Current evidence reveals that the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score demonstrates good accuracy in forecasting cardiovascular disease (CVD). This research seeks to examine the link between the HALP score and short-term mortality (STM) and long-term mortality among CVD patients and to assess its diagnostic performance.

Embase, SinoMed, Web of Science, VIP, Cochrane Library, Wanfang, CNKI, and PubMed were searched up to December 10, 2025. The Quality Assessment of Diagnostic Accuracy Studies-2 and the Newcastle-Ottawa Scale were employed to appraise the quality of enrolled studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were extracted. Sensitivity and specificity were analyzed using a bivariate model. The forest plots and the summary receiver operating characteristic curve were plotted. Subgroup analyses were performed to assess heterogeneity from cutoffs, disease types, countries, and sample sizes.

13 studies involving 10,639 CVD patients were included. The results demonstrated that for every unit rise in the HALP score, the risk of STM in patients with CVD declined by 0.31 times (OR=0.69, 95% CI: 0.56-0.86), and the risk of long-term mortality decreased by 0.02 times (OR=0.98, 95% CI: 0.97-0.99). Meanwhile, the HALP score showed good accuracy in predicting STM in CVD patients (sensitivity: 0.85; specificity: 0.59, AUC: 0.84).

HALP score shows promise as a biomarker for STM in CVD patients. However, its predictive value for long-term mortality is limited. Further research is needed to confirm its diagnostic accuracy and clinical utility for both mortality outcomes.

Resmetirom is an oral, liver-targeted medication that selectively activates the thyroid hormone receptor beta (THRB) and thereby targets multiple pathophysiological mechanisms of metabolic dysfunction-associated steatohepatitis (MASH). By activating hepatic THRB, resmetirom promotes fatty acid oxidation, improves mitochondrial function, and inhibits lipogenesis. Pivotal clinical trials have confirmed that resmetirom markedly reduces liver fat content, ameliorates inflammatory injury and reverses liver fibrosis, while also effectively lowering atherogenic lipid levels. The medication has a favourable safety and tolerability profile. Based on these findings, resmetirom was approved by the US Food and Drug Administration (FDA) in 2024 and by the European Union in August 2025. Further directions in this field will pivot on investigating the cardiovascular outcomes benefits of resmetirom, exploring its use in combination with other drugs, and the elucidation of its underlying molecular mechanism networks. This article reviews the pharmacological and clinical evidence regarding the treatment of MASH with resmetirom published by February 2026. The aim is to expand the pharmacological profile of resmetirom and promote the development of THRB agonism-based anti-MASH pharmacotherapies.

Primary aldosteronism (PA), a major cause of secondary hypertension, is characterized by autonomous aldosterone overproduction. Although the gut microbiota is closely linked to blood pressure regulation, its role in PA remains unclear. We performed metagenomic sequencing on fecal samples from 13 patients with essential hypertension (EH), 57 with unilateral PA (UPA), and 51 with bilateral PA (BPA). Despite comparable overall microbial diversity, gut microbial compositional differences were observed among EH and PA subtypes, particularly at finer taxonomic levels. We next identified 39 microbial species that were positively associated with plasma aldosterone concentration (PAC), and 29 that were negatively associated. In the co-abundance network, Ruminococcus gnavus emerged as one of the top three central nodes and was negatively correlated with PAC. Functionally, R. gnavus efficiently degraded aldosterone and multiple natural steroid hormones in vitro, and aldosterone degradation was accompanied by the generation of 3α,5β-tetrahydroaldosterone. R. gnavus-colonized germ-free mice showed reduced fecal aldosterone levels and downregulated expression of aldosterone downstream genes in the intestine. In an aldosterone infusion model, R. gnavus similarly decreased fecal aldosterone and improved systolic blood pressure (SBP) and serum potassium. Logistic regression further revealed that the presence of R. gnavus was associated with lower odds of having a historical highest SBP ≥ 160 mmHg in patients with PA. Collectively, this study reveals different gut microbial signatures in PA and highlights the aldosterone-metabolizing capacity and blood pressure regulation of R. gnavus. These findings advance our understanding of gut microbiota-steroid hormone interactions in PA and provide a basis for exploring microbiota-based stratification and intervention strategies in steroid hormone-related conditions.

