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Tuberculosis is the most common cause of hospitalisation and death globally among people with HIV (PWH), even in the antiretroviral therapy era. Diagnosis of tuberculosis is challenging in PWH as bacillary load is lower in sputum and a high proportion have extrapulmonary or disseminated tuberculosis. The clinical features of tuberculosis in PWH are nonspecific and there is a wide differential diagnosis of other opportunistic infections. Tuberculosis progresses rapidly in people with advanced HIV disease, necessitating rapid diagnosis. In this narrative review, key changes are described in the diagnosis of HIV-associated tuberculosis in adults from 1990 until the present. Smear microscopy was the only rapid diagnostic test for tuberculosis until 2011, but its sensitivity is lower in PWH. Algorithms for diagnosing smear-negative tuberculosis had poor diagnostic accuracy, resulting in both underdiagnosis, which increased tuberculosis deaths, and overdiagnosis, leading to missed or delayed diagnosis of the opportunistic infections causing the symptoms. The evidence base for screening for HIV-associated tuberculosis is strong among ambulatory PWH, but screening algorithms have lower sensitivity in people on antiretroviral therapy. The development of novel rapid diagnostic tests (nucleic acid amplification tests and urine lipoarabinomannan lateral flow assay) for tuberculosis and the advent of antiretroviral therapy have dramatically changed the landscape of diagnosing HIV- associated tuberculosis, resulting in reductions in both tuberculosis incidence and deaths. Diagnostic challenges persist as none of the currently available rapid diagnostic tests have sensitivities that are ideal, and only one test (urine lipoarabinomannan detection) is both affordable and simple to perform at the point of care. Therefore, there is still a need for the development of novel, accurate and affordable point-of-care tests to improve the rapid diagnosis of HIV-associated tuberculosis.

Virtual surgical planning (VSP) and clinical 3D printing (C3DP) enable patient-specific anatomic models and surgical guides to be developed and produced from medical imaging using additive manufacturing techniques in a health care facility. This affords a level of precision beyond that allowed with conventional techniques, shortens surgical times, decreases rates of surgical complications and blood loss, and improves patient outcomes. The authors outline the general principles of VSP-C3DP used by subject matter experts in the clinical, imaging, engineering, and manufacturing domains, including image acquisition (eg, thin-section imaging, dual-energy CT, pediatric imaging, MRI bone imaging, interpolation, multimodal imaging); image segmentation (eg, manual and automated); virtual modeling and surgical guide design (eg, segmentation to model conversion, design principles); printing, processing, and delivery of models (eg, material selection); quality assurance (eg, risk assessment and mitigation, validation, troubleshooting, and rescue strategies); and knowledge of the current regulatory and reimbursement landscape. The authors describe how VSP-C3DP is used through case samples in specific orthopedic, hand, and spine surgical procedures to simulate, rehearse, and execute the preoperative plan in the broad categories of arthroplasty (ie, shoulder arthroplasty), joint realignment (eg, periacetabular osteotomy and distal femoral and high tibial osteotomy), deformity correction (eg, high cervical fusion, correction of lumbar spondylolisthesis, distal radius deformities, distal ulna malunions, alunions, pediatric metatarsal deformities, pelvic fracture fixation, treatment of Blount disease), and tumor excision (eg, humerus osteochondroma, pelvic iliac wing osteosarcoma, and giant cell tumors of the distal femur). Current limitations and potential future directions of VSP-C3DP are discussed. ©RSNA, 2026 Supplemental material is available for this article.

