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01.
medRxiv (Medicine) 2026-06-25

Extracellular vesicles as biomarkers for psoriatic arthritis: a systematic review & meta-analysis

Authors:
Zhang↗Zoha↗F.-S↗Zhu↗Ackerfield↗Luu↗Wang↗Ning↗Suh↗Brophy↗R. H↗Knapik↗…

Background: Psoriatic arthritis (PsA) is an inflammatory condition involving joints, tendon-bone entheses and synovium that can develop in individuals with psoriasis. Early, accurate clinical diagnosis remains difficult. Extracellular vesicles (EVs) carry proteins and miRNAs that Methods: PubMed and Embase were searched from inception through May 21st, 2026, and human studies examining EV-associated protein or miRNA biomarkers in PsA and related psoriatic or inflammatory diseases were included, with risk of bias assessed using a modified Newcastle-Ottawa Scale and diagnostic accuracy summarized using HSROC/BRMA models when data were sufficient. Results: Seven studies met the inclusion criteria, including 119 individuals with PsA (weighted mean age: 49.8 years; 43.7% female), 205 individuals with non-PsA psoriasis (weighted mean age: 46.4 years; female %: NA), 55 controls (weighted mean age: 44.5 years; 38.2% female), and 50 individuals with other inflammatory joint disorders (weighted mean age: 58.0 years; 58.0% female). EV-associated protein markers demonstrated heterogeneous findings related to immune, vascular, inflammatory, and osteoimmunological signaling. Only 4.2% (4/95) of miRNAs were consistently identified across studies comparing PsA with non-PsA psoriasis, with lower overlap (1.5%, 1/67) in studies comparing PsA with controls. ROC meta-analysis suggested preliminary diagnostic potential, particularly for distinguishing PsA from non-PsA psoriasis, although evidence was constrained by small study numbers. Conclusions: EV-associated proteins and miRNAs are potential biomarker candidates for PsA, reflecting inflammatory, vascular, and osteoimmunological processes underlying disease pathophysiology. However, current evidence remains preliminary and limited by small cohorts, methodological heterogeneity, and inconsistent reporting across studies.

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02.
medRxiv (Medicine) 2026-06-15

Toward a National Registry for Inborn Errors of Immunity in Peru: A Qualitative Implementation Study

Authors:
Veramendi-Espinoza↗L. E↗De la Cruz-Torralva↗Pezo-Pezo↗Vargas-Herrera↗J. R↗Neyra Quijandria↗Martina↗Sullivan↗K. E↗Huaman↗M. A↗…

Background: Peru lacks an integrated information system for patients with Inborn Errors of Immunity (IEI). Although disease registries are essential tools for data management and health planning, their success depends on implementation science approaches that account for local contextual factors. This study reports Phase I of a three-phase mixed-methods implementation project to design and develop a national IEI registry. Methods: Phase I consisted of a phenomenological qualitative study exploring stakeholder perspectives. Semi-structured focus groups and in-depth interviews were conducted with 29 key stakeholders across four groups: policy-makers, clinical experts, end-users (immunologists, residents, allied health personnel), and patient organization representatives. Interviews followed a guide structured around four a priori domains (structure, navigation, feasibility, and perception of existing systems). Discussions were conducted in Spanish, audio-recorded, transcribed verbatim, and coded using ATLAS.ti. A hybrid thematic analysis combining deductive and inductive coding was performed. Data elements proposed for the registry were triangulated with qualitative findings. Results: Thirty-six initial codes were consolidated into 15 categories, which were further integrated into four overarching themes conceptualized as pathways toward intention to use: (1) Environment, where governance, regulatory backing, and sustainable financing were identified as key enablers, while limited interoperability emerged as a structural barrier; (2) Technical Dimension, emphasizing usability, alignment with clinical workflow, and a hierarchical data architecture (demographic, clinical, therapeutic); (3) Users, highlighting clinical leadership, protected time, digital readiness, and perceived usefulness as stronger motivators than financial incentives; and (4) Patients, underscoring data protection, transparency, trust, and advocacy as essential for legitimacy and sustainability. Conclusions: A national IEI registry in Peru is perceived as necessary and feasible if implemented with strong regulatory foundations, interoperable design, robust data security, and user-centered architecture. These findings informed the development of an initial functional prototype and the operational plan for Phase II, focused on usability evaluation.

