ORTHOPAEDICS

The paradoxical increase in gout flare risk upon initiation of urate-lowering therapy presents challenges for the measurement and analysis of gout flares in clinical trials of urate-lowering therapy. In this Perspective, the authors highlight these issues and discuss potential solutions.

Managing Gout Flare Risk in Urate-Lowering Therapy: Challenges and Solutions | Expert Perspective

IRE improved nasal obstruction symptoms with low morbidity in adults with inferior turbinate hypertrophy.

Irreversible Electroporation for Inferior Turbinate Hypertrophy

A prospective multicenter study of 48 adults with medically refractory nasal obstruction found that irreversible electroporation (IRE) significantly improved NOSE, NO-VAS, and SNOT-22 scores within 1 week and through 3 months. The non-thermal technique was associated with low postoperative pain, no major complications, and resolution of transient mucosal changes by 3 months.

ENDO-DIABETOLOGY

Study reveals depot-specific insulin receptor patterns that may influence adipogenesis and insulin responsiveness in fat cells.

Insulin Receptor Isoforms Differ in Subcutaneous and Visceral Fat

A human adipose stem cell study found distinct insulin and IGF-I receptor patterns between subcutaneous and visceral fat. During adipocyte differentiation, insulin receptor expression increased in both depots, while IRb became particularly prominent in visceral cells. Subcutaneous cells showed greater adipogenic conversion and stronger insulin-induced Akt activation, suggesting depot-specific mechanisms of insulin responsiveness.

OPHTHALMOLOGY

Aqueous chlorhexidine showed comparable ocular antiseptic efficacy to povidone-iodine with better pain tolerability.

Chlorhexidine vs Povidone-Iodine for Ocular Antisepsis

A systematic review and meta-analysis of eight studies found aqueous chlorhexidine (AqCHX) and povidone-iodine (PI) had comparable effectiveness for ocular antisepsis, with no significant differences in endophthalmitis or microbial culture positivity. AqCHX was associated with significantly less pain and fewer pain-related ocular symptoms, although uncertainty remains because endophthalmitis events were rare.

PULMONOLOGY

Syndecan-1 levels were linked to hypoxemia, impaired lung mechanics, prolonged ventilation and mortality in ARDS patients.

Alveolar Glycocalyx Damage Linked to ARDS Severity and Mortality

A multicenter study found that higher levels of syndecan-1, a marker of alveolar epithelial glycocalyx shedding, were associated with impaired lung mechanics, more severe hypoxemia, prolonged mechanical ventilation, and higher mortality in patients with ARDS. Findings were consistent across directly aspirated and noninvasively collected airspace fluid, supporting further investigation of glycocalyx-targeted therapies.

Low Cachexia Index was linked to severe treatment toxicity and poorer survival in HPV-negative head and neck cancer.

Cachexia Index Predicts Toxicity and Survival in Head and Neck Cancer

A study of 353 patients with HPV-negative head and neck squamous cell carcinoma found that a low pretreatment Cachexia Index (CXI), incorporating skeletal muscle, albumin, and inflammation, was associated with higher risk of severe treatment toxicity and poorer overall survival. The findings support further evaluation of CXI as a pretreatment risk stratification tool.

OSA-related hypoxia and obesity may influence cancer development and outcomes, highlighting potential therapeutic opportunities.

Obstructive Sleep Apnea, Obesity and Cancer: Emerging Links

Emerging evidence highlights an interconnected link between obstructive sleep apnea (OSA), obesity, and cancer. OSA-related intermittent hypoxia, inflammation, oxidative stress, and immune dysregulation may contribute to tumor development and progression. Hypoxic burden and nocturnal oxygen desaturation may offer greater prognostic value than the apnea-hypopnea index, while CPAP and weight-loss therapies warrant further study.

DERMATOLOGY

Anxiety, depression and genetic susceptibility were associated with higher risk of developing vitiligo in a UK Biobank study.

Anxiety, Depression and Genetic Risk Linked to Vitiligo

A prospective UK Biobank study of 379,589 participants found that anxiety and depression were associated with increased risk of incident vitiligo over a median 13.6-year follow-up. Genetic susceptibility also influenced risk, with participants who had both psychiatric morbidity and elevated vitiligo polygenic risk showing the highest observed risk, although causal mechanisms remain uncertain.

Systemic pruritus may signal underlying disease and is increasingly understood as a neuroimmune disorder requiring targeted evaluation.

