Tag: pubmed

FASEB J. 2026 Sep 15;40(17):e72238. doi: 10.1096/fj.202602915R.

ABSTRACT

Gastric cardia adenocarcinoma is biologically distinct from distal disease, but deployable molecular markers remain scarce. We investigated whether explainable deep learning applied to public transcriptomes could nominate diagnostic and survival-associated candidates. We developed and externally evaluated an explainable transcriptome-based classifier. The Asian Cancer Research Group SuperSeries GSE66229 (300 tumors and 100 patient-matched non-tumor tissues) underwent robust multi-array average preprocessing and quality control. An attention-based deep neural network was evaluated by stratified fivefold cross-validation for tumor-versus-non-tumor classification. Inputs were restricted before training to genes available in all cohorts and ordered identically; no missing model inputs were imputed. Shapley additive explanations nominated 20 genes, and univariable Cox models evaluated overall survival associations. External testing without refitting used GSE29272 and The Cancer Genome Atlas stomach adenocarcinoma cohort. Pathway analyses provided biological context. Cross-validated receiver operating characteristic and precision-recall areas under the curve were both 1.00. External values were 0.85/0.93 for cardia and 0.50/0.67 for non-cardia in GSE29272, and 0.78/0.80 and 0.71/0.50, respectively, in The Cancer Genome Atlas cohort. Six genes showed nominal survival associations in GSE66229. None replicated statistically in the strict external cardia subset; LVRN and WISP2 were nominally concordant in the full stomach adenocarcinoma cohort, but neither survived six-test correction. Enrichment implicated immune and lipid-related processes. Explainable deep learning prioritized candidates with stronger external performance in cardia-versus-non-tumor contrasts. These exploratory diagnostic and survival findings require clinically adjusted, prospective validation before clinical use.

PMID:42667125 | DOI:10.1096/fj.202602915R

JAMA Netw Open. 2026 Aug 3;9(8):e2634516. doi: 10.1001/jamanetworkopen.2026.34516.

ABSTRACT

IMPORTANCE: Evidence on the safety of atrial fibrillation ablation during rapid growth in both procedural volume and the number of hospitals performing it remains inconsistent. Although clinical registries and randomized trial meta-analyses report extremely low mortality, administrative databases have suggested rates up to 10-fold higher, with concerning temporal increases.

OBJECTIVE: To define the periprocedural mortality risk following elective atrial fibrillation ablation using a validated nationwide database and to determine whether this expansion was associated with diffusion-related safety penalties (ie, transient erosion of safety driven by a widening efficacy-effectiveness gap).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, nationwide, population-based cohort study used data from a nationwide administrative database of participating cardiovascular hospitals in Japan from April 1, 2012, to March 31, 2023. Analyses were conducted in 2025 to 2026, with follow-up through discharge from the index hospitalization for the primary outcome. Patients with atrial fibrillation who underwent scheduled elective catheter ablation with transseptal puncture were included.

EXPOSURES: Elective atrial fibrillation ablation.

MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality during the index hospitalization. In-hospital mortality and other event rates are presented as proportions with exact (Clopper-Pearson) binomial 95% CIs. Multivariable analyses used Firth penalized logistic regression.

RESULTS: Among 618 024 catheter ablation procedures, 412 947 were elective atrial fibrillation ablations (median [IQR] patient age, 68 [60-74] years; 288 825 male patients [69.9%]) performed between 2012 and 2022. Annual procedural volume increased from 10 969 procedures in 2012 to 63 014 procedures in 2022. In-hospital mortality occurred in 119 patients (0.029%; 95% CI, 0.024%-0.034%), with a modest but statistically significant decline (P for trend = .04). Within 30 days of the procedure, deaths occurred during the index hospitalization in 91 patients (0.022%; 95% CI, 0.018%-0.027%) and during readmission in 72 patients (0.017%; 95% CI, 0.014%-0.022%). The most frequent concurrent complication among index-hospitalization deaths was cardiac tamponade (26 patients [21.8%]). In Firth penalized multivariable analysis, factors independently associated with in-hospital mortality included older age (odds ratio [OR], 1.04; 95% CI, 1.01-1.07), lower body mass index (OR, 0.94; 95% CI, 0.89-1.00), Charlson Comorbidity Index score of 3 or higher (OR, 4.59; 95% CI, 2.59-8.12), low institutional volume (OR, 2.52; 95% CI, 1.45-4.38), and preserved functional status (Barthel Index >90; OR, 0.11; 95% CI, 0.07-0.19).

