Tag: pubmed

JMIR Res Protoc. 2026 Jul 14;15:e94797. doi: 10.2196/94797.

ABSTRACT

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition affecting approximately 7% to 8% of children and adolescents, characterized by persistent inattention, hyperactivity, and impulsivity. Adolescence represents a period of heightened vulnerability, during which pharmacological treatments are frequently limited by adverse effects, suboptimal adherence, and partial response. Physical exercise, particularly high-intensity interval training (HIIT), has demonstrated superior effects on inhibitory control and inattention compared with moderate-intensity continuous exercise. However, the repetitive nature and high perceived exertion of traditional HIIT protocols result in poor adherence, especially in individuals with ADHD. Virtual reality (VR)-based exergames have been proposed as a strategy to sustain vigorous physiological demands while maintaining intrinsic motivation. Despite this potential, the existing literature is predominantly limited by passive control conditions, which prevent adequate control for the effects of VR immersion and cognitive engagement, limiting causal inference regarding the specific contribution of physiological exertion.

OBJECTIVE: This paper presents the protocol for a randomized clinical trial designed to evaluate whether an HIIT-based VR exergame produces greater improvements in inhibitory control and inattention symptoms compared with an active, nonexercise VR control condition in adolescents with ADHD.

METHODS: This multisite, parallel-group, single-blind randomized clinical trial will recruit 98 adolescents aged 12 to 17 years with a confirmed diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, from 2 outpatient centers in Brazil. Participants will be allocated 1:1 to an HIIT-based VR exergame intervention (Move Sapiens) or an active control condition using the same VR platform without vigorous physical exertion. The intervention comprises 20 sessions over 4 weeks delivered in a home-based format following supervised laboratory familiarization. Primary outcomes are Swanson, Nolan, and Pelham Rating Scale version IV inattention subscale scores and go/no-go commission errors. Secondary outcomes include working memory, cognitive flexibility, processing speed, impulsivity, sleep quality, and anxiety symptoms. Analyses will follow an intention-to-treat approach using linear mixed-effects models.

RESULTS: The trial is ongoing. Funding was granted in October 2024. As of April 2026, 58 participants have been enrolled across 2 sites, of whom 46 (79.3%) have completed the full intervention protocol. Data collection is expected to be completed by October 2026, with results anticipated by December 2026.

CONCLUSIONS: This trial will provide controlled evidence on the efficacy of an HIIT-based VR exergame for adolescents with ADHD using an active control condition matched for technological immersion. The design will enable examination of whether vigorous physical exertion beyond VR immersion and digital engagement constitutes an essential active component for improvements in inhibitory control and inattention in this population. If effective, the intervention may offer an engaging, home-based adjunctive treatment option for adolescents with ADHD.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06632249; https://clinicaltrials.gov/study/NCT06632249.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/94797.

PMID:42446902 | DOI:10.2196/94797

JAMA Netw Open. 2026 Jul 1;9(7):e2623057. doi: 10.1001/jamanetworkopen.2026.23057.

ABSTRACT

IMPORTANCE: Timely treatment in colorectal cancer (CRC) may influence the disease course and, thus, outcomes, but optimal delay thresholds remain uncertain. Identifying pathway-specific time-to-treatment initiation (TTI) effects can guide benchmarks and policies for coordinated, timely care.

OBJECTIVE: To evaluate the association between TTI and 3-year metastasis risk in patients with newly diagnosed nonmetastatic CRC undergoing curative-intent surgery, with attention to variation by treatment pathway.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of insured US patients with nonmetastatic CRC used deidentified administrative claims from Optum’s Clinformatics Data Mart. Eligible individuals were adults aged 40 years or older with incident nonmetastatic CRC diagnosed during January 1, 2017, to December 31, 2021, who underwent curative-intent surgery within 1 year of diagnosis and had continuous coverage 1 year before and after. Data were analyzed June 2025.

EXPOSURES: TTI was defined as days from CRC diagnosis to the first receipt of cancer-directed therapy (surgery, chemotherapy, or radiation). Patients were categorized into 4 treatment pathways: surgery with or without radiation, surgery followed by adjuvant therapy with or without radiation, neoadjuvant therapy followed by surgery with or without radiation, and trimodality therapy (neoadjuvant therapy, followed by surgery, followed by adjuvant therapy with or without radiation).