This article is a structured narrative review that synthesizes empirical findings and expert consensus and provides policy guidance to outline implementation pathways for integrating Yoga into mainstream healthcare systems, with India as a case example. Yoga is an ancient health practice traditionally used as a holistic approach to health management and wellbeing. However, the acceptance of Yoga as an evidence-based practice in the modern healthcare delivery requires systematic reassessment for its implementation within the healthcare system to make healthcare more affordable, improve prevention, rehabilitation, and resilience thus reduce strain on medical resources. In this review, we have organized the literature review and practical insights around three core themes: stakeholder configurations and governance, economic and quality management, and implementation strategies and evaluation to develop an actionable framework for an optimal care system responsive to patients' needs and adaptable to different community settings. This article has incorporated peer-reviewed studies on the effectiveness of Yoga, its implementation in mainstream healthcare, along with relevant publicly available policy, accreditation, and practice standard sources, to emphasize constructs of implementation science and evidence-based practice. The review identifies a know-do gap between growing evidence for Yoga and its system-level adoption, proposing a staged framework that integrates stakeholder engagement, economic evaluation, quality management, and monitoring to support evidence-based implementation. We propose a comprehensive, context-sensitive model that combines traditional wisdom with contemporary behavioral, clinical, and systems-based approaches. By embedding Yoga within an implementation science framework, we advocate for its role as a mainstream, evidence-informed system. Adoption of Yoga as a therapeutic and preventive modality can be accelerated through standardized protocols, transparent evaluation and regulation, and tripartite governance among state actors, healthcare institutions, and Yoga professionals; however, the feasibility hinges on context-sensitive financial support, stakeholder management, and workforce development.

Guazuma ulmifolia is traditionally used for liver disorders, but its protective mechanisms against heavy metal toxicity are poorly defined. This study evaluated the phytochemical profile and hepatoprotective mechanisms of G. ulmifolia butanol extract (Gul-BuOH) against cadmium-induced liver injury. Gul-BuOH was chemically profiled by UPLC-PDA-ESI-qTOF-MS/MS. Cadmium hepatotoxicity was induced in rats, followed by Gul-BuOH treatment (100 and 200 mg/kg). Liver injury, oxidative stress, inflammation, gene expression (Let-7a, HOTAIR), histopathology, HO-1/Sirt-1 immunoreactivity, and serum metabolomic changes were assessed. Chemical profiling led to the annotation of 42 compounds, including mainly flavonoids and phenolic acids, highlighting the rich phytochemical composition of G. ulmifolia. CdCl2 exposure increased hepatic Cd accumulation and elevated ALT, AST, and ALP, reduced TAC, and increased NO and MDA. Gul-BuOH significantly reduced hepatic Cd levels by 2.6- and 3.2-fold, restored TAC by 38.3% and 83.2%, and decreased NO (56.3% and 63.4%) and MDA (45.4% and 54.6%) at 100 and 200 mg/kg, respectively. Inflammatory markers NF-κB-p and TNF-α were markedly suppressed, while miRNA Let-7a was upregulated and lncRNA HOTAIR was downregulated. Histological and immunohistochemical analyses revealed near-complete restoration of hepatic architecture and normalization of HO-1 and Sirt-1 expression at the high dose. Serum metabolomics' OPLS-DA model performance indicators demonstrated strong reliability, with an R2Y (explained variance) of 0.991 and a Q2 (predictive variance) of 0.988). The model identified 36 significantly altered metabolites that were largely normalized by Gul-BuOH, implicating linoleic acid metabolism, amino acid biosynthesis, and ascorbate-related pathways. Gul-BuOH affords dose-dependent protection against Cd-induced liver injury by modulating oxidative stress, inflammation, metal detoxification, and metabolic pathways, supporting the traditional use of G. ulmifolia and its potential as a multi-target hepatoprotective agent.

We herein develop hypervalent iodine-mediated regioselective fluoroselenenylation of commercial haloalkynes or internal alkynes with diorganyl diselenides to afford α,β-unsaturated (E)-fluoroalkenyl selenides.

