To directly test the generalisability of cardiovascular disease (CVD) risk predictor effects across populations in a high income versus non-high income country, derive comparable risk equations, and identify more effective strategies for prediction across populations.

Population based cohort study.

Primary prevention cohorts in New Zealand and China.

Equivalent New Zealand and Chinese cohorts of people aged 30-74 years with diabetes and no CVD based on electronic health records.

Country specific five year equations were derived using standardised methods to predict first cardiovascular events; predictor hazard ratios were compared. New Zealand equations were applied to the Chinese cohort, with performance assessed before and after standard recalibration, followed by the updating of predictor hazard ratios that differed statistically significantly.

Between 2004 and 2018, 47 958 New Zealand participants had 5622 (11.7%) first CVD events. Between 2010 and 2018, 46 558 Chinese participants had 3650 (7.8%) first CVD events. Sex specific equations included 16 predictors. Hazard ratios for most predictors were similar between New Zealand and Chinese equations but differed markedly for age (eg, women: 1.61, 95% confidence interval 1.51 to 1.71 per 10 years in New Zealand, 2.51 (2.32 to 2.72) per 10 years in China). Standard recalibration of New Zealand equations did not improve calibration in the Chinese cohort (expected to observed ratio: 0.938 in men, 0.809 in women). Replacing New Zealand age coefficients with Chinese coefficients noticeably improved calibration (expected to observed ratio 1.027 in men, 1.025 in women).

Applying a high income country derived CVD risk prediction equation to a population from a non-high income country with diabetes may introduce systematic errors, primarily driven by differences in the effect of age. Moving beyond simple recalibration to updating key predictor coefficients, particularly age, should be considered for more accurate risk stratification. This study highlights potential limitations of high income country equation updating practices and proposes a feasible approach to improve their accuracy when used in populations from non-high income countries.

This report describes the rates and characteristics of health center visits by adults with type 2 diabetes, subsequently referred to as diabetes. Health centers provide primary care to health professional shortage areas.

Data are from the 2024 National Ambulatory Medical Care Survey Health Center Component, a nationally representative survey of federally qualified health centers (FQHCs), which receive federal funding from the Health Resources and Services Administration (HRSA), and FQHC look-alikes, which meet HRSA requirements but do not receive HRSA funding. Weighting was conducted to account for sampling probabilities and nonresponse, resulting in nationally representative estimates of health center visits to all 50 states and the District of Columbia.

The health center visit rate for adults with diabetes was 52.7 visits per 1,000 adults in 2024. An estimated 34.9% of health center visits by adults with diabetes also included a diagnosis of overweight or obesity. Among visits by adults with diabetes, just over one-half were made by adults with no complications of diabetes. A majority of visits by adults with diabetes had a documented prescription for diabetes medication, with 62.3% having an oral glucose-lowering medication, 27.0% having a GLP-1 agonist, and 24.7% having insulin.

Chronic Hepatitis C virus (HCV) infection is associated with numerous clinically significant extrahepatic manifestations. Endocrine disorders, including thyroid diseases, insulin resistance (IR), metabolic syndrome (MetS), and diabetes mellitus (DM), are common in patients with HCV. Chronic inflammation, immune dysregulation, and direct viral effects on extrahepatic tissues contribute to the pathogenesis of these diseases. Achieving sustained virological response (SVR) with new Direct-Acting Antivirals (DAAs) has not only reduced liver-related events and improved patient outcomes but also prevented or reversed various extrahepatic endocrine disorders. However, the extent and durability of endocrine improvements vary across patient subgroups, particularly among those with advanced liver disease. Evidence indicates that some endocrine diseases persist in patients with liver cirrhosis, even after successful viral eradication. Consequently, patients diagnosed with HCV-mediated endocrine disorders, particularly those with advanced liver disease at the time of DAA initiation, require ongoing surveillance by a multidisciplinary team even after achieving HCV eradication.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity, type 2 diabetes mellitus, and cardiometabolic disease through effects on weight reduction, glycemic control, and systemic inflammation. Their varied immunometabolic actions have generated increasing interest in dermatology, where chronic inflammatory skin diseases frequently coexist with obesity, insulin resistance, metabolic syndrome, and cardiovascular disease. Emerging evidence from clinical trials, observational studies, and real-world analyses suggests that GLP-1RAs may improve outcomes in psoriasis, hidradenitis suppurativa, and atopic dermatitis while simultaneously reducing the burden of associated metabolic and cardiovascular comorbidities. In psoriasis, combination therapy with tirzepatide has demonstrated enhanced skin clearance, substantial weight loss, and reduced risk of psoriatic arthritis. In hidradenitis suppurativa and atopic dermatitis, GLP-1RAs have been associated with improvements in cardiometabolic outcomes and reductions in systemic complications. Collectively, these findings support an evolving paradigm in which the greatest therapeutic utility of GLP-1RAs in dermatology may lie not only in direct modulation of cutaneous inflammation but also in addressing the metabolic dysfunction and chronic systemic inflammation that drive disease severity and multimorbidity. We review the current clinical evidence and propose a conceptual framework positioning GLP-1RAs as immune-metabolic therapies that target the systemic comorbidities of inflammatory skin disease, highlighting future opportunities for disease modification and integrated dermatologic care.

