Tag: pubmed

J Pediatr Hematol Oncol. 2026 May 18. doi: 10.1097/MPH.0000000000003211. Online ahead of print.

ABSTRACT

Pediatric hematology/oncology fellows at our institution lacked formal training in prescribing chemotherapy and supportive care. This pilot study aimed to assess the feasibility of implementing a structured curriculum in a fellowship program and to gain preliminary insights into its impact on fellows’ confidence and competence in placing chemotherapy and supportive care orders in the Epic Beacon system. We developed Beacon Bootcamp using Kern 6-Step Approach to Curriculum Development. General and targeted needs assessments informed the learning objectives. We held individual practice sessions, grounded in Kolb experiential learning theory, as one of our educational strategies and piloted a near-peer teaching model. The curriculum was implemented during the 2024 to 2025 academic year, and outcomes were compared with a baseline cohort from the prior academic year. Fellows who participated in Beacon Bootcamp reported higher levels of comfort with prescribing chemotherapy and supportive care compared with the previous cohort, which did not receive formal training. We observed a lower rate of order corrections required following the intervention (21% vs. 38%); however, the small sample size limited statistical analysis. Our findings suggest that Beacon Bootcamp improves fellows’ confidence and may reduce prescribing errors. Its impact could be greater if implemented during the first quarter of the fellowship. Further evaluation in a larger cohort is needed to more definitively assess its effectiveness.

PMID:42154508 | DOI:10.1097/MPH.0000000000003211

Quintessence Int. 2026 May 19;0(0):0. doi: 10.3290/j.qi.b7011446. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Peri-implant mucositis (PiM) is a reversible inflammatory condition that may progress to peri-implantitis if untreated. Professional mechanical plaque removal (PMPR) is the standard therapy, although complete resolution is not always achieved. This review aimed to evaluate the effectiveness of chemical and pharmacological adjunctive therapies to PMPR in PiM management.

MATERIALS AND METHODS: A literature search was conducted in PubMed and Scopus up to March 2025. Randomized controlled trials (RCTs) including adult patients with PiM, reporting bleeding on probing (BoP) changes, and with a minimum follow-up of 3 months were included. Nine RCTs (414 patients) were qualitatively analyzed.

RESULTS: PMPR alone resulted in significant reductions in BoP and probing depth (PD), but complete disease resolution was inconsistent. Adjunctive therapies, including chlorhexidine, local antibiotics, sodium hypochlorite, probiotics, and bioactive agents, showed intra-group improvements. However, additional benefits over PMPR alone were limited and often not statistically significant. Study heterogeneity in diagnostic criteria, outcome definitions, and treatment protocols limited comparability.

CONCLUSIONS: PMPR remains the gold standard for PiM treatment. Adjunctive therapies may provide additional clinical benefits in selected cases, but their routine use is not supported by consistent evidence. Standardized RCTs with long-term follow-up are needed.

PMID:42154501 | DOI:10.3290/j.qi.b7011446

Acta Otolaryngol. 2026 May 19:1-9. doi: 10.1080/00016489.2026.2667889. Online ahead of print.

ABSTRACT

BACKGROUND: Overlapping signal intensities in conventional MRI limit parotid tumor characterization, necessitating advanced techniques like arterial spin labeling (ASL) to assess physiological parameters such as vascularity.

OBJECTIVES: To evaluate the diagnostic performance of ASL in differentiating parotid gland tumors by quantifying tumor blood flow ASLm (mean) and ASLmax (maximum) and determining optimal cutoff values correlated with histopathological findings.

METHODS: Forty-seven patients (20 pleomorphic adenomas [PA], 20 Warthin tumors [WT], 7 malignant) underwent standardized 1.5 T MRI protocols and ASL prior to parotidectomy. Quantitative ASL values were obtained from lesions and contralateral tissue. Statistical comparisons and ROC analyses were performed to identify diagnostic cutoff values.

RESULTS: ASLm and ASLmax values were higher in WT compared to PA (p < 0.01). No significant side-to-side differences were found in PA and malignant groups. For PA differentiation, ASLm and ASLmax yielded AUCs of 0.766 (p = 0.002) and 0.742 (p = 0.005), respectively. For WT differentiation, both parameters showed excellent performance, yielding AUCs of 0.774 (p < 0.001) and 0.769 (p = 0.002).

CONLUSIONS: While ASL perfusion MRI effectively differentiates common benign parotid tumors, its limitations in malignancy evaluation necessitate its integration into a multiparametric MRI protocol for a more reliable preoperative diagnosis.

PMID:42154491 | DOI:10.1080/00016489.2026.2667889

Plast Reconstr Surg. 2026 May 19. doi: 10.1097/PRS.0000000000013206. Online ahead of print.