CONCLUSIONS AND RELEVANCE: In this Japanese nationwide registry study of 412 947 elective atrial fibrillation ablation procedures, in-hospital mortality was 0.029%, comparable to contemporary registry benchmarks. No evidence of a diffusion-related safety penalty was observed during rapid expansion.

PMID:42667122 | DOI:10.1001/jamanetworkopen.2026.34516

J Nurs Manag. 2026;2026(1):e1251723. doi: 10.1155/jonm/1251723.

ABSTRACT

INTRODUCTION: The ward atmosphere in closed psychiatric wards significantly influences nurses’ well-being and quality of care. However, the formation mechanisms of ward atmosphere perceptions remain underexplored, and previous research has largely overlooked individual heterogeneity in how nurses perceive different dimensions of the ward environment. This study aims to identify distinct profiles of ward atmosphere among psychiatric nurses in closed wards and examine the predictive effects of physical environmental factors and workplace violence on profile membership.

MATERIALS AND METHODS: This quantitative, cross-sectional study adopted mixed nonprobability sampling combining purposive and convenience sampling and collected data via online questionnaires. A total of 1037 psychiatric nurses from 34 hospitals in China completed self-report questionnaires between July and August 2024. Ward atmosphere was measured using the Chinese-version Essen Climate Evaluation Schema. Physical environment characteristics were collected using a self-developed questionnaire. Workplace violence was measured using the Workplace Violence Scale. Latent profile analysis was conducted using Mplus 8.3 to identify distinct ward atmosphere profiles. Multinomial logistic regression (R3STEP) was used to examine predictors of profile membership. All respondents provided electronic informed consent, and the study was approved by the institutional ethics committee.

RESULTS: Three distinct profiles of ward atmosphere were identified: “Triple-High group” (10.8%), “Safety-Deficient group” (77.1%), and “Support-Depleted group” (12.1%). Compared with nurses in the Triple-High group, those in the Safety-Deficient and Support-Depleted groups reported poorer ventilation, smaller ward size, less adequate safety measures, more frequent workplace violence, and higher rates of permission for smartphone use. Greenery, video surveillance, tidiness, and larger ward size differentiated the Safety-Deficient group from the Support-Depleted group.

CONCLUSION: Psychiatric nurses’ perceptions of ward atmosphere are heterogeneous, with the majority experiencing safety deficits. Both physical environmental features and exposure to workplace violence are important predictors of these perceptions. Hospital administrators should implement targeted modifications to the physical environment of the wards and reduce workplace violence to enhance the ward atmosphere.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should acknowledge the heterogeneity in nurses’ perceptions of ward atmosphere. Targeted improvements to ward physical environments-such as enlarging ward space, enhancing ventilation, and upgrading safety facilities-are recommended. Effective strategies should also be developed to mitigate workplace violence in closed psychiatric wards. Simple, low-cost environmental adjustments may improve ward atmosphere, potentially alleviate psychological stress, and further contribute to nurse well-being and retention.

PMID:42667118 | DOI:10.1155/jonm/1251723

IJID Reg. 2026 Jul 18;20:100960. doi: 10.1016/j.ijregi.2026.100960. eCollection 2026 Sep.

ABSTRACT

OBJECTIVES: The increasing incidence of primary multidrug-resistant tuberculosis (MDR-TB) creates a new burden in national tuberculosis (TB) control. Understanding the characteristics of primary MDR-TB aids in predicting its spread. This study aimed to determine the differences in characteristics of primary and acquired MDR-TB patients in a hospital setting in Indonesia.

