electronic nicotine vapor product (ENVP) use is important for understanding how marketplace and regulatory changes have affected product use patterns, but information from national surveys is often delayed by several years.</p><p><strong>Methods: </strong>The Rutgers Omnibus Study is a quarterly serial, rapid-response, web-based convenience survey. Using a Markov multistate transition model, we estimated transition rates and one-year transition probabilities between never, non-current, ENVP-only, cigarette-only, and dual use among 5,292 adults aged 18-45 who participated in at least two of Waves 1-16 (February 2022-February 2026), as well as overall transition hazard ratios by sex, age group, and race & ethnicity in a multivariable model.</p><p><strong>Results: </strong>About 40% of individuals using cigarettes (39.5%; 95% CI: 36.9-42.0) or ENVP (40.1%; 95% CI: 36.4-43.7), and 60% of those using both products (60.8%; 95% CI: 58.3-63.2) were predicted to remain in those states after one year. Female participants began using cigarettes from never use (adjusted hazard ratio [aHR] 0.44; 95% CI: 0.29-0.66) or non-current use (aHR 0.65; 95% CI: 0.48-0.88) at lower rates than male participants. Participants aged 35-45 years initiated ENVP-only use from non-current use (aHR 0.34; 95% CI: 0.23-0.51) at a lower rate than those aged 18-34 years. Compared to non-Hispanic White participants, non-Hispanic Black participants initiated ENVP-only use from never use at a higher rate (aHR 4.39; 95% CI: 2.09-9.25).</p><p><strong>Conclusion: </strong>Rapid response surveys can provide important preliminary information on tobacco use transition patterns while we wait for the slower release of nationally representative survey data.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cross-Sectional Analysis of Depression and Anxiety Symptoms in the US National Health Interview Survey 2022: A Descriptive Focus on the Black‑Latiné Community.","authors":"Estrella D Allen, Erendira C Di Giuseppe, Maria Cruz, Samantha Christie, Ekland Abdiwahab, Kala M Mehta","doi":"10.64898/2026.09.23.26361644","DOIUrl":"https://doi.org/10.64898/2026.09.23.26361644","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the prevalence of anxiety and depression symptoms among Black-Latinés compared to other racial/ethnic groups in the United States.</p><p><strong>Methods: </strong>This cross-sectional analysis leveraged data from the 2022 National Health Interview Survey (NHIS) to estimate the prevalence of anxiety and depression as measured by the GAD-7 and PHQ-8, respectively. Anxiety and depression scores in Black-Latiné were compared to White-Latiné, Non-Latiné White, and Non-Latiné Black respondents.</p><p><strong>Results: </strong>Black-Latinés were more likely to score higher on both the GAD-7 and PHQ-8 indicating higher prevalence of more than minimal anxiety (22.0%) and more than minimal depression (26.0%) than both Non-Latiné Black, anxiety (18.0%) and depression (22.0%), and White-Latiné, anxiety (16.0%) and depression (18.0%), respondents.</p><p><strong>Conclusions: </strong>Black-Latinés are more likely to report more depression and anxiety symptoms than their Non-Latiné Black and White-Latiné counterparts. Studies should try to disaggregate Black subgroups in order to identify the most vulnerable populations.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Pregnancy Glycosylated Hemoglobin in Relation to Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes: Evidence from a Multisite Low- and Middle-Income Countries Cohort.","authors":"Wen-Chien Yang, Sarah Sunil Joseph, B Vijayalekshmi, Bethany L Freeman, Muhammad Imran Nisar, Qing Pan, Santosh Joseph Benjamin, Jayakumar Amirtharaj G, Neeraj Sharma, Sarmila Mazumder, Zahra Hoodbhoy, Victor Akelo, Florence Aweyo, Emily R Smith, Christopher N Mores, Erin M Oakley, M Bridget Spelke, Humphrey Mwape, Sarah Mukuka, Margaret P Kasaro, Anne George Cherian","doi":"10.64898/2026.09.23.26362980","DOIUrl":"https://doi.org/10.64898/2026.09.23.26362980","url":null,"abstract":"<p><strong>Background: </strong>Oral glucose tolerance test (OGTT), the gold standard for diagnosing gestational diabetes mellitus (GDM), faces significant implementation challenges, prompting interest in alternative biomarkers, such as glycated hemoglobin (HbA1c), for early detection. This study aimed to assess the association between early pregnancy HbA1c and subsequent GDM and adverse perinatal outcomes in low- and middle-income countries.