ABSTRACT

BACKGROUND: Hematoma remains a major complication following breast surgery. While tranexamic acid (TXA) efficacy is established in reduction mammaplasty, its utility across other breast procedures remains unclear.

METHODS: This retrospective cohort study included 5,202 consecutive procedures (2019-2025) performed by multiple surgeons at a single private hospital: primary augmentation (n=3,738), reduction mammaplasty (n=943), explantation with mastopexy (n=358), and explantation alone (n=163). TXA administration was at surgeon discretion. Inverse Probability of Treatment Weighting controlled for temporal adoption bias and confounders. Primary outcome was hematoma requiring surgical intervention within 30 days; isolated ecchymosis without palpable collection was not classified as hematoma.

RESULTS: TXA adoption increased from 7.0% (2019) to 93.0% (2025). After achieving covariate balance (all SMD <0.2), procedure-specific effects emerged. In reduction mammaplasty, TXA significantly reduced hematoma (2.2% vs 7.2%; adjusted OR 0.28, 95% CI 0.14-0.58, p<0.001; NNT=20). Explantation with mastopexy showed similar benefit (1.6% vs 6.0%; OR 0.42, 95% CI 0.20-0.88, p<0.001). Primary augmentation demonstrated no statistically detectable difference (1.2% vs 1.2%; OR 0.94, 95% CI 0.36-2.42, p=0.905), regardless of implant plane. No thromboembolic events occurred. Surgical site infection showed a nominally significant difference (OR 0.47, p=0.02) but should be considered exploratory given small event counts and absence of a plausible biological mechanism. Seroma and wound dehiscence showed no significant differences.

CONCLUSIONS: TXA efficacy is procedure-dependent. It provides significant protection in reduction mammaplasty and mastopexy involving extensive parenchymal dissection, but shows no statistically detectable benefit in primary augmentation. These findings support procedure-specific practice guidance rather than universal prophylaxis.

PMID:42154472 | DOI:10.1097/PRS.0000000000013206

JAMA Netw Open. 2026 May 1;9(5):e2613571. doi: 10.1001/jamanetworkopen.2026.13571.

NO ABSTRACT

PMID:42154470 | DOI:10.1001/jamanetworkopen.2026.13571

JAMA Netw Open. 2026 May 1;9(5):e2613292. doi: 10.1001/jamanetworkopen.2026.13292.

ABSTRACT

IMPORTANCE: Electronic cigarettes (EC) have been shown to expose users to fewer tobacco-related toxicants compared with combustible cigarettes. The current generation of ECs has rapidly shifted toward pod-based nicotine salt formulation ECs, and more research is needed to understand the impacts of using these EC products among those who smoke.

OBJECTIVE: To determine the short-term effects of switching from cigarettes to a pod-based 5% nicotine EC, compared with a 0% nicotine EC.

DESIGN, SETTING, AND PARTICIPANTS: This double-blind, parallel-arm, randomized, placebo-controlled trial with follow-up at 6 weeks (randomized phase) and 10 weeks (postrandomized phase) was conducted at a single-site academic medical center in Pennsylvania from April 22, 2022, to December 12, 2023. Participants included adults who smoked more than 4 cigarettes per day (CPD) and expressed interest in switching completely to an EC. Data were analyzed from August 23, 2024, to December 1, 2025.

INTERVENTIONS: Participants were allocated 1:1 to the standardized research EC (SREC) with 5% nicotine or 0% nicotine for 6 weeks.

MAIN OUTCOMES AND MEASURES: The primary outcome was concentration of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine corrected for creatinine level at 6 weeks. Secondary outcomes included exhaled carbon monoxide (CO), cotinine level, CPD, CO-verified cigarette abstinence, and levels of volatile organic compounds.

RESULTS: A total of 104 participants (52 per group) were randomized, of whom 68 (65.4%) were female, with a mean (SD) age of 50.9 (10.0) years. At 6 weeks, the 5% SREC group did not have significantly lower NNAL levels (mean difference [MD], -116.6 [95% CI, -245.4 to 12.2] pg/mg; P = .08). However, a greater proportion of participants in the 5% SREC group were abstinent from cigarettes (19 of 52 [36.5%] vs 6 of 52 [11.5%]; P = .005), compared with the 0% SREC group. The 5% SREC group had greater cotinine levels (MD, 2367.8 [95% CI, 407.5-4328.2] ng/mg; P = .02); however, there were no differences in CPD (MD, -0.9 [95% CI, -3.9 to 2.1] CPD; P = .55) or exhaled CO levels (MD, -5.1 [95% CI, -12.9 to 2.6] ppm; P = .19) between groups. Levels of cyanoethyl mercapturic acid (CYMA) (MD, -49.0 [95% CI, -90.4 to -7.6] ng/mg; P = .02) and 3-hydroxypropyl mercapturic acid (3HPMA) (MD, -290.8 [95% CI, -514.0 to -67.6] ng/mg; P = .01), biomarkers of acrylonitrile (a carcinogen) and acrolein (a cardiac toxicant) exposure (both of which are respiratory toxicants), were lower in the 5% SREC group compared with the 0% SREC group.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of adults who smoke, switching from cigarettes to a 5% SREC vs a 0% SREC resulted in reduced exposure to some toxicants delivered by cigarette smoking and an increased rate of smoking cessation. ECs that deliver nicotine like a cigarette may have an important role in reducing the harmful toxicant exposure caused by cigarette smoking.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03625986.