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03.
arXiv (CS.AI) 2026-06-15

A Deep Reinforcement Learning (DRL)-Based Transformer Method for Solving the Open Shop Scheduling Problem

Authors:
Faezeh Ardali↗Mwembezi A. Nyelele↗Gerald M. Knapp↗

arXiv:2606.13682v1 Announce Type: new Abstract: The open shop scheduling problem (OSSP) arises in many industrial and service settings but remains computationally challenging as the number of jobs and machines increases. While exact methods quickly become intractable, classical dispatching rules and metaheuristics may require substantial tuning to maintain solution quality at large scales. This study develops a Transformer-based scheduling policy for OSSP using an encoder-decoder architecture with multi-head attention. The model is trained on Taillard benchmark instances (4x4, 5x5, 7x7, and 10x10) using only the processing-time matrix as input and produces feasible schedules with makespans typically within 15-30% of best-known values. To evaluate scalability, the trained policy is applied without retraining to randomly generated instances from 40x40 to 100x100 and compared against classical dispatching heuristics, including SPT, LPT, MWKR, and EST. Across these large instances, the Transformer achieved average gaps of 12.89-15.12% relative to a standard lower bound. Compared with EST, the Transformer remained competitive, typically within a modest margin, while substantially outperforming SPT and LPT. These results indicate that a Transformer policy trained on small OSSP instances can generalize to substantially larger problems and provide a feature-light, learning-based alternative to classical dispatching rules.

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04.
medRxiv (Medicine) 2026-06-17

Characterisation of disease progression in hantavirus haemorrhagic fever with renal syndrome

Authors:
Armstrong↗Rus↗Knap↗Drousiotis↗Eyers↗Buchan↗I. E↗Avsic-Zupanc↗Hiscox↗J. A↗Korva↗

Hantaviruses can cause haemorrhagic fever with renal syndrome (HFRS). This is a clinically variable disease in which severe outcomes are hypothesized to arise from dysregulated host responses. To characterise this, longitudinal, label-free plasma proteomics was used to compare disease progression in a unique well-defined cohort of patients infected with either Dobrava virus (DOBV) or Puumala virus (PUUV) hantaviruses. Patients were stratified by clinical severity. The average viral load in the first available sample from hospitalized patients was higher in those who went on to have severe infection, and higher in patients infected with DOBV. There was marked separation of infected patients from controls across early, mid and late disease, including after viral RNA clearance, suggesting a sustained systemic host-response signature. Proteomic signatures were consistent with a strong acute-phase response in both mild and severe disease. There was evidence of activation of the adaptive humoral response at later stages. Hierarchical clustering identified severity-associated pathways linked to endothelial dysfunction, thrombocytopenia, vascular leakage and renal injury. These findings define a durable plasma proteomic signature of hantavirus disease and support a model in which severe HFRS is driven by persistent inflammatory, complement and platelet/coagulation pathway activation rather than viral burden alone.

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05.
arXiv (CS.AI) 2026-06-19

Emyx: Fast and efficient all-atom protein generation

Authors:
Nicholas J. Williams↗Ward Haddadin↗Matteo P. Ferla↗Constantin Schneider↗Nicholas B. Woodall↗Ruby Sedgwick↗Christian D. Madsen↗Andrew L. Hopkins↗Edward O. Pyzer-Knapp↗

arXiv:2606.19377v1 Announce Type: cross Abstract: Computational enzyme design requires generating proteins that scaffold catalytic residues and ligands, a task that demands both geometric accuracy and structural diversity from the underlying generative model. Current all-atom generators inherit expensive architectures from structure prediction, leading to high training costs and limited sample diversity. We argue that much of this complexity is unnecessary for generators, which condition on sparse geometric constraints rather than rich co-evolutionary signals. Emyx is a 140M-parameter conditional flow matching model that concentrates capacity within standard transformer blocks, replacing heavy embedding stacks with lightweight conditional representations and sparse connectivity. We additionally derive an exact reparametrisation of the flow matching interpolant into the EDM noise-level framework, bridging flow matching training efficiency with state-of-the-art sampling methods designed for diffusion models without retraining. Despite being the smallest model, Emyx outperforms both Proteína-Complexa and RFdiffusion3 against the AME enzyme design benchmark across success rate under strict evaluation requiring both global fold recovery and catalytic geometry accuracy, structural novelty, scaffold diversity, and geometric validity, while training in just $682$ GPU-hours, roughly $4\times$ less than RFdiffusion3.

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