</p><p><strong>Methods: </strong>We analyzed data from the <b>Pregnancy Risk, Infant Surveillance, and Measurement Alliance - Maternal and Newborn Health</b> (PRISMA-MNH) cohort, which followed pregnant women enrolled before 20 weeks of gestation across five study sites in Kenya, India, Pakistan, and Zambia. We excluded participants with overt diabetes, severe anemia (Hb <7.0 g/dl), multiple gestations, or pregnancies that ended before 24 weeks of gestation. HbA1c was measured at enrollment. The primary outcome was GDM, diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria based on OGTT performed after 24 weeks of gestation. Secondary outcomes included hypertensive disorder of pregnancy, emergent Cesarean section, preterm birth, large for gestational age, and stillbirth after 28 weeks. We used AUC and ROC analyses to evaluate predictive performance and single- and two-threshold approaches to identify optimal cutoffs for predicting GDM. We used modified Poisson regression with robust standard errors to assess associations between early HbA1c and outcomes, and meta-analysis to pool site-specific estimates.</p><p><strong>Results: </strong>Among 10,918 pregnancies, GDM prevalence was 6.4%. Women with GDM were older (28.0±5.4 versus 26.0±5.3 years) and had higher BMI at enrollment (25.0±5.8 versus 22.9±5.0 kg/m ² ) than women without GDM. The AUC for HbA1c alone in predicting GDM was 0.65 (95% confidence interval 0.63-0.67). A single early HbA1c threshold of 5.4%, based on the largest Youden's index, showed limited predictive performance (sensitivity 46.7%, specificity 75.8%). A two-threshold approach identified rule-out and rule-in cutoffs of 5.0% (sensitivity 80.3%, specificity 35.6%) and 5.5% (sensitivity 34.5%, specificity 83.1%), respectively. In adjusted models, each 0.1% increase in HbA1c was associated with a 12% higher risk (RR 1.12, 95% CI 1.10-1.15) of GDM, while no significant associations were observed for any secondary outcomes.</p><p><strong>Conclusion: </strong>Early pregnancy HbA1c is independently associated with an increased risk of subsequent GDM. However, it demonstrated limited discriminatory ability as a standalone alternative to OGTT for identifying women who would later develop GDM. The identified rule-out threshold may help identify women at low risk of GDM, although the majority would still require OGTT for definitive diagnosis.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coming Into Resistance: Clinically Important Antibiotic Resistance Genes in NICU vs. Healthy Infants.","authors":"Rachel E Strength, Angelina Angelova, Emily Robbins, Shira Levy, Kathryn E McCauley, Kevin M Lloyd, Elisa B Margolis, Andrew S Burns, Shreni Mistry, Poorani Subramanian, Aimee Dassner, Christa Zerbe, Victor I Band, Sivaranjani Namasivayam, Qing Chen, Esther Esadah, Katherine Rees, Mickayla Bacorn, Ruhika Prasad, Phoebe LaPoint, Hector N Romero-Soto, John P Dekker, Cynthia L Sears, Craig Shapiro, Rana F Hamdy, Joseph M Campos, Suchitra K Hourigan","doi":"10.64898/2026.09.23.26363796","DOIUrl":"10.64898/2026.09.23.26363796","url":null,"abstract":"<p><strong>Importance: </strong>Antibiotic-resistant infections in neonates often arise from the infant's own colonizing bacteria harboring antibiotic resistance genes (ARG). This study evaluates ARG that impact antibiotic selection and drive resistance-related mortality, termed clinically important antibiotic resistance genes (CI-ARG).</p><p><strong>Objective: </strong>To determine differences in gut CI-ARG abundance in children from birth through 3 years old, stratified by neonatal intensive care unit (NICU) admission and antibiotic (abx) exposure in the first two months.</p><p><strong>Design: </strong>Cohort study (sequencing, analysis completed 2025-2026) using shotgun metagenomic sequencing of stool samples from infants in two studies: \"Neonatal Intestinal Microbiome\" (+NICU groups, 2015-2022), \"The First 1000 Days of Life and Beyond\" (-NICU groups, 2018-2021). Infants grouped into four cohorts: +NICU/+abx, +NICU/-abx, -NICU/-abx, and -NICU/+abx. Prespecified CI-ARG abundance compared longitudinally among groups.</p><p><strong>Setting: </strong>NICU, well-baby nursery, Inova Fairfax Hospital, Virginia.