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[Editorial] Russia spiralling into an HIV crisis

Recent reports on HIV in Russia suggest the country's response to the epidemic continues to spiral to new depths. Reduced state funding, prohibitions on external funding, and crackdowns on the activities of civil society organisations are severely affecting the HIV response. In August, the AIDS.CENTER Foundation, a Russian non-governmental organisation (NGO) providing essential services, including HIV testing, treatment, and education, failed to secure crucial state grants. In 2025, foreign funders, including the Elton John AIDS Foundation and Aidsfonds, ceased operations in the country.

Ethical Basis of the Pediatric Vaccine Encounter—Correcting the Record

In this Viewpoint, the authors argue that the Department of Health and Human Services’ use of medical ethics to justify its recent removal of the COVID-19 vaccine from the Centers for Disease Control and Prevention’s recommended immunization schedule for healthy children ignores the existing foundational functions of medical ethics in the vaccination encounter.

Considering Thrombolysis for Mild Stroke

The number of patients presenting to emergency departments with mild stroke (National Institutes of Health Stroke Scale [NIHSS] score 0-5) is substantial and seems to be increasing over time. Determining the acute reperfusion therapy approach in an individual patient has presented many challenges. These include the individualized nature of the functional impact of a particular mild deficit (eg, subtle nondominant hand weakness has more of an impact on function for a professional violinist than a retired person); cognitive effects, which are often underrecognized at emergent presentation; the risk of later neurological decline outside the eligible time window for lytic therapy; the potential for spontaneous recovery over time; and the small but real risk of symptomatic intracranial hemorrhage associated with lytic administration. Two pivotal trials, one by the National Institute of Neurological Disorders and Stroke (NINDS) and the European Cooperative Acute Stroke Study 3 (ECASS-3), both excluded patients with mild, nondisabling deficits (Table).

Leveraging the Brain to Design and Revise Interventions

Neuroimaging techniques have been increasingly used in research over the past couple of decades to try to better understand brain function and structure and how it relates to important outcomes of interest. Insights from the brain from functional magnetic resonance imaging (fMRI), electroencephalography, and functional near-infrared spectroscopy can be used to advance questions in clinical, developmental, cognitive, affective, and social contexts. Although examining the brain is not without its limitations, neuroimaging can be a powerful tool to gain access to information that is difficult or impossible to assess with other measures. This Editorial will focus on some examples of neuroimaging methods that have helped advance research questions with the hope that they inspire new interdisciplinary and multimethodological collaborations within the JAMA Pediatrics community.

Weekly Insulins and Therapeutic Burden in Type 2 Diabetes

One of the more difficult decisions for patients with poorly controlled type 2 diabetes, as well as for their clinicians, is when to add or switch to daily insulin therapy. Initiation of longer-acting insulins, such as glargine or degludec, administered at bedtime, has gained widespread use and is effective in…

An Aspirin a Day for Improved Colorectal Cancer Outcomes

The painkilling, antipyretic, and antiinflammatory properties of aspirin have been known for centuries. The understanding that aspirin targets cyclooxygenase-1 (COX-1) (also known as prostaglandin-endoperoxide synthase 2 [PTGS1]) and COX-2 (also known as PTGS2), which are key enzymes required for prostaglandin synthesis, provided a rationale for using aspirin to treat thrombosis….

A Tale of Two Diseases

The association between obesity and type 2 diabetes has been recognized for decades — for example, Ethan Sims and colleagues coined the term “diabesity” in the 1970s. Yet, both conditions were treated separately, often at odds with each other, with an acceptance of the weight gain observed with some glucose-lowering…

Mimicking Complex Receptor Actions with Small(ish) Molecules

As a therapeutic area, type 2 diabetes includes a wide range of treatment options in several mechanistic classes (although metformin has multiple classifications). One of the best therapies, however, is and has always been weight loss through diet and exercise. On the face of it, a weight-loss strategy involving diet…

Gene Expression Profiling and Melanoma Sentinel Node Status

In this issue of JAMA Surgery, Hieken et al present the first blinded, prospective trial analyzing gene expression profiling (GEP) in patients with melanoma undergoing sentinel lymph node biopsy (SLNB). The authors introduce the Merlin assay and hypothesize it can identify who can safely forgo SLNB, with a long-term objective of determining the test’s prognostic significance for patients with node-negative disease. Results focus on the former objective. The assay combines GEP with patient age and tumor depth (clinicopathological factors plus GEP, or CP-GEP) to classify a “low” or “high” risk of SLNB metastases in 1761 patients. This study had strict eligibility criteria, resulting in overall SLNB positivity of 17% and low-risk-score SLNB positivity of 7.1%. While it came very close, the low risk score did not reach the National Comprehensive Cancer Network arbitrary benchmark, which indicates SLNB can be excluded if the risk of SLN metastasis is less than 5%.