BackgroundEnergy drink (ED) consumption is common among undergraduate students and has been linked with adverse health outcomes, including sleep disturbances, cardiovascular effects, and risk-related behaviours.AimThis study aimed to estimate the prevalence of ED consumption among undergraduate students and examine regional variations, associated factors, and reported adverse effects.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, CINAHL, and Web of Science were searched from database inception to August 2025, with additional screening of Google Scholar and grey literature. Cross-sectional studies reporting ED consumption among undergraduate students were included. Three reviewers independently screened studies, extracted data, and assessed risk of bias using the Joanna Briggs Institute checklist. A random-effects meta-analysis was used to estimate the pooled prevalence.SummaryFifty-eight studies were included. The pooled prevalence of ED consumption among undergraduate students was 49.6% (95% CI: 39.8%-59.5%), although substantial heterogeneity was observed (I2 = 99.6%). Subgroup analyses showed the highest prevalence in Africa (61%), followed by Asia (50%), North America (47%), and Europe (37%). Common motivations for consumption included staying awake, enhancing academic performance, and improving energy levels, while peer influence, marketing, affordability, and availability were identified as important contributing factors. Reported adverse effects primarily involved cardiovascular, neurological, and psychological symptoms. Overall, ED consumption appears to be common among undergraduate students and is associated with behavioural and environmental factors and a range of self-reported adverse effects. As the evidence is derived from cross-sectional studies, causal inferences cannot be made, highlighting the need for longitudinal research to better understand long-term health outcomes and inform targeted interventions.

A set of rubber oxygenases was discovered through phylogenetic analysis and AI-based structural modeling of complexes of the putative enzymes with a substrate mimicking cis-1,4-polyisoprene. Sixteen candidate proteins were selected from thermophilic microorganisms, all sequence-related to the Latex clearing protein from Streptomyces sp. K30 (LcpK30). Sequence truncation and solubility tags were then evaluated to enhance protein expression, with the SUMO tag proving to be the most effective. Including LcpK30, nine heme-containing oxygenases were successfully expressed in E. coli NEB 10-beta cells, purified (35-157 mg L-1 yield) and characterized. Steady-state kinetics revealed significant rubber latex-degrading properties for six of them, with the truncated SUMO-fused LcpK30 (SUMO-LcpK30T) showing activity in agreement with literature. Notably, the catalytic efficiencies of all the expressed homologs lay within one order of magnitude and the oxygenase from Thermomonospora echinospora was found to be particularly promising in terms of activity, especially at high latex concentrations (more than 1% w/v). The analysis of reaction mixtures by both HPLC and HPLC-MS confirmed the oxidation of cis-1,4-polyisoprene to form the expected isoprenoid oligomers (n = 2-12), whose distribution was consistent with the usual endo-type cleavage pattern in all but one case. This bioprospecting effort afforded a platform of new rubber-degrading enzymes with diverse efficiencies and product profiles, capable of adapting to targeted applications.

Mesenchymal stromal cell (MSC) injection has afforded heterogeneous outcomes in knee osteoarthritis (KOA). Herein, a framework that dually correlates KOA patient responsiveness with baseline autologous bone marrow-derived MSC(M) donor batch attributes and baseline clinical and biomarker features is provided. Using clinical trial data (NCT02351011), we demonstrated that MSC(M) with increased immunomodulatory potency are more efficacious. Multivariable MSC(M) genes correlated strongly with responder status and 12- and 24-month improvements in Knee Injury and Osteoarthritis Outcome Scores. Responder MSC(M) donor batches had unique microRNA expression and ability to polarize CD14+ monocytes in vitro. KOA responders had lower baseline physical activity and trended toward more severe baseline KOA. Baseline local but not systemic biomarkers showed trending correlations with patient responsiveness. 42% of KOA patients were responders at 24 months, emphasizing durability of single MSC(M) injections. Together, our analytical methodology defines critical quality attributes of potent MSC(M) donor batches and identifies putative KOA patient theratypes to MSC treatments.