METHODS: This is a retrospective cohort study of adult patients (aged >18 years) with pulmonary MDR-TB who received treatment at Hasan Sadikin General Hospital, West Java, Indonesia. Patients who finished MDR-TB treatment between 2020 and 2022 were included. Patients whose therapeutic outcomes could not be determined and those with incomplete data were excluded.

RESULTS: This study included 337 participants; 32% were primary MDR-TB and 68% were acquired MDR-TB. Findings showed a significant difference between primary and acquired MDR-TB by contact with a TB index case. Primary MDR-TB was 4.31 times higher in patients who had contact (prevalence odds ratio 4.31, 95% confidence interval 2.65-7.01). Other characteristics showed some differences but were not statistically significant.

CONCLUSION: Contact with the TB index case was found to differ significantly between primary and acquired MDR-TB. The transmission-driven nature of drug-resistant TB underscores the urgent need to reposition contact investigation and preventive therapy as central pillars of the MDR-TB control strategy.

PMID:42666390 | PMC:PMC13522372 | DOI:10.1016/j.ijregi.2026.100960

Front Comput Neurosci. 2026 Aug 14;20:1845838. doi: 10.3389/fncom.2026.1845838. eCollection 2026.

ABSTRACT

Reservoirs, typically implemented as recurrent neural networks (RNNs) with fixed random connection weights, can be combined with a simple trained readout layer to perform a wide range of computational tasks. However, increasing the magnitude of reservoir connection weights to exploit non-linear dynamics can cause the network to develop strong spontaneous activity that drives neurons into saturation, dramatically degrading performance. In this work, we investigate two distinct countermeasures against such runaway excitation. The first approach introduces a subtle non-homogeneous structure into the matrix of connection weights. w _ij , without altering the overall probability distribution p(w). We identify several favorable structuring principles, such as creating a small subset of neurons with weaker-than-average input connections. Even if the rest of the reservoir falls into runaway saturating behavior, this weakly coupled subset remains in a mildly non-linear regime whose dynamics can still be exploited by the readout layer. The second approach implements a form of automatic gain control (AGC), in which a dedicated control unit dynamically regulates the reservoir’s average global activation toward an optimal setpoint. Although the control unit modulates the excitability of the reservoir only via a global gain factor, this mechanism substantially enlarges the dynamical regime favorable for computation and renders performance largely independent of the underlying connection statistics.

PMID:42666383 | PMC:PMC13522119 | DOI:10.3389/fncom.2026.1845838

Front Public Health. 2026 Aug 14;14:1933281. doi: 10.3389/fpubh.2026.1933281. eCollection 2026.

ABSTRACT

BACKGROUND: Dental professionals are routinely exposed to occupational biological hazards, yet evidence from low-resource settings remains limited. This study assessed infection prevention and control (IPC) knowledge and practices, quantified occupational biological exposures, and identified factors associated with sharps injuries and occupational infections.

METHODS: A cross-sectional analytical study was conducted among 220 dental professionals in Bulawayo, Zimbabwe. Data were collected using a structured self-administered questionnaire and analysed using descriptive statistics and bivariate and multivariable logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.

RESULTS: Lifetime sharps injury was reported by 61.2% of participants, 14.7% reported a sharps injury during the preceding 12 months, and 18.3% reported an occupational infection. Despite high awareness of core IPC principles, occupational exposure remained common. Recent sharps injury was independently associated with early-career role (aOR = 4.01; 95% CI: 1.26-12.76), eye protection use (aOR = 2.88; 95% CI: 1.21-6.84), poor hand hygiene adherence (aOR for often/always = 0.34; 95% CI: 0.12-0.97), and lower perception scores (aOR = 0.49 per unit increase; 95% CI: 0.32-0.75). Public-sector employment was independently associated with self-reported occupational infection (aOR = 2.66; 95% CI: 1.25-5.64).

CONCLUSION: Dental professionals in Bulawayo experienced substantial occupational biological hazards despite generally high awareness of IPC principles. These findings demonstrate that IPC knowledge alone is insufficient to prevent occupational exposure. Strengthening competency-based IPC training, post-exposure management, institutional IPC systems, and targeted support for early-career dental professionals can reduce occupational injuries and occupational infections.