Next-Generation Sequencing in Cutaneous T-Cell Lymphoma

Early cutaneous T-cell lymphoma (CTCL) remains challenging to diagnose, as it clinically and histologically may mimic inflammatory conditions such as eczematous dermatitis, pityriasis lichenoides, or psoriasis. The consequence is delay in time from symptom onset to diagnosis, which commonly spans years (median, 36 months; interquartile range, 12-90 months). Definitive diagnosis continues to hinge on careful clinicopathologic correlation, which is sometimes supported by detection of a clonal T-cell population in skin and/or blood. Yet, the polymerase chain reaction (PCR)–based T-cell receptor (TCR) γ and β gene rearrangement assays most widely available in practice have limited sensitivity and can yield false-negative results; conversely, clonal T-cell populations are not pathognomonic and may be detected in inflammatory conditions. However, detecting clonal T-cell populations is not only important in establishing diagnosis of CTCL, but also, the overall clonal burden or tumor clone frequency (TCF) is associated with prognosis. In patients with a TCF greater than 25%, there is a reduction in progression-free survival and overall survival. Against this backdrop, technologies that provide more sensitive and granular assessment of TCR repertoires are particularly salient, as they promise to refine diagnosis, quantify clonal burden, and potentially inform prognosis and management.

Defibrillators in Private Homes

Defibrillation is a highly effective treatment for ventricular fibrillation and pulseless ventricular tachycardia when delivered promptly after the onset of cardiac arrest. As time in cardiac arrest progresses, shockable rhythms degenerate to nonshockable rhythms, global organ damage worsens, and the likelihood of successful resuscitation and neurological recovery diminishes. Reducing the time to defibrillation is therefore crucial to survival and good recovery. A key strategy to reducing time to defibrillation is harnessing the community response to deliver bystander-initiated defibrillation using an automated external defibrillator (AED). Public access defibrillator programs, where AEDs are placed in public places, have been highly effective. However, only 20% of out-of-hospital cardiac arrests occur in a public place. The majority occur in the home, where access to AEDs is limited. Strategies to enable timely community defibrillation in the home setting, such as provision of AEDs in private homes, have the potential to extend the benefits of early defibrillation and save thousands more lives.

Shot Through the Heart—Can RSV Vaccination Reduce Risk of Cardiovascular Outcomes?

Respiratory syncytial virus (RSV) causes severe disease in older adults at rates similar to seasonal influenza, particularly among those with chronic heart and lung disease, including congestive heart failure, chronic obstructive pulmonary disease (COPD), and bronchiolitis. Patients may present with signs and symptoms of viral pneumonia but commonly present with decompensated heart failure or COPD exacerbations, with RSV as the inciting event leading to worsening of their underlying disease. Recently, adults hospitalized with RSV have been shown to have a higher risk of invasive mechanical ventilation and death compared with those with influenza or COVID-19 who had received vaccination.

Digitoxin — A Reminder for Digoxin

Cardiac glycosides are among the oldest medications in cardiovascular care, prized for their actions as positive inotropic agents and modulators of atrioventricular conduction. In heart failure with reduced ejection fraction, their mechanistic rationale was so convincing that digitalis became a mainstay of treatment long before the initiation of large-scale trials...

Progress through Persistence — Turning the Page in Pulmonary Fibrosis Clinical Trials

The field of pulmonary fibrosis has come a long way in the past 25 years, with the approach to patient care evolving from a predominantly experience-based decision-making model to a more data-driven model. Along that journey, we have learned that certain practices that were considered to be standards of care…

A Rare-in-Common Paradigm for Precision Genomic Medicine

Precision medicine tailors clinical management strategies for treatment and prevention in light of each person’s genetic makeup, history of environmental exposures, and lifestyle. More specifically, precision medicine is about making correct, actionable diagnoses and offering appropriate, patient-specific treatment. Genomics has contributed to precision medicine, especially in the areas of rare…