Veteran use of Veteran Health Administration (VHA)-purchased community care (CC) for mental health has accelerated at a faster pace compared to both primary care and emergency services. Few studies have conducted an in-depth exploration of rural Veteran experience using community mental health. This paper focuses on the voices of rural Veterans, with the aim of exploring advantages and disadvantages for Veterans receiving mental health services through CC.

We conducted interviews with rural Veterans, using purposive sampling to identify Veterans through the Integrated Veteran Care Consolidated Data Sets who were enrolled in VHA medical centers in the southcentral United States, had received CC for mental health, and were living in a rural area. Interviews asked Veterans about their experience with receiving community mental health care. We used thematic analysis to organize quotes and present salient themes from interviews.

We interviewed 30 Veterans. We highlight four findings: (1) Most Veterans were pleased with the mental health care they received through the community. (2) Some Veterans reported instances of unprofessionalism and recognized a lack of military expertise among community providers. (3) Rural Veterans continue to face access barriers and noted limited availability of community mental health providers. (4) Difficulty with navigating multiple health systems impacted some rural Veterans' continuity of care.

While CC has improved access to mental health care for Veterans, there are concerns related to the quality of care and continuity gaps for rural Veterans.

The therapeutic alliance is a well-established predictor of psychotherapy outcomes. With the advancement of digitization, guided internet-based cognitive behavioral therapy (ICBT) has demonstrated effectiveness. However, the conceptual framework of the digital therapeutic alliance (DTA) within ICBT remains conceptually underdeveloped. Data were collected from a guided ICBT program in China. We conducted virtual individual semi-structured in-depth interviews among a purposive sample of intervention recipients (young sexual minority men, n = 20), and all implementers (counselors and supervisors, n = 6). Data were analyzed using qualitative template analysis. A DTA framework was developed with 4 key components: roles, interactions, characteristics, and influencing factors. Clients typically initiate the counseling process through online materials and assignments, treating the digital platform as a "safe space," "invisible friend," "warm harbor," or "repository of knowledge and tools." Counselors serve as guides and provide professional support asynchronously. High frequency of interaction and emotional connection via phone calls strengthened DTA. "Being client-driven," "fostering an equal relationship," and "being difficult to establish but easy to terminate" were identified as characteristics. Influencing factors included client-related aspects (eg, motivation), counselor-related elements (eg, response timeliness), and platform-related considerations (eg, trust, confidentiality). This study develops a DTA conceptual framework, elaborating on the roles, interactions, characteristics, and influencing factors among clients, counselors, and digital platforms in guided ICBT. Findings inform strategies to enhance engagement, counselor training, and platform design in digital psychosocial interventions.

Pakistan faces a substantial burden of tuberculosis (TB) and comorbid depression. Although the TB control programme has made progress, it lacks personalised care for patients with both conditions. Therefore, we aim to explore the health system's readiness and challenges in effectively addressing TB-depression comorbidity. We conducted a multi-site focused ethnography in TB centres in Peshawar and Haripur, Khyber Pakhtunkhwa, Pakistan, involving observations and semi-structured interviews (SSIs). We purposively selected 15 TB centres for observation. For 29 SSIs, we recruited seven TB healthcare providers, 12 patients, and 10 caregivers. An inductive-deductive thematic analysis was performed using the framework method. We identified factors within Pakistan's TB care framework that influence the system's capacity to address TB-depression comorbidity. We organised findings into four themes: the first focusing on accessibility, location, and infrastructure of TB centres; the second highlighting patients' fears, psychological distress, and their past and current experiences; the third examining the working environment of healthcare providers, their behaviour, and interactions with patients; and the final theme emphasising opportunities to address TB-depression comorbidity within the system. Integrating mental health services into Pakistan's TB care is crucial. Training providers, fostering patient engagement, and involving stakeholders can enhance support systems and help address TB-depression comorbidity.

Current literature recommends the personalization of airway clearance technique (ACT) regimens for people with chronic suppurative lung diseases, such as primary ciliary dyskinesia (PCD). However, how physiotherapists navigate cues including the individual's physical and psychosocial presentation, the properties of the ACT regimen and their response to the ACT regimen, remains unknown.