To determine the impact of urinary diversion for severe pelvic radiation injury on bowel-related quality of life. This study was a prospective single-institution cohort survey study of patients undergoing urinary diversion for radiation injury from 2017-2024. Surveys were taken preoperatively and at least 6 months postoperatively and included validated bowel-related quality of life questionnaires (Fecal Incontinence QoL Instrument (FIQL) and Fecal Incontinence Severity Index (FISI)). Paired survey responses were analyzed using mixed effect models. A total of 38 participants had paired bowel-related quality of life data with median follow up of 454 days (IQR 371-703). The majority (82%) had prostate cancer radiation. Most patients underwent creation of an ileal conduit (55%). Bowel-related quality of life decreased amongst the full cohort (β=-8.34 [95% Confidence Interval -16.43, -0.26] p=0.043) and with patients with any fecal diversion (-14.15 [-25.30, -3.01] p=0.013). Ileal conduits did not have worsened bowel-related quality of life or fecal incontinence with or without fecal diversion. Compared to ileal conduits, patients with colon conduits (-20.66 [-40.92, -0.40] p=0.046) and right colon pouches (-22.29 [-41.72, -2.85] p=0.026) had worse perioperative changes in bowel-related quality of life and higher rates of fecal incontinence episodes. Though many health domains demonstrate improvements following urinary diversion for radiation injury, bowel-related quality of life and fecal incontinence may worsen postoperatively especially with patients requiring the use of large bowel in their diversion. This finding is important for counseling patients and for selecting bowel segments in patients whose anatomy affords multiple reconstructive options.

Comparing prairie voles (Microtus ochrogaster), a species that forms lasting pair bonds and exhibits biparental care, with meadow voles (Microtus pennsylvanicus), a non-monogamous species showing maternal care only, provides a framework to examine the genomic basis of behavioral divergence over short evolutionary time. Here, we develop a simplified assembly approach combining PacBio HiFi and CiFi sequencing in a single library and run, producing high-quality contiguous chromosome-scale diploid prairie and meadow vole genomes (2.3 Gbp). Comparative analysis reveals substantial differences, including near-complete Y chromosome divergence and a prairie-vole-specific duplication of Avpr1a, a vasopressin receptor gene implicated in social bonding and autism in humans. These extensive genomic changes suggest rapid chromosome evolution as a driver of the dramatic Microtus radiation, generating ∼60 vole species in >2 million years. This single-library approach facilitates a simplified and more affordable assembly workflow, producing near-complete genomes of diverse species using one sequencing platform.

Constructing crystalline chiral covalent organic frameworks (CCOFs) with programmable chiroptical properties from a single chiral source remains highly challenging. Herein, we report a dynamic covalent evolution strategy that transforms supramolecular-induced helical covalent organic polymers into mesoscopic helical CCOFs through thermodynamic self-crystallization as well as single-step and stepwise monomer exchange. Remarkably, two distinct chiroptical inversion modes are preserved during framework evolution: a conventional inversion accompanied by opposite helical sense and a second inversion displaying opposite chiroptical activity despite identical mesoscopic helicity, originating from different sub-nanometer chiral packing arrangements. Time-dependent experiments and theoretical calculations reveal persistent chirality- and packing-memory effects throughout dynamic reconstruction. Using a single chiral template system, this strategy affords 24 mesoscopic helical CCOFs with diverse linkage chemistries and programmable chiroptical responses. Furthermore, pore-confined incorporation of aggregation-induced emissive guests extends both inversion modes into flexible circularly polarized luminescence films.

A visible-light-driven metallaphotoredox strategy has been developed for the synthesis of β-cyanoketones using readily available 2-bromoacetophenones and aryl acetonitriles under dual eosin Y/Co(OAc)2·4H2O catalysis in the presence of DBU and blue LED irradiation. This operationally simple and mild protocol enables efficient C-C bond formation via a radical pathway, affording synthetically valuable β-cyanoketones in high yields with broad functional-group tolerance.