MAIN OUTCOMES AND MEASURES: The outcome was 3-year cumulative incidence of metastasis. XGBoost identified optimal TTI thresholds, and Fine-Gray models with death as a competing risk evaluated these thresholds and estimated their associations with metastasis.

RESULTS: Among 11 927 patients (mean [SD] age, 70.7 [10.8] years; 6007 women [50.4%]; 1251 Black [10.5%], 7948 White [66.6%]), 4539 (38.0%) had moderate or severe comorbidity. Over 3 years, 1438 patients (12.1%) developed metastasis. Longer TTIs were associated with higher metastasis risk, varying by treatment pathway. For surgery plus adjuvant therapy, TTIs of 4 to 46 days (subdistribution hazard ratio [sHR], 1.27; 95% CI, 1.04-1.55) and 47 days or longer (sHR, 1.55; 95% CI, 1.08-2.23) were significantly associated with increased risk vs zero to 3 days. For surgery followed by radiation, delays of 223 days or longer showed higher risk (sHR, 2.00; 95% CI, 0.95-4.25) than TTI up to 222 days, although these results were not significant. For neoadjuvant therapy plus surgery, TTI of 68 days or longer were associated with higher risk (sHR, 2.66; 95% CI, 1.02-6.94) than TTI up to 67 days. For patients receiving trimodality therapy, there was no association between TTI and risk of metastasis.

CONCLUSIONS AND RELEVANCE: In this cohort study, treatment delays were associated with higher, pathway-specific metastasis risk. These findings support pathway-tailored benchmarks for treatment initiation and highlight the importance of integrated care in reducing delays and improving timely, equitable, cost-effective CRC care.

PMID:42446881 | DOI:10.1001/jamanetworkopen.2026.23057

JAMA Netw Open. 2026 Jul 1;9(7):e2623166. doi: 10.1001/jamanetworkopen.2026.23166.

ABSTRACT

IMPORTANCE: Pembrolizumab plus chemotherapy, with or without bevacizumab, improves overall survival (OS) in advanced cervical cancer (ACC), but platinum choice and bevacizumab use remain discretionary.

OBJECTIVE: To compare OS by platinum agent and bevacizumab use among patients with ACC receiving first-line pembrolizumab plus chemotherapy in a clinical setting.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study used a retrospective multinational cohort with propensity score matching in the TriNetX Global Collaborative Network. Participants included adults with ACC (International Statistical Classification of Diseases, 10th Revision, Clinical Modification, code C53) treated between January 1, 2015, and October 31, 2024. Patients with prior cancer or contraindications to bevacizumab therapy were excluded. Matching was performed on age, race and ethnicity, body mass index, smoking status, and prior chemoradiotherapy. Data were analyzed from November 19 to 28, 2024.

EXPOSURES: Cisplatin or carboplatin, with or without bevacizumab, both combined with first-line pembrolizumab plus paclitaxel.

MAIN OUTCOMES AND MEASURES: Two comparisons were analyzed: cisplatin vs carboplatin and bevacizumab vs no bevacizumab. The primary outcome was OS, defined as time from treatment initiation to death from any cause. Secondary outcomes were adverse events of special interest, including fistula, bowel perforation, and pulmonary embolism.