Breath analysis is a candidate non-invasive approach for detecting disturbances in glucose metabolism, but its clinical applicability has not been systematically assessed across analytical platforms and clinical targets. This systematised review evaluates breath-based biomarkers and analytical technologies for the detection of diabetes, prediabetes, insulin resistance, gestational diabetes, and hypoglycaemia, and for blood glucose estimation. A structured PubMed search identified human studies published between 2010 and 2025; 30 studies met the inclusion criteria. Most analysed volatile organic compounds using laboratory platforms such as gas chromatography-mass spectrometry or proton transfer reaction mass spectrometry, a growing number used portable sensor-based systems including electronic noses and single-gas sensors, and a smaller group used isotope-based breath tests measuring labelled carbon dioxide after substrate ingestion. Reported diagnostic performance was highest and most consistent for hypoglycaemia detection in type 1 diabetes mellitus (sensitivity and specificity approximately 90 to 95%) and for isotope-based discrimination of prediabetes and diabetes subtypes (approximately 90 to 100%), whereas qualitative diabetes detection and quantitative blood glucose prediction were more variable. Both findings are based on a small number of studies, and the isotope-based results originate from a single research group and require independent replication. Performance depended strongly on signal complexity, with multivariable and spectral approaches outperforming single-compound methods. However, most studies used small cohorts and internal validation only, and sampling procedures and reporting were poorly standardised. Standardised protocols, larger externally validated cohorts, and platform selection matched to the intended clinical role are required before implementation.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce heart failure (HF) risk, but the underlying mechanisms remain unclear.

To assess the causal effect of GLP-1R pathway activation on HF risk and identify inflammatory mediators using genetic approaches.

We conducted two-sample and two-step Mendelian randomization (MR). Cis-eQTL SNPs for GLP1R expression (P 〈 5 × 10⁻⁸, F 〉 10) were selected from the eQTLGen Consortium to proxy the GLP-1R pathway, with positive control against type 2 diabetes mellitus (T2DM). The primary analysis used inverse-variance weighted (IVW) method, with four MR methods as sensitivity analyses. Using two-step MR, we assessed 95 inflammatory biomarkers as mediators, with significant ones validated externally using an independent dataset. Mediation effects were calculated via Delta and parametric Bootstrap methods.

Genetic instruments showed a strong association with reduced T2DM risk (OR = 0.8217, 95% CI 0.7852 to 0.8598, P = 2.32 × 10⁻¹⁷). Genetically proxied GLP1R expression was associated with lower HF risk (OR = 0.9327, 95% CI 0.8715 to 0.9981, P = 0.0439). Among 95 biomarkers, matrix metalloproteinase-1 (MMP-1) reduction showed a significant indirect effect (-0.0196, Delta 95% CI -0.0342 to -0.0050, P = 0.0084; Bootstrap -0.0356 to -0.0066), accounting for 28% of the total effect. External validation confirmed this mediation (indirect effect -0.0148, Delta 95% CI -0.0266 to -0.0030, P = 0.0140; Bootstrap 95% CI -0.0275 to -0.0039), explaining 21% of the total effect.

This study provides genetic evidence that GLP-1R activation protects against HF and identifies MMP-1 reduction as a partial mediator, illuminating an anti-inflammatory mechanism underlying GLP-1RA efficacy.

To evaluate the association between low-grade intrapartum fever (37.5-37.9°C) and obstetric and neonatal outcomes, and to compare its clinical significance with that of overt intrapartum fever (≥38.0°C).

This retrospective cohort study included nulliparous women with singleton pregnancies who delivered over a 7-year period at a single tertiary academic medical center. Participants were categorized according to maximal intrapartum maternal temperature into three groups: low-grade intrapartum fever (37.5-37.9°C), overt intrapartum fever (≥38.0°C), and afebrile controls. The primary analysis focused on outcomes associated with low-grade fever compared with afebrile women, while the intrapartum fever group was included as a reference to contextualize the magnitude of risk. The primary outcomes were operative vaginal delivery (OVD) and intrapartum cesarean delivery (CD), analyzed separately. Secondary outcomes included selected neonatal outcomes, including a 5-minute Apgar score < 7. Multivariable logistic regression was performed to adjust for potential confounders.

