Tag: pubmed

World J Surg Oncol. 2026 Jun 29. doi: 10.1186/s12957-026-04466-5. Online ahead of print.

ABSTRACT

BACKGROUND: Axillary management in breast cancer has evolved toward de-escalation to reduce complications, particularly breast cancer-related lymphedema (BCRL). This study aimed to assess current practices and trends of axillary surgery and BCRL management in China.

METHODS: A nationwide survey was conducted across hospitals performing ≥ 200 breast cancer surgeries annually in 2022. The questionnaire evaluated institutional characteristics, clinical practices of axillary surgery and BCRL care. Data were compared with those from the 2017 national survey involving 110 hospitals to assess temporal changes in hospital-reported practice patterns.

RESULTS: The 198 hospitals surveyed performed a total of 123,237 breast cancer surgeries in 2022. SLNB for cN0 patients was routine practice, with 59.6% of hospitals performing SLNB in > 90% of these cases, whereas the use of SLNB in patients with clinically suspicious axillary nodes and FNA-confirmed metastasis remained cautious. The omission of ALND for patients with limited SLN metastasis (1-2 positive SLNs) remained conservative, particularly for mastectomy cases. However, significant increases were observed compared with the 2017 survey (breast-conserving surgery: median 30.0% vs. 9.0%, P = 0.001; mastectomy: median 11.0% vs. 6.6%, P < 0.001). The timing of SLNB in patients receiving neoadjuvant chemotherapy (NAC) shifted toward the post-NAC setting compared with 2017 (54.0% vs. 45.5%). Comprehensive assessment after NAC, including targeted axillary dissection (TAD) with dual-tracer mapping, was underutilized (23.7%). Hospital-reported BCRL care teams had been established in 52.0% of hospitals, while surgical BCRL interventions remained rare (11.6%).

CONCLUSION: Compared with the 2017 national survey, hospital-reported adoption of axillary de-escalation strategies in China was broader, although implementation remained cautious and uneven across clinical scenarios and institutional settings. As a hospital-level practice-mapping survey, this study describes implementation patterns rather than patient-level oncologic safety or efficacy. These findings suggest that tracer accessibility, evidence-based protocols, and multidisciplinary BCRL care may be important areas for future improvement.

PMID:42374488 | DOI:10.1186/s12957-026-04466-5

BMC Sports Sci Med Rehabil. 2026 Jun 29. doi: 10.1186/s13102-026-01830-6. Online ahead of print.

ABSTRACT

BACKGROUND: Feedback is considered a fundamental component of motor skill learning, yet evidence comparing the effectiveness of visual, verbal, and combined feedback modalities in youth gymnastics remains limited. This study examined the effects of mixed (visual + verbal), visual, and verbal feedback on the acquisition of selected gymnastics skills using two-dimensional kinematic analysis.

METHODS: Sixty female gymnasts aged 7-11 years were randomly assigned to mixed feedback (n = 20), visual feedback (n = 20), or verbal feedback (n = 20) groups. Participants completed an 8-week gymnastics training program. Performance in the Front Scale, Back Scale (Knee-Knee), Back Scale (Shoulder-Knee), and Split Jump was assessed at pre-test, mid-test, and post-test using Kinovea-based kinematic analysis. A mixed-design ANOVA was conducted to evaluate the effects of feedback modality, time, and the Group × Time interaction. Bonferroni-adjusted post hoc comparisons were performed where appropriate.

RESULTS: Significant Group × Time interactions were observed for the Back Scale (Knee-Knee) (F = 3.375, p = .020, η² = .106), Back Scale (Shoulder-Knee) (F = 32.662, p < .001, η² = .534), and Split Jump (F = 3.510, p = .023, η² = .110), indicating that performance improvements differed across feedback conditions. Mixed feedback generally led to greater improvement than visual or verbal feedback for these skills. In contrast, although Front Scale performance improved over time, the Group × Time interaction was not statistically significant (F = 1.680, p = .160), suggesting that improvement patterns did not differ significantly among feedback modalities for this skill. Across all analyses, verbal feedback alone tended to produce smaller improvements than mixed or visual feedback.

CONCLUSION: The findings indicate that the effectiveness of feedback modalities may depend on the specific gymnastics skill being learned. Mixed feedback appears particularly advantageous for skills requiring greater coordination and postural control, whereas no clear superiority of any feedback modality was observed for Front Scale performance. Integrating visual demonstrations with verbal instruction may therefore represent an effective strategy for enhancing motor skill acquisition in youth gymnastics.