</p><p><strong>Participants: </strong>+NICU criteria: admission to the NICU, anticipated length of stay (LOS) of at least five days, maternal age ≥18 years. -NICU: parents with good general health and age ≥18 years enrolled prior to infant birth. Stool samples: adequate stool processing volume, at least one stool sample from before one month and after one year of age, 7-day minimum between serial samples.</p><p><strong>Exposures: </strong>NICU versus well-baby nursery; antibiotics versus none in first two months of corrected age.</p><p><strong>Main outcomes and measures: </strong>Predefined primary outcome- longitudinal CI-ARG abundance by group, compared using linear mixed effects models with adjustment for multiple comparisons (Benjamini-Hochberg procedure). Predefined secondary outcomes- differences in overall microbiota and resistome composition.</p><p><strong>Results: </strong>1000 serial stool samples, 179 infants (birth-39 months). Longitudinal abundance significantly differed among cohorts for 11 CI-ARG (p<0.05); often higher in the +NICU groups in early life, with or without antibiotic exposure. Abundance of ARG conferring resistance to aminoglycosides, macrolides, and fluoroquinolones later decreased below -NICU levels. <i>mecA,</i> which often drives methicillin resistance in <i>Staphylococcus</i>, was detected only in +NICU infants during premature period.</p><p><strong>Conclusions: </strong>This longitudinal study demonstrates significant longitudinal CI-ARG differences in children grouped by early-life NICU status and/or antibiotic exposure. Future studies should explore the mechanisms driving these CI-ARG changes and evaluate their impact on infection risk and community spread.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD3-engaging bispecific antibodies convert human regulatory T cells into cytotoxic effectors.","authors":"Julius J Michel, Jan H Frenking, Anna D Metzler, Antonia Schach, Erin W Meermeier, Vera Thiel, Niklas Kehl, Tim R Wagner, Julian Zoller, Sven Cuntz, Cornelius Funk, René Onken, Alanna Kirschner, Stefanie Huhn, Alexander Brobeil, Andreas Trumpp, Mohammad Rahbari, Mathias Heikenwälder, Carsten Müller-Tidow, P Leif Bergsagel, Hartmut Goldschmidt, Hermann Einsele, Leo Rasche, Marta Chesi, Marc S Raab, Niels Weinhold, Mirco J Friedrich","doi":"10.64898/2026.09.23.26363285","DOIUrl":"https://doi.org/10.64898/2026.09.23.26363285","url":null,"abstract":"<p><p>Bispecific T cell engagers (BTCEs) have transformed the treatment of B cell malignancies, but how they remodel non-conventional T cell circuits in patients, and how they should be ideally combined with existing treatment backbones, remains unclear. Here we show that CD3-engaging BTCEs convert human FOXP3⁺ regulatory T cells (Tregs) into an AP-1-imprinted hybrid cytotoxic state that contributes to tumor clearance. Leveraging longitudinal bone marrow and peripheral blood sampling from patients with newly diagnosed multiple myeloma (NDMM) treated with BTCE-based induction in the phase 2 (GMMG-HD10/DSMM-XX/MajesTEC-5) trial, which achieves uniformly deep, minimal residual disease (MRD)-negative remissions, we integrate single-cell RNA, ATAC and TCR sequencing with functional and metabolic profiling to define the underlying mechanism. BTCE-containing induction drives expansion of cytotoxic CD8⁺ clones and the emergence of a Treg population characterized by GZMA, GNLY and NKG7 expression, enriched cytotoxic gene signatures, and licensed by BATF-AP-1-centered chromatin remodeling. <i>In vitro</i> , BTCE-exposed Tregs acquire <i>bona fide</i> lytic function, killing tumor cells in a target- and dose-dependent manner and undergoing metabolic rewiring towards an effector-like state while retaining canonical Treg lineage markers. Immunomodulatory drugs (IMiDs) do not initiate but quantitatively amplify and qualitatively reshape this BTCE-driven cytotoxic program, providing a mechanistic rationale for BTCE-IMiD combination regimens. Cytotoxic Treg reprogramming is conserved across BTCEs targeting BCMA, GPRC5D, and CD19 and across multiple myeloma, as well as acute lymphoblastic leukemia. These findings reveal unexpected plasticity of human Tregs under synthetic T cell engagement and establish cytotoxic Tregs as active effectors, candidate biomarkers and tractable levers for optimizing T cell-redirecting immunotherapy.