We establish a molecular design blueprint for highly emissive, metal-free organic NIR emitters by integrating an electron-rich S,N-heteroacene core into a C-shaped architecture, affording CT-F, and further extending this framework through selenium incorporation to generate the S,Se,N-heteroacene-based CT-Se and CT-2Se. This molecular architecture synergistically enhances intramolecular charge transfer (ICT) while suppressing internal reorganization energy through increased molecular rigidity. The optimized CT-F dye achieves a solid-state photoluminescence quantum yield of 14.3% at 970 nm. Incorporation of CT-Se into a hyperfluorescent OLED employing a transfer-printed sensitizer and balanced charge injection yields an external quantum efficiency (EQE) of 3.07% at 1000 nm, whereas introducing an additional PM6 buffer layer enables relay-type interfacial energy transfer, elevating the EQE to 3.56% at 995 nm. Comprehensive mechanistic studies reveal that electron-rich core-driven ICT modulation, molecular rigidification with controlled stacking, asymmetric vibronic coupling regulation, and balanced intrinsic charge transport cooperatively establish an omnidirectional optimization strategy for achieving high-efficiency organic OLEDs peaking around 1000 nm and extending into the NIR-II region.

This study reports the first development of gas chromatographic columns packed with activated carbon (AC)-coated adsorbent particles. The AC-coated adsorbent particles were prepared by coating an AC layer on solid support particles using a vacuum carbon coater. Glass beads, diatomite, a porous polymer, and activated alumina particles were investigated as the support materials. The AC layer was uniformly coated on the surface of each support material, achieving a thickness of approximately 300-400 nm after 500 coating cycles. The AC-coated particles were packed in a stainless steel tube with an inner diameter of 1.0 mm and a length of 1.0 m to prepare a packed capillary column. The retention performance of the AC-coated particle-packed columns was evaluated using a capillary gas chromatograph coupled with a flame ionization detector. Strong retention for typical low-molecular-weight organic compounds, including methane, ethane, and propane, was observed. The retention power increased with increasing number of AC-coating cycles and support surface area. The theoretical plate numbers were lower for adsorbents coated on nonporous and low-porous supports, and higher for supports with a large specific surface area. The results demonstrated that the present AC-coating method readily affords AC adsorbents with high retention for typical volatile compounds.

Administrative costs account for nearly one-quarter of US hospital expenditures and are substantially higher than those in other high-income countries. Although mandatory value-based payment programs implemented by the Centers for Medicare & Medicaid Services (CMS) aim to improve quality and efficiency, they may be associated with increased administrative burden. To evaluate the association between participation in CMS mandatory value-based payment programs and hospital administrative costs. This cohort study used a synthetic difference-in-differences design to compare hospital administrative costs obtained from the Medicare cost report data from fiscal years 2006 to 2020. The sample included Medicare-certified general acute care hospitals, critical access hospitals, and long-term acute care hospitals. Administrative costs at hospitals participating in mandatory value-based payment programs, including the Hospital Value-Based Purchasing (HVBP) program, Hospital Readmissions Reduction Program (HRRP), and Hospital-Acquired Condition Reduction Program (HACRP), were compared with hospitals not participating in these programs. In addition, hospitals participating in the Comprehensive Care for Joint Replacement (CJR) model were compared with hospitals not participating in this model. Data were analyzed between July 5 and December 25, 2025. Hospital participation in CMS mandatory value-based payment programs initiated under the Affordable Care Act (HVBP, HRRP, and HACRP) or the CJR model. The primary outcome was hospital administrative costs, defined as the sum of administrative and general, nursing administration, and medical records costs reported in Medicare cost report data. A total of 4332 hospitals were included in the sample. Of these hospitals, 2820 (65.1%) participated in the mandatory value-based payment programs (HVBP, HRRP, and HACRP). Nonparticipating hospitals included 42 general acute care hospitals in Maryland (0.9%), 1159 critical access hospitals (26.8%), and 311 long-term acute care hospitals (7.2%). In addition, 357 hospitals participated in the CJR model compared with 2029 that did not participate in the model. Participation in the 3 mandatory value-based programs was associated with annual increases in administrative costs of $1.23 (95% CI, $0.11-$2.36) million per hospital compared with general acute care hospitals in Maryland, $0.93 (95% CI, $0.27-$1.59) million compared with critical access hospitals, and $0.65 (95% CI, $0.01-$1.29) million compared with long-term acute care hospitals. Participation in the CJR model was associated with an annual increase in administrative costs of $1.40 (95% CI, $0.30-$2.49) million per hospital. Aggregated nationally, these increases corresponded to more than $3 billion in additional annual administrative costs. In this cohort study, participation in mandatory value-based payment programs was associated with increased hospital administrative costs. These findings suggest that policymakers should consider administrative burden when designing and evaluating payment reforms to ensure that anticipated improvements in cost, quality, and access are not offset by increased complexity.