TRIAL REGISTRATION: ClinicalTrials.gov (NCT07082647). Registered retrospectively on July 15, 2025.

PMID:42374486 | DOI:10.1186/s13102-026-01830-6

BMC Oral Health. 2026 Jun 29. doi: 10.1186/s12903-026-09021-y. Online ahead of print.

ABSTRACT

BACKGROUND: Comprehensive dental care includes health education strategies that highlight the importance of disease prevention and reach as many people as possible. Bacteria are central to most oral diseases, yet few studies have explored the impact of including specifics of microbial pathogenesis on oral health education. Therefore, the objectives of this study were to determine if oral hygiene instructions (OHI) provided to undergraduate students in a group-setting positively impacted oral health knowledge and beliefs, and whether integration of microbiology-focused instructions and activities further improved these oral health measures.

METHODS: A pre-test/post-test experimental study was conducted among undergraduate life-science students. Participants were allocated to the control group, (n=35) receiving Standard OHI (SD-OHI) and the experimental group (n=40) receiving Microbiology-focused OHI (MICRO-OHI). Each group completed questionnaires before and after the educational intervention for measurement of changes in oral health knowledge, beliefs, and behaviors.

RESULTS: Descriptive statistics were conducted on the pre-test/post-test responses for SD-OHI and MICRO-OHI. Both groups showed improved responses on items related to oral health knowledge and beliefs and high agreement with statements on intention to adhere to routine oral hygiene practices. Microbiology-related items had significant improvement in the MICRO-OHI group compared to the SD-OHI group (p<0.05). Qualitative analysis of responses to “Why should we brush our teeth?” revealed that a higher percentage of MICRO-OHI responses added emphasis on bacteria/biofilm removal compared to SD-OHI.

CONCLUSIONS: Both methods of group-based instruction increase health-promoting responses and the addition of microbiology-focused instructions has the potential to uniquely augment comprehensive oral healthcare strategies.

PMID:42374485 | DOI:10.1186/s12903-026-09021-y

BMC Oral Health. 2026 Jun 29. doi: 10.1186/s12903-026-08866-7. Online ahead of print.

ABSTRACT

BACKGROUND: Smokeless tobacco products and areca nut, widely used in Uttar Pradesh, are strongly associated with oral cancer, which ranks among the top three cancers in India. Data from the Population-Based Cancer Registry, Varanasi, highlights one of the highest oral cancer burdens across India. Despite the availability of national guidelines, frontline health workers (ASHAs) remain underutilised for tobacco cessation counselling and oral cancer symptom-based screening. This study assessed the impact of a structured training intervention on their knowledge, practices, and legal awareness.

METHODS: A pre-post intervention study was conducted in one rural block of Varanasi district between January and May 2023. A total of 202 ASHAs were enrolled through purposive sampling. The one-day training, based on Government of India modules, covered epidemiology, clinical features, determinants of tobacco use, cessation counselling, symptom-based oral cancer screening, and relevant legislation. Data were collected using a validated questionnaire before and after training. Descriptive statistics, Stuart-Maxwell tests, and Spearman’s correlations were applied for analysis.

RESULTS: Baseline scores revealed substantial knowledge and practice gaps: 45.6% of ASHAs had poor epidemiological awareness, 56.9% poor clinical knowledge, and 81.7% poor understanding of determinants of tobacco use. Only 19.8% reported routinely performing symptom-based screening for oral cancer, and while 64.8% “always” provided counselling, legal literacy was limited (only 38.1% aware of the COTPA Act). Following the intervention, significant improvements were observed across all domains (p < 0.01). Post-intervention most ASHAs reported willingness for oral cancer screening (64.8%) and provide tobacco cessation counselling (75.7%). Awareness of the COTPA Act increased to 65.4%. Strong positive correlations were observed between knowledge domains, suggesting synergistic gains.

CONCLUSION: A structured, government-endorsed training programme significantly improved ASHAs’ knowledge, attitudes, and practices related to tobacco cessation and oral cancer screening, demonstrating the feasibility of leveraging frontline workers for community-based cancer prevention. However, achieving higher competency levels requires more intensive, competency-based training with supportive supervision. Integration within routine health systems and further research on long-term impact are warranted.

