Purpose Rupture of the extensor pollicis longus (EPL) tendon is an uncommon but clinically important complication of distal radius fractures. We investigated its incidence, timing, associated factors, and functional consequences in a prospective cohort. Methods This is a secondary analysis of a prospective multicenter cohort at two Swedish orthopedic departments, 2009–2012. Consecutive adults with acute distal radius fractures were enrolled and followed to 12 months. EPL function was assessed by active thumb extension testing at 3 and 12 months. Extensor tendon status was recorded in 419 fractures at 3 months and 373 at 12 months. Associations were analyzed between EPL rupture and age, sex, initial fracture displacement, dorsal comminution, treatment modality, surgical technique, 12-month grip strength, Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and EQ-5D. Results Ten EPL ruptures were identified among the 419 fractures assessed at 3 months, representing an incidence of 2.4%. One rupture was acute; none occurred between 3 and 12 months. Seven ruptures occurred in undisplaced or minimally displaced fractures, and three occurred in displaced fractures (P = .06). Four followed surgical treatment, and six followed nonsurgical management. EPL rupture was not significantly associated with age, sex, dorsal comminution, treatment type, or surgical technique. At 12 months, grip strength, QuickDASH, and EQ-5D did not differ significantly between patients with and without EPL rupture. Seven of the 10 patients with rupture underwent tendon transfer; 12-month QuickDASH scores did not differ between these subgroups. Conclusions EPL rupture occurred in 2.4% of distal radius fractures, and all cases occurred within 3 months. No clear demographic, fracture-related, or treatment-related risk factors were identified. Long-term grip strength, function, and quality of life were comparable between patients with and without rupture. Outcomes were acceptable in the few selected patients managed nonsurgically, but the study was not powered to compare treatments. These findings underscore the importance of early surveillance and support an individualized approach. Type of study/level of evidence Prognostic II.
Objectives: The Global Leadership Initiative on Malnutrition (GLIM) is a framework for diagnosing malnutrition. The applicability of GLIM in patients receiving dialysis remains insufficiently explored. This study aimed to identify the most prevalent phenotypic criteria, assess whether dialysis per se can be used as the sole etiological criterion, and evaluate dietitians' perceptions of GLIM's feasibility in clinical practice. Methods: In this exploratory mix-method study, adult patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) were recruited from six Swedish dialysis centers. Malnutrition was diagnosed and graded according to GLIM. Phenotypic criteria included unintentional weight loss, low body mass index, and low muscle mass assessed by calf or arm muscle circumference. Two etiologic models were applied: (I) reduced dietary intake or inflammation, and (II) dialysis as the sole disease-related burden. Renal dietitians conducted assessments and completed a questionnaire on feasibility. Results: Ninety-three patients were included (HD n = 57, PD n = 36), median age 74 y; 60% were male and 43% had diabetes. Low muscle mass was the most prevalent phenotypic criterion (49%). Malnutrition prevalence was 42% using model I and 55% using model II. Ten dietitians completed the assessments, with a median time of 15 minutes. Facilitators included clear guidelines, appropriate equipment, and organizational support. Assessment was also perceived as motivating for patients. Conclusions: The prevalence of malnutrition among dialysis patients using GLIM varied between 42% and 55% depending on the etiological model. Low muscle mass was the most common phenotypic criterion. GLIM appeared feasible for routine use in dialysis care.
Tuberculosis treatment has undergone its most profound transformation since the launch of the standardised DOTS strategy in 1994. Since 2020, a series of pivotal randomised trials, including TB-PRACTECAL, ZeNix, Nix-TB, endTB, BEAT-TB, SHINE, and Study 31/A5349, have redefined the management of both drug-susceptible and drug-resistant tuberculosis. These studies have enabled shorter, fully oral regimens with improved efficacy and safety across adult and paediatric populations, including people with HIV, and have driven major updates to WHO treatment guidelines. Despite these advances, tuberculosis remains the leading cause of death from a single infectious agent worldwide, with substantial mortality occurring before treatment initiation due to delayed diagnosis and pretreatment loss to follow-up, and additional deaths during treatment related to advanced disease, drug resistance, comorbidities, and challenges with treatment tolerance and adherence. In 2024, an estimated 10·7 million people developed tuberculosis of whom approximately 390 000 developed multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis. Tuberculosis caused an estimated 1·23 million deaths globally, including approximately 150 000 deaths attributable to MDR tuberculosis or RR tuberculosis. Outcomes remain poorest among people with HIV, young children (who rarely access treatment and prevention), migrants, and displaced populations. The tuberculosis drug development pipeline in 2026 is more advanced than at any time since the introduction of rifampicin. Novel and repurposed compounds, including DprE1 inhibitors, next-generation oxazolidinones (including TBAJ-587 and TBAJ-876), cytochrome bc1 inhibitors, and long-acting formulations, are in late-stage evaluation. Host-directed therapies are also advancing as adjunctive strategies to reduce inflammation-mediated tissue damage and long-term morbidity, although they remain investigational. This Series paper synthesises advances in adult and paediatric tuberculosis therapeutics from Nov 15, 2020, to Jan 15, 2026, and highlights priorities to translate therapeutic innovation into equitable population-level effects.
Tetralogy of Fallot (TOF) patients are at risk for long-term adverse events. Electrocardiogram (ECG) abnormalities may reflect ventricular maladaptation and predict complications. We investigated whether ECG changes correlated with cardiac magnetic resonance imaging (CMR) measures of right ventricular (RV) function and their prevalence in less mature myocardium (prematurity or early repair). This retrospective study included 219 TOF patients operated between 2000-01-01 and 2018-12-31. Parameters analyzed included PQ interval, QRS duration, dispersion, fragmentation, QTc, JTc, and right bundle branch block (RBBB) at predefined time points. In patients undergoing pulmonary valve replacement (PVR) with available CMR, measures of RV size and function were compared with ECG variables. Early repair was defined as < 3 months and prematurity < 37 weeks’ gestation. Median age at follow-up was 12.3 years (IQR, 8.4;17), and 4.9 months (IQR, 3.4;6.9) at primary repair. PQ interval correlated with RV end-diastolic, stroke and regurgitant volume, whereas RBBB correlated with larger RV. Forty-five patients (21
Understanding the mechanism of action (MoA) of bioactive compounds is a central challenge in drug discovery and chemical biology. We propose a strategy for integrating morphological data with proteomics to provide deeper insights into the MoA of compounds. We combine the rich phenotypic profiles of Cell Painting (CP) with the unbiased protein target detection of Thermal Proteome Profiling (TPP), and construct protein-protein interaction networks based on potential targets identified using both assays. We validated our method with public TPP datasets for the five compounds (+)-JQ1, I-BET151, Vemurafenib, Crizotinib and Panobinostat, and public Proteome Integral Solubility Alteration (PISA) data for 49 compounds, together with CP data for 5259 drugs on U2OS cells. We show that the combined approach could accurately identify known MoAs for four out of five validation compounds and known targets for 29 out of 49 compounds. Finally, we deployed our method to characterize sinomenine, a compound with elusive knowledge of MoA. Our findings revealed novel facets of sinomenine's biological activity and highlight the value of multimodal profiling for chemical biology.