The purity, accessibility, and affordability of illicit methamphetamine have increased in recent decades, which has been linked to rising rates of methamphetamine-involved overdoses, psychosis, cardiovascular events, and other health consequences. Nevertheless, information about the quantity of methamphetamine used by regular consumers has been limited, despite the potential clinical utility of exposure quantification. From August 2024 to April 2026, self-reported daily methamphetamine consumption was assessed among n = 94 individuals in Los Angeles County. Methamphetamine samples (n = 256) were analyzed for purity using liquid chromatography-mass spectrometry. Bioavailability by route of administration and stimulant equivalency were obtained from the literature. A simulation model leveraging bootstrapping with 1,000,000 draws was used to estimate oral amphetamine milligram equivalents (AME). The average reported methamphetamine consumption was 1.09 g daily (95% prediction interval: 0.07-4.00). Average purity was 84.52% (95% PI: 14.90%-100.00%). Given estimated average bioavailability of 66.41% (95% PI: 39.35%-85.24%), the average consumer used an estimated 1432.54 AME daily (95% PI: 35.74-6973.05). We estimate that consumers of methamphetamine in Los Angeles use an average daily stimulant dose (nearly 1500 oral AME) about 25-fold higher than the maximum typical recommended clinical dose of mixed amphetamine salts (60 mg). This may help contextualize why prescription stimulant treatment trials using substantially lower doses have shown limited efficacy. Given this high dose, these findings shed light on the rising incidence of methamphetamine-related sequelae, such as psychosis, cardiovascular complications, and sudden death. Although exposure quantification is commonplace for alcohol and tobacco use disorders, uncertainties in illicit drug markets have complicated this practice for most illicit drugs. This study supports leveraging emerging information from drug checking programs so that clinicians can approximate exposure quantification.

Extracellular vesicles (EVs) originating from bacteria and gut microbiota have recently been recognized as pivotal agents in the communication between host and microbes, exhibiting considerable promise as innovative biomarkers and therapeutic instruments in the realm of oncology. These nanoscale vesicles encapsulate a heterogeneous array of molecular constituents, including metabolites, proteins, nucleic acids, and toxins, which possess the capacity to influence tumor proliferation, apoptosis, immune responses, and metastasis. Recent investigations underscore their bifunctional nature: specific bacterial EVs can facilitate oncogenesis by altering signaling cascades such as BRCA1/EXO1/TP53BP1 or TGF-β1/Smad, while others may suppress tumor growth through the induction of oxidative stress, mitophagy, or the activation of antitumor immunity via STING or cGAS pathways. The metabolomic and molecular characterizations of bacterial and fecal EVs afford a distinctive, non-invasive perspective into tumor biology and the interactions between host and microbiome. Sophisticated diagnostic methodologies, encompassing targeted metabolomics, high-throughput sequencing, and flow cytometry-based characterization of EVs, have enabled the discovery of EV-derived cancer biomarkers with exceptional specificity and sensitivity. Moreover, engineered EVs that transport therapeutic agents, including prodrugs, microRNAs, or photosensitizers, exhibit significant anticancer efficacy in preclinical experimental models. This review consolidates contemporary understanding regarding the molecular mechanisms, diagnostic capabilities, and therapeutic implications of bacterial and gut microbiota-derived EVs in the context of cancer.

A visible-light-promoted four-component reaction of α-diazoesters, cyclic ethers, elemental sulfur, and secondary phosphines has been developed. This multicomponent reaction proceeded under mild conditions to afford a range of dithiophosphinates using elemental sulfur as the sulfur source. The present photochemical protocol offers a sustainable and practical strategy for dithiophosphinate synthesis without transition metals or complex operational procedures.