CLINICAL TRIAL REGISTRATION NUMBER: Trial registration Clinical Trials Registry India CTRI/2021/02/031306. Date of registration 16/02/2021.

PMID:42374470 | DOI:10.1186/s12903-026-08866-7

Genome Biol. 2026 Jun 29. doi: 10.1186/s13059-026-04176-x. Online ahead of print.

ABSTRACT

BACKGROUND: Genetic variants in the 3′ untranslated regions (3′-UTRs) of mRNAs can alter binding of RNA-binding proteins and microRNAs and thereby influence regulation by affecting RNA stability, localization, and translation. Despite their potential impact on the risk for complex traits, including alcohol use disorder, the contribution of 3′-UTR variants has not been systematically explored. We evaluate the impact of 3′-UTR variants within loci associated with substance use and neurological disorders using a massively parallel reporter assay (MPRA) in neuroblastoma and microglia cells.

RESULTS: Of the 13,515 variants tested, 400 and 657 variants significantly alter gene expression in neuroblastoma and microglia cells, respectively. These functionally impactful variants account for more heritability of alcohol-related traits than non-functional variants. We develop a computational framework, MPRA-mediated Gene Expression Association (MGExA), that combines MPRA-derived variant effects with GWAS summary statistics and identify 31 genes whose expression changes may contribute to alcohol-related traits. CRISPR inhibition of 7 of these genes in neuronal cells leads to gene expression changes associated with neurodegenerative disorders and the oxidative phosphorylation pathway. Pharmacoepidemiological analysis of drugs that had similar effects on gene expression linked RBM14 and KANSL1 to risk for alcohol use disorder.

CONCLUSIONS: We identify genetic variants in 3′-UTR regions that affect gene expression. By integrating these functional genomics data and pharmacoepidemiological assessment with GWAS analysis, we identify genes whose expression differences could contribute to alcohol related traits. This approach provides a framework for moving from GWAS data to identifying biologically and clinically relevant genes associated with complex disorders.

PMID:42374457 | DOI:10.1186/s13059-026-04176-x

BMC Oral Health. 2026 Jun 29. doi: 10.1186/s12903-026-09043-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To comparatively evaluate the effects of fluoride varnish, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) varnish, and self-assembling peptide P₁₁-4 on the microhardness and surface morphology of hypomineralized enamel using a porcine model simulating molar incisor hypomineralization (MIH).

MATERIALS AND METHODS: Eighteen hypomineralized primary canines and needle teeth (the erupted third incisors of newborn piglets) obtained from three stillborn Yorkshire piglets were included in this in vitro study. Following stereomicroscopic examination, samples were randomly allocated into three groups (n = 6): Group 1: sodium fluoride (NaF) varnish, Group 2: NaF + CPP-ACP varnish, and Group 3: P₁₁-4. Baseline microhardness (T0) was measured using a microhardness tester under a 300 g load for 15 s. Remineralization agents were applied according to manufacturers’ instructions. P₁₁-4 application included prior sodium hypochlorite cleaning and phosphoric acid etching. Samples were stored in artificial saliva at 37 °C. Microhardness measurements were repeated at 1 week (T1) and 1 month (T2). One representative sample from each group was analyzed using scanning electron microscopy (SEM). Statistical analysis was performed using two-way repeated measures ANOVA and Bonferroni post hoc tests (p < 0.05).

RESULTS: Microhardness values significantly increased over time in all groups (p < 0.001). Significant differences were observed between all-time points (T0-T1, T0-T2, T1-T2) within each group. At T2, the P₁₁-4 group demonstrated the highest microhardness values, followed by NaF + CPP-ACP and NaF groups (p < 0.05). Intergroup comparisons revealed statistically significant differences, particularly between P₁₁-4 and the other groups at T2. SEM images demonstrated an irregular surface morphology related to mineral deposit accumulation after the application of remineralization agents. Nevertheless, in the P₁₁-4 group, the covering deposits and crack-like lines appeared less scattered and more integrated than in the other treatment groups.

CONCLUSION: All remineralization agents improved enamel microhardness; however, P₁₁-4 demonstrated superior efficacy compared to NaF + CPP-ACP and NaF varnish. Porcine enamel appears to be a reliable and biologically relevant model for simulating MIH-affected enamel in vitro.