PMID:42666377 | PMC:PMC13522109 | DOI:10.3389/fpubh.2026.1933281

Asia Pac J Sports Med Arthrosc Rehabil Technol. 2026 Aug 19;46:7-23. doi: 10.1016/j.asmart.2026.07.001. eCollection 2026 Oct.

ABSTRACT

BACKGROUND: Proprioception dysfunction, including deficits in joint position sense (JPS) and kinesthesia, is a common sequela following anterior cruciate ligament (ACL) injury. While previous studies have compared proprioceptive outcomes in ACL-injured patients undergoing different types of surgical reconstruction or repair, their findings have been inconsistent, and a systematic review is lacking.

OBJECTIVE: To summarize and evaluate proprioceptive deficits (in JPS and kinesthesia) across different postoperative time points and joint angles in patients undergoing different types of ACL reconstruction or repair, compared to healthy controls.

LITERATURE SURVEY: A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, and SPORTDiscus databases using terms related to ACL injury, reconstruction or repair, and proprioception, covering all records through November 2025.

METHOD: ology: The following information was extracted from the included articles: demographic data, sample size, selection criteria, methodology, test indicators (e.g., time points and joint angles), proprioceptive test results, and other relevant variables. Network meta-analyses were conducted to synthesize proprioceptive outcomes.

RESULTS: Nineteen studies were included in the network meta-analysis. No statistically significant differences were found in intermediate-angle JPS or kinesthesia among various ACL reconstruction and repair techniques when assessed beyond six months postoperatively. Notably, our analysis revealed that hamstring tendon autografts (SMD = 1.9, 95% CI = 0.3, 3.5) and tibialis anterior allografts (SMD = 1.7, 95% CI = 0.1, 3.5) were associated with inferior small-angle position perception outcomes at the six-month follow-up compared to control.

CONCLUSION: The results indicate that, in small-angle position at six-month follow-up, ACL repair may yield similar or even better proprioceptive recovery compared to hamstring tendon autografts and tibialis anterior allografts. However, different types of reconstructive grafts or repairs do not show significant differences in proprioceptive recovery from most angles. These findings suggest that ACL repair demonstrates proprioceptive outcomes similar to those of ACL reconstruction, and different graft selections for ACL reconstruction may produce similar proprioceptive outcomes, allowing graft choice to be guided by specific clinical needs.

PMID:42666376 | PMC:PMC13522239 | DOI:10.1016/j.asmart.2026.07.001

J Stat Phys. 2026;193(9):118. doi: 10.1007/s10955-026-03680-5. Epub 2026 Aug 27.

ABSTRACT

From N + 1 random points on a line we wish to select M + 1 points so as to maximize the minimal spacing between them. We consider an initial configuration with independent and identically distributed spacings. Equivalently, the points are arrival times of a generic renewal process. For general spacing distributions, and for all M ≤ N , we derive exact distributional identities for the maximal minimal spacing and obtain its asymptotic behavior. The problem admits a reformulation in terms of a threshold-resetting random walk. The walk advances by successive random increments and is reset to the origin upon exceeding a fixed threshold. The probability that the optimal spacing exceeds a given value coincides with the probability that the walk completes at least M reset cycles within N steps. This yields an exact representation in terms of first-passage functionals of the walk. The same mapping suggests a numerical scheme for the max-min spacing problem in the regime of large N and M, whose accuracy is tested against the exact results obtained here.

PMID:42666375 | PMC:PMC13522019 | DOI:10.1007/s10955-026-03680-5

Front Microbiol. 2026 Aug 14;17:1906211. doi: 10.3389/fmicb.2026.1906211. eCollection 2026.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) vaccination provides high-level protection against cervical cancer through type-specific antibodies, although breakthrough and persistent high-risk HPV (hrHPV) infections may still occur in some vaccinated women. In addition to neutralizing antibodies, vaccination elicits other immune mechanisms that may influence viral persistence and disease progression. Because mucosal immunity is closely linked to the vaginal microbiota, microbial composition may also play an important role in HPV susceptibility, with Lactobacillus crispatus dominance associated with protection, and dysbiosis with impaired mucosal immunity. Whether HPV vaccination is associated with favorable microbiota signatures in women with confirmed cervical cancer-related conditions remains unknown.