A total of 15,093 women met inclusion criteria, including 1,294 (8.6%) with low-grade intrapartum fever, 934 (6.2%) with overt intrapartum fever (≥38.0°C), and 12,865 (85.2%) afebrile controls. Compared with afebrile controls, women with low-grade fever had higher rates of OVD (27.0% vs. 17.0%, p < 0.001), although rates remained lower than those observed in the overt fever group (31.0%, p < 0.001). Cesarean delivery rates were increased only among women with overt intrapartum fever and were comparable between the low-grade fever and afebrile groups. Low-grade fever was also associated with a higher rate of 5-minute Apgar score < 7 compared with controls (0.9% vs. 0.4%, p = 0.034). After adjustment for maternal age, diabetes mellitus, hypertensive disorders, gestational age at delivery, labor induction, epidural analgesia, and neonatal birthweight, low-grade intrapartum fever remained independently associated with increased risk of OVD (adjusted OR 1.54, 95% CI 1.35-1.76) and 5-minute Apgar score < 7 (adjusted OR 2.50, 95% CI 1.28-4.89).

Low-grade intrapartum temperature elevation was independently associated with increased operative vaginal delivery and low 5-minute Apgar score. These findings suggest that subfebrile temperature elevations may identify a more complicated intrapartum course, although the temporal relationship between temperature elevation and labor progression or delivery mode, and therefore causality, cannot be established.

Cardiometabolic pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), share similar risk factors and increase cardiometabolic risk in women. Medical/lifestyle management reduces their risk but requires early identification of high risk individuals. This study aimed to develop a risk prediction model identifying women at high risk of developing GDM and/or HDP.

A composite prognostic risk prediction model for developing GDM and/or HDP comprising first trimester sociodemographic and clinical variables was developed using routinely collected health data from women delivering singleton pregnancies in Australia from 2016 to 2022. Variables comprised age; ethnicity; height; body mass index; parity; family history of diabetes; history of GDM, pre-eclampsia/eclampsia, chronic hypertension, polycystic ovary syndrome, chronic kidney disease and fetal macrosomia. Model development used logistic regression with performance evaluated using discrimination, calibration, bootstrapped internal and temporal validations, recalibration of intercept and slopes and decision curve analyses.

GDM/HDP prevalence was 25.4% (n = 48,502). On temporal validation (n = 12,868), the model had a C-statistic of 0.739 (95% CI: 0.727, 0.738). Following recalibration, the calibration-in-the-large was -0.001 (95%CI: -0.04, 0.04) and the calibration slope was 1.00 (95% CI: 0.95, 1.05)]. On decision curve analysis, the model outperformed both treat-all and treat-none strategies across threshold probabilities from 8 to 72%.

The model demonstrated fair-good discrimination and excellent calibration. Decision curve analysis indicated potential clinical utility across a range of threshold probabilities for identifying women at high risk. External validation is required.

Tracheal, bronchus, and lung (TBL) cancer remains a major cause of cancer morbidity and mortality. We quantified historical trends, structural drivers, inequality, and future burden of TBL cancer among Asian adults aged ≥60 years.

Using Global Burden of Disease 2023 data, we assessed incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2023. Age-standardised rates (ASRs), estimated annual percentage changes, sex- and age-specific patterns, socioeconomic inequality, and demographic decomposition were evaluated. Bayesian age-period-cohort modelling projected burden to 2050.

From 1990 to 2023, incident cases increased from 334,563 to 1,102,794 and DALYs from 7.3 million to 19.4 million. ASR point estimates changed modestly, with Asia-wide EAPCs not statistically distinguishable from zero. Burden increased sharply with age and remained consistently higher in males. Socioeconomic inequality attenuated, particularly for mortality and DALYs. Population growth accounted for much of the absolute increase, while negative age-specific-rate components partly offset demographic effects in several Central Asian countries. From 2024 to 2050, ASIR and ASDR were projected to decline by 44.2% and 45.6%, respectively, with only modest reductions in absolute numbers.

TBL cancer burden in older Asian adults is increasingly shaped by demographic expansion and heterogeneous epidemiological change. Despite projected declines in ASRs, population ageing will sustain substantial burden, underscoring the need for targeted prevention and age-responsive health-system planning.

There are several ongoing phase 3 randomized trials involving radiopharmaceutical therapies (RPTs), which are expected to provide practice-changing evidence in the coming years. This review covers ongoing pivotal phase 3 trials designed to expand applications for RPTs. Trials such as PSMAcTION, STAMPEDE2, PSMA-DC, and PSMAddition focus on prostate-specific membrane antigen-directed treatments for patients with prostate cancer. NETTER-3, ACTION-1, and COMPOSE evaluate somatostatin receptor-targeted radiopharmaceuticals in individuals with neuroendocrine neoplasms. Expansion of phase 3 registration trials has been driven by increased industry investment. Ongoing RPT phase 3 trials serve as hybrids, merging nuclear medicine procedures for imaging and drug application with oncology-driven standards of care and endpoint definitions. Despite the challenges associated with this integration, phase 3 RPT trials present an opportunity to revolutionize future cancer care by introducing and expanding the use of image-guided RPT.