PMID:42154468 | DOI:10.1001/jamanetworkopen.2026.13292

JAMA Netw Open. 2026 May 1;9(5):e2613399. doi: 10.1001/jamanetworkopen.2026.13399.

ABSTRACT

IMPORTANCE: Previous evidence suggests a bidirectional association between physical activity and cognitive function. It remains unclear whether long-term cognitive trajectories are associated with later differences in how older adults allocate time during the day between physical activity, sedentary behavior, and sleep.

OBJECTIVE: To assess whether long-term cognitive trajectories are associated with the subsequent amount of daily time in physical activity, sedentary behavior, and sleep.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included community-dwelling adults aged 50 years or older at baseline and residing in England, using cognitive data from waves 1 (2002 to 2003) to 9 (2018 to 2019) and accelerometer data from wave 10 (2021 to 2023) of the English Longitudinal Study of Ageing.

EXPOSURES: Participant-specific annual rate of change in episodic memory (assessed via immediate and delayed recall) and verbal fluency (assessed via animal naming), estimated using linear mixed-effects models.

MAIN OUTCOMES AND MEASURES: The movement behavior composition, comprising mean daily minutes of moderate to vigorous physical activity, light physical activity, sedentary behavior, and sleep time. Differences were estimated in time spent in each behavior between a less favorable memory or fluency trajectory (corresponding to the 25th percentile for participant-specific memory or fluency change), median trajectory (50th percentile), and a more favorable trajectory (75th percentile).

RESULTS: The study included 2529 participants (1394 [55.1%] female, 1135 [44.9%] male) with a mean (SD) baseline age of 56.1 (5.4) years. Compared with the less favorable memory trajectory, the more favorable trajectory was associated with 14 (95% CI, 8 to 21) more minutes of light physical activity and 12 (95% CI, -20 to -5) fewer minutes of sedentary behavior per day, with larger differences among participants older than 70 years (eg, 20 [95% CI, 11 to 30] more minutes light physical activity). Memory-related differences in moderate to vigorous physical activity and sleep were comparatively minor. Fluency showed similar patterns to memory, but time-use differences between trajectories were smaller.

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, participants with less favorable long-term memory trajectories were subsequently less active and more sedentary, suggesting that later-life activity patterns may partly reflect cognitive change.

PMID:42154466 | DOI:10.1001/jamanetworkopen.2026.13399

JAMA Netw Open. 2026 May 1;9(5):e2613616. doi: 10.1001/jamanetworkopen.2026.13616.

ABSTRACT

IMPORTANCE: Geographic variation in amputations following diabetic lower-extremity (DLE) wounds is substantial. Understanding the sociodemographic and health care factors associated with variations can inform policy to reduce amputations.

OBJECTIVE: To examine associations of regional patient and health care system characteristics with major amputations following DLE wounds.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted among Medicare fee-for-service beneficiaries aged 66 years and older with DLE wounds from 2017 to 2019. Data were aggregated at the hospital referral region (HRR) level. Analyses were performed between February 2025 and February 2026.

EXPOSURE: Diagnosis of a DLE wound.

MAIN OUTCOME AND MEASURES: The outcome was the HRR-year proportion of DLE wounds undergoing major amputation within 12 months after diagnosis. Key measures included HRR-year percentages of Black and Hispanic Medicare beneficiaries with DLE wounds, an economic deprivation index, clinician supply per 10 000 Medicare beneficiaries (primary care, endocrinology, podiatry, and revascularization-performing specialists), and the percentage of hospitals with wound management programs. Spatial-temporal bayesian models estimated associations of HRR-year amputations with these measures and were reported as odds ratios (ORs) with 95% credible intervals (CrIs).