PMID:42374455 | DOI:10.1186/s12903-026-09043-6

Nutr Metab (Lond). 2026 Jun 27. doi: 10.1186/s12986-026-01158-5. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent and frequently associated with elevated liver enzymes, indicating hepatic injury. Although vitamin E has been investigated as a therapeutic antioxidant, its effects on liver enzyme levels remain inconsistent. This study aims to systematically review and quantitatively synthesize the evidence of the effects of vitamin E administration on liver enzymes in patients with MASLD.

METHODS: A systematic search of scientific databases was conducted up to September 2025 to identify relevant randomized clinical trials (RCTs). Data on alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) were extracted. Pooled effect sizes were calculated as weighted mean differences (WMD) with 95% confidence intervals (CIs) using a random-effects model.

RESULTS: The pooled analysis of 16 RCTs (22 effect sizes) showed that vitamin E administration significantly reduced serum liver enzyme levels in patients with MASLD, including AST (WMD: -5.94 IU/L), ALT (WMD: -7.33 IU/L), ALP (WMD: -5.68 IU/L), and GGT (WMD: -5.54 IU/L), all with statistical significance (p ≤ 0.008). Subgroup analyses revealed that longer intervention durations and higher vitamin E doses were generally associated with greater improvements in liver enzyme levels, particularly AST and ALT. In contrast, Significant reductions in ALP were mainly observed in shorter trials and with lower vitamin E doses, especially at higher doses and among obese populations. Overall, benefits were consistent across BMI categories, though effects appeared more pronounced in obese individuals.

CONCLUSION: Vitamin E supplementation was associated with significant reductions in serum liver enzymes, suggesting improvement in hepatocellular injury and necroinflammatory activity in patients with MASLD. However, the available evidence is insufficient to determine its effects on fibrosis progression, metabolic burden, or long-term liver-related outcomes.

PMID:42374454 | DOI:10.1186/s12986-026-01158-5

J Transl Med. 2026 Jun 27. doi: 10.1186/s12967-026-08431-4. Online ahead of print.

ABSTRACT

BACKGROUND: Sepsis-induced acute respiratory distress syndrome (ARDS) is a life-threatening inflammatory lung condition with high mortality and no specific pharmacological treatments. The complex spatial heterogeneity of the lung during sepsis hinders the discovery of effective therapies. This study aimed to use spatial transcriptomics to map the septic lung’s molecular landscape to identify and validate a novel therapeutic agent.

METHODS: We performed spatial transcriptomics on lung tissues from mice subjected to cecal ligation and puncture (CLP) to model sepsis. A computational drug screen identified Mavacamten. In vitro, lipopolysaccharide-stimulated murine alveolar epithelial cells were used to assess Mavacamten’s effects on inflammation and cell injury. In vivo, CLP mice received Mavacamten, and we assessed survival, lung function, pulmonary edema, histology, and inflammatory markers. The underlying mechanism was investigated by analyzing the PI3K/AKT/mTOR pathway and autophagy markers. Statistical analyses included ANOVA, t-tests, and Kaplan-Meier analysis.

RESULTS: Spatial transcriptomics revealed distinct cellular clusters that were dramatically rearranged during sepsis. In vitro, Mavacamten significantly attenuated lipopolysaccharide-induced inflammation, cellular injury, and oxidative stress. In the CLP mouse model, Mavacamten treatment markedly improved 7-day survival, restored arterial oxygenation, reduced pulmonary edema, and lessened histological lung injury. Mavacamten also significantly lowered local and systemic pro-inflammatory cytokine levels. Mechanistically, Mavacamten reversed the sepsis-induced inhibition of autophagy and suppressed the activation of the PI3K/AKT/mTOR signaling pathway in lung tissues.

CONCLUSIONS: Mavacamten confers robust protection against sepsis-induced ARDS in a preclinical model by mitigating inflammation and lung injury, leading to improved survival. Its therapeutic action is mediated by inhibiting the PI3K/AKT pathway and restoring protective autophagy. Mavacamten is a promising candidate for repurposing in the treatment of sepsis-induced ARDS.

PMID:42374449 | DOI:10.1186/s12967-026-08431-4

BMC Med Educ. 2026 Jun 29. doi: 10.1186/s12909-026-09799-z. Online ahead of print.

ABSTRACT

BACKGROUND: Point-of-care Ultrasound (POCUS) is increasingly introduced in obstetrics and gynecology as a focused bedside extension of conventional ultrasound, although evidence on its implementation in routine care remains limited. This study examined physicians’ attitudes towards POCUS, their perceived diagnostic confidence across different clinical scenarios, and their preference for POCUS compared with standard ultrasound devices. These outcomes were assessed during early implementation in routine care accompanied by structured training.