RESULTS: Among the 1931 patients receiving first-line pembrolizumab with paclitaxel (mean [SD] age, 54.0 [13.2] years), 623 matched pairs of cisplatin-treated patients (n = 719) and carboplatin-treated patients (n = 1212) were included. The mean (SD) age was 51.2 (12.7) years for cisplatin-treated patients and 50.8 (12.7) years for carboplatin-treated patients; the median follow-up was 10.8 (IQR, 3.7-18.0) months and 9.9 (IQR, 2.5-17.2) months, respectively. The median OS was 25.1 (IQR, 9.2 to not reached) months in both groups (HR, 0.98 [95% CI, 0.81-1.18]; P = .35). Bevacizumab-treated patients (n = 803) and those not receiving bevacizumab (n = 667) yielded 455 matched pairs. The mean (SD) age was 53.6 (13.3) years in the bevacizumab-treated group and 54.3 (13.3) years in the group not receiving bevacizumab; the median follow-up was 11.3 (IQR, 4.4-18.2) months and 8.4 (IQR, 1.6-15.1) months, respectively. Twelve-month OS was 74.8% (95% CI, 70.4%-79.2%) vs 64.5% (95% CI, 59.8%-69.2%), respectively; 24-month OS was 56.2% (95% CI, 50.9%-61.5%) vs 54.0% (95% CI, 48.7%-59.3%), respectively. No increased risk of fistula (odds ratio [OR], 0.94 [95% CI, 0.63-1.40]; P = .76), bowel perforation (OR, 1.21 [95% CI, 0.52-2.82]; P = .67), or pulmonary embolism (OR, 0.62 [95% CI, 0.38-1.01]; P = .052) was observed.

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness study of patients with ACC in a clinical setting, cisplatin and carboplatin treatment were associated with similar effectiveness when combined with pembrolizumab. Bevacizumab was associated with early OS benefit, which attenuated over time. These findings warrant prospective validation.

PMID:42446878 | DOI:10.1001/jamanetworkopen.2026.23166

ESC Heart Fail. 2026 Jul 14:xvag184. doi: 10.1093/eschf/xvag184. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Acute decompensated heart failure (ADHF) results in high rates of hospitalisation, re-admissions, and mortality, straining healthcare systems. Loop diuretics are crucial for fluid management in ADHF, but optimal dosing and monitoring remain unclear. The 2021 European Society of Cardiology guidelines suggest individualised dosing based on home diuretic use and close urinary sodium monitoring for better decongestion. This study evaluates the effectiveness of a new natriuresis- and urine output-guided protocol at Maastricht University Medical Centre+ (MUMC+) based on these recommendations.

METHODS: This retrospective study compared patients treated with a natriuresis- and urine output-guided protocol, introduced in May 2022, to those receiving standard care before May 2022. The guided protocol involved individualised loop diuretic dosing, regular urine sodium monitoring, and incremental adjustments as needed. Data on demographics, lab values, length of stay, mortality, and re-admission rates were analysed, with statistical adjustments for potential confounders.

RESULTS: The guided protocol was associated with significantly shorter hospital stay (median 6.9 vs. 7.5 days, P=0.029), lower six-month mortality (10.9% vs. 17.9%, P=0.017), and cardiac rehospitalisation rates (26.1% vs. 35.7%, P=0.015). These effects were independent of baseline differences and confounders. At 12 months, the guided protocol group showed sustained association of reduced cardiac rehospitalisation rates and a trend toward lower mortality.

CONCLUSION: This guided AHF protocol was associated with reduced hospital stays, six-month rehospitalisation rates, and mortality. Tailoring individual optimised diuretic therapy for ADHF seems promising, but further research is needed to confirm its long-term benefits.

PMID:42446874 | DOI:10.1093/eschf/xvag184

J Autism Dev Disord. 2026 Jul 14. doi: 10.1007/s10803-026-07416-y. Online ahead of print.

ABSTRACT

BACKGROUND: Wikipedia is a major health information resource, yet little is known about how autism is represented across language editions.

OBJECTIVES: To examine sourcing, framing, editorial dynamics and readership of autism-related Wikipedia pages in six languages (English, Spanish, French, Italian, Norwegian and Georgian).

METHODS: We constructed a corpus of the main autism article in each language and used Python-based pipelines to extract references, revision histories (2004-2024) and monthly pageviews (2020-2024). We conducted descriptive statistics, lexicometric analyses and inductive thematic coding.

RESULTS: Across languages, autism is lexically and thematically framed primarily as a childhood, biomedical condition: child-related terms outranked adult-related terms in all editions, and “neurodiversity” appeared only marginally. Sourcing patterns differed markedly, with English and Italian relying more heavily on journals, French and Spanish on websites, Norwegian on institutional documents and Georgian under-sourced. Pageviews were highly unequal in absolute terms but, once normalised per million speakers, smaller language communities (Georgian, Norwegian and Italian) showed the highest relative demand. These high-demand editions nonetheless had the smallest editorial bases and fewest cumulative edits.