</p><p><strong>Highlights: </strong>Frontline teclistamab (BCMA×CD3) induces deep MRD-negative remissions in newly diagnosed multiple myeloma patients and reshapes the T cell compartment in the phase 2 MajesTEC-5 trial. BTCEs convert FOXP3⁺ Tregs into AP-1-imprinted cytotoxic effector cells <i>in vivo</i> . IMiDs amplify BTCE-driven cytotoxic Treg reprogramming without loss of identity.Cytotoxic reprogramming of Tregs is observed across BTCEs and blood cancers.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and determinants of antibiotic use by age two: a prospective cohort study.","authors":"Adrianna Staal, Harry Zhen, Toni Zhang, Morgan C Byrd, Neil Kamdar, John R Shaffer, Daniel W McNeil, Mary L Marazita, Betsy Foxman","doi":"10.64898/2026.09.23.26363799","DOIUrl":"10.64898/2026.09.23.26363799","url":null,"abstract":"<p><strong>Background: </strong>Half of US children are prescribed an antibiotic by age 2. Maternal education and socio-economic factors influence prescribing but the role of other factors, such as age of solid food introduction is unknown.</p><p><strong>Objectives: </strong>We assessed risk factors for time to first antibiotic use between birth to age 2 to identify modifiable drivers of antibiotic use.</p><p><strong>Methods: </strong>We analyzed interviews from mothers' of 1032 children participating in the mother-child Center for Oral Health Research in Appalachia cohort 2 between 2011-2017. The cohort enrolled healthy, English-speaking, pregnant White women ≥ 18 years with singleton pregnancies. We used time-to-event analyses and a Cox Proportional Hazards model to describe and estimate hazard ratios (HRs) for time to first antibiotic.</p><p><strong>Results: </strong>By age 2, 78% of children received at least one antibiotic (median age at first antibiotic: 12.5 months). Over half (58%) of antibiotics prescribed were for ear infections. After adjustment for household income and birth quarter as fixed variables, time of solid food introduction (aHR: 4.75; 95% CI: 3.19-7.07), time of first ear infection (aHR: 3.28; 95% CI: 2.58-4.17), and time of first illness (aHR: 4.60; 95% CI: 3.32-6.36) were significantly associated with time of first antibiotic use.</p><p><strong>Conclusions: </strong>Earlier time of solid food introduction was associated with earlier antibiotic use. Childhood illnesses, especially ear infections, also strongly influence antibiotic initiation. These modifiable factors offer targets to reduce unnecessary early antibiotic use.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Perspectives on PCB Exposure, Health Risks, and Exposure-Reduction Strategies in Guánica, Puerto Rico, Home to a Newly Designated Superfund Site.","authors":"Nicolle Acuña, Johana Ortiz, Noelia Estévez De Rosario, Sara St George, Samantha González, Olveen Carrasquillo, Laura T Domenech, Ana Ortiz, Nancy Coredor-Cardona, Luis Anthony Alvarez Cruz, Saned Ramos Ramos, Michael Gabriel Silva, Jose A Rodriguez, Naresh Kumar","doi":"10.64898/2026.09.23.26363578","DOIUrl":"https://doi.org/10.64898/2026.09.23.26363578","url":null,"abstract":"<p><strong>Background: </strong>Guánica, Puerto Rico, has one of the highest concentrations of environmental polychlorinated biphenyls (PCBs). This PCB contamination coupled with persistent poverty, population loss, and repeated environmental disasters has taken a heavier toll on Guánica community. Our environmental sampling has documented high levels of PCBs in sediment, air and fish, but far less is known about how residents themselves understand exposure, interpret health risk, and weigh contamination against the other pressures of daily life.</p><p><strong>Methods: </strong>We used a qualitative descriptive design nested within the larger HELP Study. This paper presents the final analysis of all qualitative data collected in Guánica: ten sessions comprising five focus groups and five interviews with fishermen (N = 31), conducted between November 2024 and October 2025 in familiar community settings. Sessions followed a semi-structured guide translated from English to Spanish and back-translated for accuracy. Recordings were transcribed in Spanish, verified against the audio, and analyzed in NVivo using codebook-style thematic analysis; three bilingual researchers coded collaboratively and resolved disagreements by consensus.