Systemic Pruritus: Neuroimmune Mechanisms and Diagnosis

Chronic itching without primary skin disease may be an early sign of systemic illness. A review highlights renal, hepatobiliary, endocrine, metabolic, hematologic, malignant, neuropathic and drug-related causes, and proposes a neuroimmune model involving cytokines, neuronal sensitization, opioid imbalance and altered nerve signalling to guide diagnosis and targeted treatment.

DENTISTRY

Herbal toothpastes showed variable fluoride, antibacterial activity and cytotoxicity, highlighting the need for safer formulations.

Herbal Toothpastes Show Variable Fluoride and Cytotoxicity

An evaluation of 15 herbal toothpastes found wide variation in fluoride content, with two-thirds containing less than 600 ppm. While 26.67% showed strong antibacterial activity against Streptococcus mutans, four formulations demonstrated high cytotoxicity in fibroblast models. The findings highlight the need for clearer fluoride labeling and careful formulation of herbal toothpastes.

RHEUMATOLOGY

Emerging imaging and AI tools may complement DXA by improving assessment of bone strength, low bone mass and fracture risk.

Emerging Imaging and AI Tools for Osteoporosis Assessment

Emerging imaging and computational technologies may complement DXA in assessing osteoporosis and fracture risk. Tools including finite element analysis, trabecular bone score, DXA-based 3D modelling, quantitative ultrasound, radiofrequency echographic multi-spectrometry and AI-based radiology analysis can provide additional information on bone strength, microarchitecture and low bone mass, potentially supporting screening and treatment monitoring.

NEUROLOGY

CRPS-I may be under-recognized after TBI, with edema and motor limitation supporting targeted three-phase bone scintigraphy.

CRPS-I Under-Recognition After Traumatic Brain Injury

A 12-year cohort study of 5,773 patients with traumatic brain injury identified CRPS-I in 0.42% of the overall cohort, while 19.5% of clinically suspected patients had confirmed disease on three-phase bone scintigraphy. Edema and motor limitation were common clinical triggers, highlighting the potential value of adjunctive imaging in cognitively impaired TBI survivors.

Animal naming showed strong performance for detecting aphasia preoperatively in patients with left-hemisphere gliomas.

Animal Naming Test May Detect Aphasia in Brain Tumor Patients

A study of 74 patients with left-hemisphere gliomas found that animal naming, automatized language sequences, and reading comprehension were useful predictors of aphasia. Animal naming showed strong discriminatory performance, with an area under the ROC curve of 92.7%, suggesting that this brief semantic verbal fluency task may support preoperative language screening in brain tumor surgery.

CARDIOLOGY

Endothelial-derived CSF1 maintains resident macrophages in the aortic intima during homeostasis and early atherosclerosis.

Endothelial CSF1 Maintains Macrophages in Early Atherosclerosis

A mouse study identified endothelial cell-derived CSF1 as a key local signal maintaining tissue-resident macrophages in the aortic intima during normal conditions and early atherosclerosis. CSF1 supported macrophage proliferation and retention, while monocyte-derived macrophages depended on distinct mechanisms, revealing compartment-specific regulation of arterial inflammation.

MOF promotes inflammatory macrophage activity in AAA, while pathway inhibition reduced aortic inflammation and aneurysm development.

MOF Pathway Drives Macrophage Inflammation in Aortic Aneurysm

A study of human abdominal aortic aneurysm tissue and mouse models identified males absent on the first (MOF) as a regulator of inflammatory macrophage activity. TNF-α-induced MOF promoted NF-κB-mediated inflammatory gene transcription through H4K16 acetylation. Genetic or pharmacological MOF inhibition reduced aortic inflammation, elastin fragmentation and aneurysm development.

FAMILY HEALTH

Phase 3 data show survodutide significantly reduced body weight in adults with type 2 diabetes and obesity.

Survodutide Reduces Weight in Type 2 Diabetes and Obesity

In a phase 3 trial of 752 adults with type 2 diabetes and obesity, once-weekly survodutide reduced body weight significantly more than placebo at 76 weeks. Mean weight loss was 8.2% with 3.6 mg and 9.8% with 6.0 mg versus 3.9% with placebo. Gastrointestinal adverse events were the most common, generally mild to moderate and transient.

When underlying biology t...

When underlying biology threatens the randomization principle — initial gout flares of urate-lowering therapy