CONCLUSION: Autism-related Wikipedia pages constitute pivotal but uneven knowledge infrastructures. Strengthening adult, lifespan and neurodiversity perspectives and supporting smaller language communities could improve the robustness of online autism information.

PMID:42446867 | DOI:10.1007/s10803-026-07416-y

J Racial Ethn Health Disparities. 2026 Jul 14. doi: 10.1007/s40615-026-03029-4. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer screening and timely diagnosis are essential for reducing mortality and improving outcomes. However, access to preventive services and early detection remains uneven across social groups, particularly in low- and middle-income countries such as Brazil. This study aimed to describe educational, racial, and geographic inequalities in breast cancer screening and diagnosis among Brazilian women using data from the 2019 Brazilian National Health Survey.

METHODS: The sample included women aged 50 to 69 years. The outcomes were breast cancer diagnosis and screening, including mammography and clinical breast examination (CBE). Skin color, area of residence, and educational level were used as equity stratifiers. Simple and complex measures of inequality were applied, including the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).

RESULTS: White women, urban residents, and those with higher education levels had greater access to mammography referrals, screening, and CBE. Among women with the same education level, the prevalence of breast cancer diagnosis was higher among White women (2.6%) and Brown women (3.4%) than among Black women (2.3%). Likewise, urban residents had a higher prevalence of breast cancer diagnosis (3.1%) than rural residents (1.9%).These findings indicate that breast cancer screening and diagnosis disproportionately benefit White, highly educated, and urban-dwelling women.

CONCLUSION: Educational, racial, and geographic inequalities persist in breast cancer screening and diagnosis in Brazil, even among women with similar levels of education. These results highlight the need for equitable screening programs, awareness strategies, and public health policies targeting structurally disadvantaged groups to reduce disparities in breast cancer outcomes.

PMID:42446866 | DOI:10.1007/s40615-026-03029-4

Phys Eng Sci Med. 2026 Jul 14. doi: 10.1007/s13246-026-01760-0. Online ahead of print.

ABSTRACT

Globally, cardiovascular diseases (CVDs) constitute a leading cause of death. Significant reductions in mortality are possible with early detection and treatment of CVDs. The electrocardiogram (ECG) is an easy-to-understand, non-invasive technique for assessing the state of the heart. A specific CVD can be determined by a slight deviation in the ECG, which is difficult and time-consuming to diagnose manually. This work suggests an empirical mode decomposition (EMD)-based approach together with time and frequency series feature extraction for the automated identification of CVDs. Five CVDs are taken into consideration in this work: myocardial infarction (MI), hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), bundle branch block (BBB) and coronary artery disease (CAD). The decomposition of signals using EMD yields amplitude- and frequency-modulated waves called intrinsic mode functions (IMFs). Temporal and spectral features are extracted from the obtained IMFs. These features are ranked using the one-way anova test, and the ranked features are fed as inputs to the classification model. When combined with eleven features, the extreme gradient boosting classifier allows the suggested approach to attain a maximum classification accuracy of 99.56%. On the proposed database and 92.4% on MIT-BIH database, demonstrating strong generalizability. Clinical validation on 6,55,659 beats from RELA Hospital yielded 81.3% accuracy, highlighting the challenges of real-world deployment.

PMID:42446844 | DOI:10.1007/s13246-026-01760-0

Phys Eng Sci Med. 2026 Jul 14. doi: 10.1007/s13246-026-01777-5. Online ahead of print.