</p><p><strong>Results: </strong>Five themes emerged from our analysis concerning how residents and fishermen understand and navigate PCB contamination: (1) perceived community decline shapes how residents prioritize environmental risks; (2) limited knowledge, misinformation, and communication gaps affect understanding of PCB contamination; (3) cancer concerns are high, but links to PCB exposure remain unclear; (4) PCB contamination is seen as a threat to livelihoods, especially fishing and tourism; and (5) deep mistrust and a desire for accountability influence perceptions of environmental interventions. Participants described contamination not as an isolated hazard but as one strand of a longer history of economic decline, disaster, and institutional neglect.</p><p><strong>Conclusions: </strong>Social, economic, and environmental conditions together shape how Guánica residents perceive contamination of their environment. Meaningful progress requires sustained community involvement, support for local initiatives, development of a Community Health Worker program, and expanded partnerships with local institutions and schools to close communication gaps and promote long-term resilience to address the health effects of PCB contamination in Guánica.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Implantable Loop Recorders: Incidence, Indications for Use, and Pre-implant Rhythm Monitoring Across U.S. Health Systems from 2020-2025.","authors":"Matthew C Andersen, Joseph S Ross, Rohini Ghosh, Luis Correia, Sanket S Dhruva","doi":"10.64898/2026.09.25.26364058","DOIUrl":"https://doi.org/10.64898/2026.09.25.26364058","url":null,"abstract":"<p><strong>Background: </strong>Implantable loop recorders (ILRs) provide continuous rhythm monitoring. Professional society guidelines and expert consensus statements recommend ILR use for patients with recurrent syncope and cryptogenic stroke, but recommendations are weaker for other indications. We assessed ILR use over time and concordance between indication and clinical guidance.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using Epic Cosmos data from 1/1/2020-12/31/2025. Among active patients with at least one of 13 diagnoses potentially eligible for ILR placement, we identified ILR placements and classified them by concordance with professional society guidance: concordant, possibly, or non-addressed. Annual incidence was estimated overall and by indication. We also described the proportion of patients who received longer-term (>7 days) rhythm monitoring in the year prior to placement.</p><p><strong>Results: </strong>Of 47,046,706 patients with diagnoses potentially eligible for ILR placement, 201,103 (0.4%) had an ILR placed. ILR placements increased from 3.08 ILRs per 100,000 patient-days in 2020 to 4.13 in 2025 (5.9% annual growth). The most common indications were cryptogenic stroke (28.6%) and atrial fibrillation without prior ablation (21.4%). Overall, 43.9% were guidance concordant, 28.5% possibly concordant, and 24.8% non-addressed. Relative annual growth in ILR placements per 100,000 patient-days was significant across all guidance categories: concordant (1.3%, 95% CI, 0.9%-1.7%), possibly concordant (5.5%, 95% CI, 5.0%-6.0%) and non-addressed (7.4%, 95% CI, 6.8%-8.0%). Among 125,631 outpatient placements, 50,181 (39.9%) had any prior long-term rhythm monitoring.</p><p><strong>Conclusion: </strong>ILR placements are uncommon but increasing, with faster annual growth for indications that may not be guidance concordant. More than half of patients lacked long-term rhythm monitoring prior to outpatient ILR placement.</p><p><strong>What is known: </strong>Prior research through 2018 demonstrated that many ILRs were placed for indications not supported by professional society guidelines or expert consensus statements.Implantable loop recorder (ILR) technology has advanced with longer battery life, easier implantation processes, and robust remote monitoring and reprogramming.</p><p><strong>What the study adds: </strong>ILR use remains uncommon for patients with diagnoses potentially eligible for ILR placement.Annual incidence of ILR placement is increasing, especially among patients with indications not addressed by professional society guidelines or expert consensus statements.Most ILR placements occur without pre-implant rhythm monitoring.