RESULTS: The study cohort included 707 971 Medicare DLE wounds (median [range] age, 76 [65-11]; median [range] sex, 55.0% [44.0%-68.0%] male) in 306 HRRs with wide variation in median (range) racial composition (5.2% [0.0%-53.1% Black and 1.4% [0.0%-87.0%] Hispanic), economic deprivation index (60.6 [7.2-87.8]), specialist supply per 10 000 Medicare beneficiaries (podiatry: 4.0 [1.1-16.3]; endocrinology: 1.4 [0.2-5.4]; revascularization-performing specialties: 8.0 [3.9-28.0]) and the percentage of hospitals with wound management programs (63.4% [25.0%-100%]). The median (range) HRR-year proportion of DLE wounds followed by major amputation was 3.0% (0.3%-9.3%). In bayesian models, the percentages of Black (OR, 5.19; 95% CrI, 3.78-7.12) and Hispanic patients (OR, 2.39; 95% CrI, 1.73-3.29) and economic deprivation (OR, 1.29; 95% CrI, 1.02-1.62) had positive associations with amputations. Among health care factors, only HRR-level podiatrist supply had a negative association with amputations (OR, 0.74; 95% CrI, 0.66-0.82), corresponding to an estimated 19.1%, 6.6%, and 3.2% reduction in amputation odds with 1 additional podiatrist per 10 000 Medicare beneficiaries in low-, medium-, and higher-supply markets (approximately 1, 4, and 9 podiatrists per 10 000 beneficiaries).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Medicare beneficiaries with DLE wounds, beyond social determinants of health, higher podiatrist supply was associated with fewer amputations. These findings suggest that increasing access to podiatry may reduce amputations among patients with DLE wounds.

PMID:42154463 | DOI:10.1001/jamanetworkopen.2026.13616

Clin Rheumatol. 2026 May 19. doi: 10.1007/s10067-026-08159-y. Online ahead of print.

ABSTRACT

PURPOSE: The primary objectives of this study were: (1) to describe the clinical characteristics and disease burden in a cohort of patients with SAPHO syndrome; (2) to evaluate the impact of SAPHO syndrome on quality of life using DLQI and HAQ; and (3) to identify independent risk factors associated with impaired quality of life.

METHODS: We retrospectively analyzed clinical data from 225 SAPHO patients at two tertiary hospitals using Dermatology Life Quality Index (DLQI) and Health Assessment Questionnaire (HAQ) scores. Correlation and regression analyses identified factors influencing QoL and physical function.

RESULTS: There was no significant correlation between bone pain location and total HAQ scores (P = 0.264); skin lesion types showed a significant correlation with DLQI scores (P = 0.039), and PPP was the main factor leading to impaired skin-specific quality of life.Patients were predominantly female (65.3%; mean onset age 35 ± 13 years). Palmoplantar pustulosis (92.9%) and sternoclavicular joint involvement (59.6%) were predominant. There is a statistically significant association between treatment type and DLQI score (P = 0.028), with a significant correlation with HAQ score (P = 0.05).Median DLQI was 17 (78.5% moderate-severe) and HAQ 0.12. Alcohol and education correlated with DLQI (P < 0.05), with education as an independent factor (P = 0.002). Duration and alcohol correlated with HAQ (P < 0.05), with alcohol as an independent factor (P = 0.036).

CONCLUSION: SAPHO significantly impacts patients’ quality of life, worsened by modifiable factors like alcohol and education; targeted interventions may improve prognosis.

PMID:42154424 | DOI:10.1007/s10067-026-08159-y

Ir J Med Sci. 2026 May 19. doi: 10.1007/s11845-026-04450-8. Online ahead of print.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is frequently associated with neurological manifestations, most notably anosmia, raising questions regarding central nervous system involvement. Neuropathological studies have reported heterogeneous findings, and the relative contribution of direct viral neurotropism versus indirect systemic mechanisms remains controversial.

METHODS: An autopsy-based case-control study was conducted including 16 COVID-19-positive decedents and 15 age- and sex-matched COVID-19-negative controls. Histopathological examination focused on the olfactory bulb, olfactory tract, and frontal cortex. Reactive gliosis, microglial activation, perivascular inflammation, microvascular injury, neuronal eosinophilia, and corpora amylacea were assessed using standardized semiquantitative criteria and compared between groups.

RESULTS: COVID-19-positive cases demonstrated significantly increased reactive gliosis and microglial activation in the olfactory bulb, along with a higher frequency of mild perivascular lymphocytic infiltration in the frontal cortex. In contrast, corpora amylacea and petechial hemorrhages were observed in both COVID-19-positive and control groups, without statistically significant differences. No evidence of viral cytopathic changes or diffuse encephalitis was identified. Systemic pathological findings in COVID-19-positive cases were consistent with severe multisystem disease.

CONCLUSIONS: COVID-19 is associated with region-specific but non-uniform neuropathological alterations dominated by reactive and vascular changes rather than encephalitic processes. The inclusion of a contemporaneous control group demonstrates that several commonly reported histological findings represent nonspecific background changes. These findings support predominantly reactive and vascular mechanisms of CNS involvement in COVID-19 rather than direct encephalitic processes.

PMID:42154414 | DOI:10.1007/s11845-026-04450-8