METHODS: In this prospective, longitudinal implementation study, 22 physicians from a university department of gynecology and obstetrics evaluated standard ultrasound devices at baseline (T0a), completed a structured hands-on POCUS training, and assessed POCUS immediately after training (T0b) and after 2 weeks (T1), 1 month (T2), and 3 months (T3) of clinical use. Evaluations were conducted using repeated quantitative surveys. Outcomes were attitude (4 items, 7-point Likert), perceived diagnostic confidence in obstetric and gynecologic scenarios (17 items, 7-point Likert), and device preference (7-point Likert and dichotomous). Quantitative analyses included descriptive statistics, paired tests, mixed-effects models, and non-parametric sensitivity analyses.

RESULTS: Attitude toward POCUS was significantly more favorable than attitude toward standard devices at baseline (T0a 3.69 vs. T0b 5.83; p < .001) and remained high throughout follow-up. Perceived diagnostic confidence for POCUS was not higher immediately after training but increased significantly over time in both obstetrics and gynecology after independent clinical use (both p < .001). Highest confidence was observed in focused bedside scenarios relevant to rapid orientation and immediate decision-making, including fetal vitality assessment, placental localization, amniotic fluid assessment, postvoid residual urine measurement, and urinary tract obstruction, whereas confidence remained lower for more complex applications such as cervical length assessment, Doppler-based examinations, and fetal growth restriction. Preference for POCUS was already high at baseline and remained stable over time.

CONCLUSIONS: POCUS showed high acceptance in gynecologic and obstetric care from early implementation to routine use. Its clinical relevance appears greatest for focused mobile use and rapid bedside decision-making. These findings were observed during early implementation and support the role of POCUS as a complement to comprehensive ultrasound.

CLINICAL TRIAL REGISTRATION: German Registry of Clinical Trials; registration number: DRKS 00036941; date of registration: July 16, 2025; title: GO-POCUS: Point-Of-Care UltraSound in Gynecology and Obstetrics: Attitude and Perceived Diagnostic Confidence among Physicians.

PMID:42374445 | DOI:10.1186/s12909-026-09799-z

BMC Med Educ. 2026 Jun 27. doi: 10.1186/s12909-026-09727-1. Online ahead of print.

ABSTRACT

BACKGROUND: Twenty-first-century skills-such as critical thinking, problem solving, leadership, digital literacy, and innovation-are among the core competencies required for future health managers to function effectively within the complex and technology-driven structure of modern healthcare systems. The purpose of this study was to determine the 21st-century skill levels of undergraduate Health Management students in Türkiye and to examine whether these skills significantly differ according to demographic (gender, age, year of study) and academic (academic achievement and accreditation status) variables.

METHODS: This study employed a cross-sectional descriptive design. Data were collected via an online survey from 565 undergraduate Health Management students across Türkiye. The Multidimensional 21st Century Skills Scale, consisting of five subdimensions, was used as the data collection instrument. Descriptive statistics, independent samples t-test, one-way analysis of variance (ANOVA), and multiple regression analysis were performed to analyze the data. A significance level of p < .05 was adopted.

RESULTS: The overall 21st-century skill levels of the students were found to be above average. The highest mean scores were observed in the Career Consciousness and Information and Technology Literacy dimensions, whereas the lowest means were obtained in the Entrepreneurship and Innovation and Critical Thinking and Problem Solving subdimensions. Regarding gender, a significant difference was found only in the Career Consciousness dimension in favor of female students (p < .05). In general, increases in age and year of study were associated with higher 21st-century skill levels. Academic achievement produced significant differences particularly in Information and Technology Literacy and Critical Thinking skills. While no significant differences were found regarding the official accreditation status of universities, students’ perceived accreditation revealed significant differences in certain skill dimensions. Multiple regression analysis indicated that age and perceived accreditation were significant predictors of overall 21st-century skills.

CONCLUSIONS: Health Management students demonstrated strong profiles in career awareness and digital competencies, yet showed areas for development in critical thinking, innovation, and leadership. The findings suggest the importance of revising Health Management curricula in alignment with 21st-century skills, expanding experiential and project-based learning opportunities, and designing educational strategies that foster students’ innovation and entrepreneurship capacities.

PMID:42374438 | DOI:10.1186/s12909-026-09727-1