METHOD: We analyzed vaginal samples via shotgun metagenomic sequencing from a cross-sectional study of 59 pre-menopausal women (<50 years) with confirmed cervical lesions (HPV-unvaccinated n = 26, vaccinated n = 33).

RESULTS: Alpha diversity (Shannon and Inverse Simpson indices) did not differ significantly by vaccination status, suggesting within-sample microbial diversity between the groups, but Bray-Curtis-based PERMANOVA indicated a statistically significant difference in overall community composition between groups (p = 0.042). Among women with CST I, 90.9% were vaccinated, whereas among women with CST IV, 60.0% were unvaccinated. At the species level, L. crispatus relative abundance was higher in vaccinated women in the unadjusted analysis; however, this association was attenuated and was not statistically significant after multivariable adjustment. HPV vaccination status was associated with a higher prevalence of L. crispatus-dominant, health-associated vaginal microbiota among women with cervical lesions.

CONCLUSION: These findings support the hypothesis that HPV vaccination status is associated with L. crispatus dominance in this population, but mechanistic pathways remain to be elucidated.

PMID:42666371 | PMC:PMC13522137 | DOI:10.3389/fmicb.2026.1906211

Front Psychiatry. 2026 Aug 14;17:1872413. doi: 10.3389/fpsyt.2026.1872413. eCollection 2026.

ABSTRACT

BACKGROUND: Depressive disorder is a leading cause of disability worldwide, and selective serotonin reuptake inhibitors (SSRIs) remain first-line pharmacotherapy. However, the efficacy and safety of adding Chinese patent medicines (CPMs) as adjunctive therapy to SSRIs have not been systematically evaluated in a network meta-analysis.

OBJECTIVE: To compare and rank seven CPMs combined with SSRIs for depressive disorder in terms of HAMD improvement, clinical response rate, and adverse drug reactions (ADRs) rate.

METHODS: We searched MEDLINE, EMBASE, PsycINFO, CENTRAL, CNKI, WanFang, and VIP from inception to April 1, 2026. Trials comparing any CPM + SSRI versus the same SSRI alone in adults with depressive disorder were included. Two authors independently extracted data and assessed risk of bias (RoB 2.0). Pairwise meta-analysis and network meta-analysis (using both netmeta and getmc packages) were performed; cumulative probability (SUCRA) rankings were derived from Bayesian analysis with getmc. Confidence in evidence was evaluated with CINeMA.

RESULTS: Sixty-five trials involving 5,975 patients were included. Compared with SSRIs alone, all CPM + SSRI combinations significantly improved HAMD score (MD range -2.60 to -6.20) and clinical response rate (OR range 1.8-5.0). For HAMD, JYW+SSRIs showed the highest SUCRA ranking, followed by BJTGT+SSRIs and SGJY+SSRIs, though these rankings are probabilistic. For response rate, BJTGT+SSRIs showed the highest SUCRA ranking, but statistically unconfirmed. For safety, TM+SSRIs showed the highest SUCRA ranking, though no ADR comparison reached significance; YXQN+SSRIs ranked second in SUCRA analysis, based on one small trial. Egger’s test indicated no publication bias for HAMD (p = 0.5753) but potential bias for clinical response rate (p = 0.0002). Sensitivity analysis excluding small studies confirmed the robustness of HAMD findings.

CONCLUSION: Adding CPMs to SSRIs may enhance efficacy and reduce ADRs. Although the rankings suggest promising efficacy, they are probabilistic in nature, and the effect estimates and their confidence intervals should be given greater weight in interpretation. No ADR comparisons reached statistical significance, and evidence supporting the safety and efficacy of some CPMs remains limited. Findings should be interpreted with caution, and future studies should further evaluate the safety and efficacy of combined therapy.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420261299414.

PMID:42666365 | PMC:PMC13522133 | DOI:10.3389/fpsyt.2026.1872413