ABSTRACT

Ureteral stents are temporary implantable devices used to maintain urinary drainage and prevent obstruction. Most designs incorporate pigtail coils to reduce migration; however, the contribution of terminal coil configuration to retention strength remains unclear. This study evaluated the retention behavior of five commercially available Double-J ureteral stents commonly used in Indonesia, representing different intended indwelling durations and terminal coil configurations. Stent length, outer diameter, inner diameter, material, angular sweep, and estimated coil number were recorded. Terminal coil number was estimated from available pre-test photographs using manual image-based angular sweep analysis. Specimens were immersed in artificial urine for one month and tested according to ASTM F1828-22 using a custom pull-out device. 1.5 coil stents showed higher mean retention forces (0.061-0.065 N) than 1 coil stents (0.010-0.034 N). Statistical analysis confirmed significant differences among stent types (F = 72.76, p = 4.665 × 10^-10). However, because the tested specimens differed in material and geometry, the observed differences should be interpreted as the combined effect of coil configuration and associated stent design rather than coil number alone. These findings represent comparative in vitro retention behavior and should not be interpreted as direct clinical thresholds for migration prevention.

PMID:42446840 | DOI:10.1007/s13246-026-01777-5

Phys Eng Sci Med. 2026 Jul 14. doi: 10.1007/s13246-026-01770-y. Online ahead of print.

ABSTRACT

Computer-assisted diagnostic tools may help improve the consistency and reliability of ultrasonographic screening for developmental dysplasia of the hip (DDH). This study aimed to compare preprocessing strategies for convolutional neural network (CNN)-based classification of infant hip ultrasound images under heterogeneous image quality conditions. We evaluated six approaches for classifying infant hip ultrasound images as normal or abnormal: original-image CNN classification, CycleGAN-based domain translation in two directions, DeepLabV3-Plus-based segmentation preprocessing, and two combined approaches using CycleGAN followed by DeepLabV3-Plus. Each approach was independently trained and evaluated ten times using ninefold cross-validation, and performance was assessed using the area under the receiver operating characteristic curve (AUC). The baseline approach using original images achieved a mean AUC of 0.724 (95% confidence interval [CI]: 0.711-0.737). CycleGAN-based domain translation did not improve performance, with mean AUCs of 0.719 (95% CI: 0.703-0.736) for Dataset A-to-B translation and 0.679 (95% CI: 0.658-0.700) for Dataset B-to-A translation. DeepLabV3-Plus-based segmentation preprocessing showed the numerically highest mean AUC of 0.791 (95% CI: 0.773-0.809), while the combined approaches achieved mean AUCs of 0.780 and 0.783. Pairwise comparisons with Bonferroni correction showed no statistically significant differences between approaches (all adjusted p-values > 0.05). These exploratory findings suggest that segmentation-based preprocessing may be a promising strategy for CNN-based classification of infant hip ultrasound images under heterogeneous imaging conditions, whereas CycleGAN-based domain translation did not provide a measurable benefit in this setting. Further validation using larger multicenter datasets is required before clinical applicability can be established.

PMID:42446839 | DOI:10.1007/s13246-026-01770-y

Prog Orthod. 2026 Jul 14;27(1):33. doi: 10.1186/s40510-026-00638-x.

ABSTRACT

BACKGROUND: This study aimed to clarify the involvement of the root formation stage and apical foramen diameter (AFD) of adjacent teeth in the occurrence of external root resorption (ERR) associated with impacted maxillary canines (IMCs), and to identify novel risk indicators for more accurate clinical prediction.

METHODS: Forty patients with IMCs (58 canines) who underwent cone-beam computed tomography (CBCT) between May 2017 and October 2022 were retrospectively analyzed. The developmental status was assessed using the root formation stage and AFD of the central incisor (U1), lateral incisor (U2), and first premolar (U4). Additionally, spatial factors, including inter-root distance and the 3D position of the IMC, were evaluated in relation to ERR.

RESULTS: ERR was detected in 72.5% of patients, affecting 37.1% of all examined adjacent teeth. Among the affected teeth, U2 showed the highest incidence (65.3%), followed by U1 (28.6%) and U4 (6.1%). In exploratory tooth-level comparisons, AFD was smaller in the ERR group for U1 and U4. In the supplementary affected-side-level mixed-effects analysis, no statistically significant independent association was demonstrated between maximum AFD and side-level ERR occurrence.

CONCLUSIONS: Developmental indicators, including AFD, may provide clinically relevant information when assessing ERR associated with IMCs. These indicators should be interpreted as potential modifying factors in conjunction with established spatial relationships rather than as independent predictive markers.

PMID:42446836 | DOI:10.1186/s40510-026-00638-x