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-treatment EEG microstates and response to antipsychotic drugs in first episode psychosis.","authors":"Jose M Rubio, Michael Murphy, Wadim Vodovozov, Ricardo Carrion, Todd Lencz, Mate Baradits, Dost Ongur, Mehrdad Sadri, John M Kane, Anil K Malhotra","doi":"10.64898/2026.09.26.26364042","DOIUrl":"https://doi.org/10.64898/2026.09.26.26364042","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>First-line antipsychotics are ineffective in ∼40% of people with first episode psychosis (FEP). Electroencephalogram (EEG)-based predictive biomarkers could be a scalable solution to reduce trial-and-error.</p><p><strong>Study design: </strong>We acquired EEG in 56 minimally treated FEP individuals before treatment initiation, and 34 matched healthy controls (HC). Treatment response was defined as >50% improvement in BPRS scores by 12 weeks of treatment. Modified k-means clustering of resting-state EEG yielded six microstates including canonical topographies (A-D). The first principal component (PC1) of microstate properties derived from HCs served as a normative reference onto which FEP patients were projected. Baseline PC1 was used to predict treatment response in adjusted regression analyses. To test stability of results, a second dataset of HCs (n=92) was fitted using the same microstate solution and compared to our native HC dataset. PC1 scores derived from this independent normative dataset were also used for predicting response in FEP.</p><p><strong>Study results: </strong>Individual microstates replicated established patient-control differences (e.g., higher presence of microstate C compared to D, p<0.001). PC1 explained 34.8% of variance. Baseline PC1 predicted subsequent treatment response (adjusted OR=0.63, p<0.001), yielding AUC=72.3% in leave-one-out cross-validation (p _perm <0.001) when combined with clinical information. PC1 from our HC transported well to the second healthy control EEG dataset (n=92) (r=0.9,p<0.001; r=0.89,p<0.001 ). PC1 in FEP derived using PC1 weights from a second normative dataset also predicted response in FEP (OR=0.70, p=0.03).</p><p><strong>Conclusions: </strong>EEG microstate architecture differing from the expected norm is associated with lower odds of treatment response in FEP.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding clinical and variant spectrum of <i>CBX1</i> -related syndrome: Report of three novel cases.","authors":"Graciela Carrillo, Shuhei Fujino, Harrison Higgs, Anita Kabahizi, Randy Le, Rachel Rabin, John Pappas, Amy Crunk, Kara Ranguin, Jérémie Mortreux, Marilyn Lackmy, Carlos A Gadia, Matthew Hoi Kin Chau, Jill A Rosenfeld, Xi Luo, Kosuke Izumi","doi":"10.64898/2026.09.28.26363820","DOIUrl":"https://doi.org/10.64898/2026.09.28.26363820","url":null,"abstract":"<p><p><i>CBX1</i> -related syndrome is characterized by developmental delay, hypotonia, autistic features, and mild dysmorphic features. This syndrome is caused by heterozygous missense variants in <i>CBX1</i> , which encodes heterochromatin protein 1 beta (HP1β). These variants are situated within the chromodomain of HP1β, a critical region that mediates the interaction between HP1β and trimethylated H3K9. While a prior study identified three individuals with pathogenic <i>CBX1</i> variants, the variant and clinical spectrum of <i>CBX1</i> -related syndrome remains largely unknown. Here we report three patients with novel <i>de novo</i> heterozygous variants in <i>CBX1</i> . Patients with <i>CBX1</i> p.(Leu40Pro) and p.(Cys60Arg) manifested with global developmental delay, while the patient with <i>CBX1</i> p.(Cys60Gly) primarily exhibited speech delay without concurrent motor developmental delay. All variants reside within chromodomain of the HP1β protein. Interestingly, <i>in vitro</i> cellular assays revealed that <i>CBX1</i> p.(Cys60Gly) variant showed an intermediate cellular phenotype between the wild type and the <i>CBX1</i> p.(Leu40Pro) and p.(Cys60Arg) variants, suggesting a possible genotype-phenotype correlation. This report provides further evidence that missense variants within the chromodomain of HP1β cause a syndromic neurodevelopmental disorder, <i>CBX1</i> -related syndrome.</p>","PeriodicalId":94281,"journal":{"name":"medRxiv : the preprint server for health sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13648779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}