This study aimed to understand how physiotherapists make decisions in relation to personalizing airway clearance regimens for children and young people with PCD.

Critical decision method (CDM) interviews were used to explore expert physiotherapists' decision-making during an ACT personalization incident. Six physiotherapists with ≥5 years PCD experience, from four specialist centers were interviewed; one-to-one virtual interviews were conducted (duration 55-100 min). Data were analyzed using the CDM derived recognition-primed decision model and an ACT personalization model.

Our interviews (n = 6) showed all physiotherapists initially found the situation to be familiar, but in most cases the initial expectancies of the physiotherapist were violated. Participants described uncertainty in personalization of ACT regimens. An iterative process was used to manage the uncertainty and make any modifications to ensure the regimen would likely work prior to implementation. This suggests a need for objective tools to support clinical decision-making. Physical characteristics (age, disease severity, pulmonary and non-pulmonary factors, medications), psychosocial factors (lifestyle, adherence, ability to engage) and treatment-related factors (regimen burden, patient's preference) were commonly considered during personalization. The ACT type, procedures and dosage were personalized for each individual. All physiotherapists undertook mental or physical simulations of their proposed actions and in most cases, this led to regimen modifications.

ACT personalization is a complex, iterative process in which uncertainty can arise. With limited tools to assess the effects of ACT regimens, it remains unknown if uncertainty would be reduced, or personalization changed with the provision of more sensitive outcome data.

An accurate understanding of prognosis in Parkinson's disease (PD) is important for patient information provision, personalized treatment, and clinical trial design, but most previous research has been biased towards younger, healthier patients.

To describe key clinical outcomes longitudinally and identify baseline prognostic factors (predictors) for these outcomes using population-representative PD cohorts.

We meta-analyzed individual patient data from six incidence cohorts in Western Europe (Norway, Sweden, and UK). Each cohort aimed to recruit and follow up all newly diagnosed cases in defined population/incidence periods (between 2000 and 2011). We described postural instability (Hoehn & Yahr Stage 3), functional dependency (needing help with daily activities), dementia, and death with up to 12 years' follow-up and investigated clinical and genetic predictors using frailty Cox models.

In 883 population-based incident patients, median age at motor symptom onset was 69.2 years. Median time to postural instability and functional dependency was 7.4 years. Dementia affected 49.6% by 10 years and 54.7% had died by 12 years (median survival 9.4 years). Older age, higher Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III (MDS-UPDRS-III) score, and lower Mini-Mental State Examination (MMSE) were significantly associated with all outcomes; cognitive symptoms and GBA polymorphisms with each outcome except mortality; and APOE ε4 with increased mortality and dementia.

This first individual patient data meta-analysis of population-based incidence cohorts provides robust prognostic data, with fewer selection biases than previous PD studies, for informing people with PD about prognosis. In incidence cohorts, overall PD prognosis is worse than previously suggested, with key outcomes often occurring early. Further work should develop validated prognostic models for objective stratification of prognostic risk and for personalized medicine. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

This study examined the efficacy of group-based acceptance and commitment therapy (ACT) in improving cognitive emotion regulation (CER) and psychological flexibility (PF) in patients with bipolar disorder (BD).

Fifty-five Chinese patients with BD type I or II from the inpatient psychiatric unit of a Grade-A tertiary psychiatric hospital in China participated in the intervention. Twenty-eight patients were randomized to the ACT+ treatment as usual (TAU) group (10 group sessions) and 27 to TAU alone. The Young Mania Rating Scale (YMRS), Self-rating Depression Scale (SDS), Cognitive Emotion Regulation Questionnaire (CERQ), Cognitive Fusion Questionnaire-Fusion (CFQ-F) and Acceptance and Action Questionnaire II (AAQ-II) were used to assess the participants' CER ability, PF and mania and depressive symptoms at a pre-treatment time-point (baseline) and a post-treatment time-point (5 weeks). ANOVA analysis was conducted to compare the scores before and after treatment in the two groups.

The ACT + TAU group demonstrated more substantial improvements in CER, PF, as well as residual mania and depression, compared to the TAU group.

Our findings indicate that combining ACT intervention into treatment as usual can play better results in enhancing the CER ability and PF of patients with BD in a clinical setting.