Tag: pubmed

J Biomech. 2026 Jul 3;205:113451. doi: 10.1016/j.jbiomech.2026.113451. Online ahead of print.

ABSTRACT

Biomechanical models of myocardial growth and remodelling (G&R) are often modelled as responses to deviations from a preferred biomechanical homeostatic state, triggered by stretch or stress. Yet how these critical values of stretch and stress should be defined remains unresolved. This study examines how different homeostatic threshold definitions influence predicted left ventricular G&R. Myocardial growth was implemented using an updated-reference constrained mixture framework, with eccentric growth driven by diastolic myofibre stretch and concentric growth driven by systolic active stress. Homeostatic thresholds were derived from the baseline LV dynamics. Our results demonstrate that the choice of critical homeostatic thresholds plays an important role in triggering cardiac G&R. For volume overload, the mean and 50th percentile end-diastolic myofibre stretch show the potential to approach a preferred mechanical state with preserved cardiac pump function. For pressure overload, a 90th percentile threshold of peak active stress appears to normalise systolic stress to baseline levels with sufficient cardiac output. Localised thresholds generally lead to more heterogeneous growth patterns and potentially high stretch/stress concentrations. These findings highlight the importance of defining homeostatic targets as tissue-level quantities and provide practical guidance to improve cardiac G&R modelling.

PMID:42456208 | DOI:10.1016/j.jbiomech.2026.113451

J Pediatr Nurs. 2026 Jul 15;90:541-546. doi: 10.1016/j.pedn.2026.07.016. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the current status of family management among children after enterostomy surgery and identify its influencing factors, providing an evidence-based foundation for developing practical resources and policy recommendations to reduce family caregiving burdens and improve postoperative rehabilitation outcomes.

METHODS: This cross-sectional study included 155 pediatric enterostomy patients and their family caregivers from June 2025 to March 2026. Family management and family function were assessed using the Chinese versions of the Family Management Measure (FaMM) and the Family Assessment Device-General Functioning (FAD-GF). We analyzed the clinical data of patients and caregivers, identified factors influencing family management, and conducted statistical analyses on these factors.

RESULTS: The average FaMM score was 162.11 ± 11.34, indicating a moderate level. Univariate analysis showed that whether the child was an only child, child’s age, family’s place of residence, disease course, caregiver education level, employment status, and average family monthly income were all influencing factors (P < 0.05). Pearson correlation analysis indicated a positive correlation between family management and family function (r = 0.934, P < 0.001). Multiple linear regression analysis revealed that family function, disease course, caregiver employment status, and average family monthly income were the primary influencing factors of family management, explaining 77.6% of the total variance.

CONCLUSION: The level of family management among children with enterostomy needs improvement. Better family function, longer disease course, employed caregivers, and higher family income are associated with higher levels of family management. Clinically, it is essential to provide these families with professional information and policy support to enhance their family management capabilities.

PMID:42456196 | DOI:10.1016/j.pedn.2026.07.016

J Am Chem Soc. 2026 Jul 15. doi: 10.1021/jacs.6c07565. Online ahead of print.

ABSTRACT

Mixing wheat flour with water transforms an otherwise dispersible powder into a cohesive and extensible dough capable of sustaining large deformations. The emergence of this malleable material is due to polymerization of glutenin subunits. However, the molecular principles governing this transformation remain unclear. Here, we investigate the hydration-induced association behavior of the N-terminal domain of the high-molecular-weight glutenin subunit 1Dx5 (1Dx5-NTD). Upon hydration, 1Dx5-NTD adopts a collapsed, heterogeneous ensemble rather than a single, well-defined folded structure and undergoes intermolecular association into assemblies ranging from trimers to ∼70,000-mers. These associations are primarily determined by favorable enthalpic interactions that are modulated by moderate ionic strength. Hydrophobic residues (Tyr52, Phe65, Tyr66, and Trp82) are buried within the collapsed monomer yet indirectly modulate protein association through correlated ensemble dynamics, as supported by mutational analysis. Importantly, 1Dx5-NTD contains three cysteine residues (Cys10, Cys25, and Cys40) that undergo disulfide bond formation during association. While multiple disulfide linkage patterns are chemically possible, mass spectrometry-based cross-linking analysis reveals a limited subset of preferential disulfide linkages. This finding suggests that disulfide formation is biased by the conformational ensemble and local cysteine accessibility, rather than occurring randomly. Together, these results support a model in which glutenin polymerization emerges from ensemble-averaged intermolecular contacts coupled with statistically biased disulfide bond formation, giving rise to a cohesive, multidimensional protein network without requiring a uniquely defined folded structure. This work highlights how collapsed protein ensembles can encode chemical selectivity and macroscopic material properties.

PMID:42456183 | DOI:10.1021/jacs.6c07565

JMIR Res Protoc. 2026 Jul 15;15:e92270. doi: 10.2196/92270.

ABSTRACT

BACKGROUND: Posttraumatic stress disorder (PTSD) affects up to 25% of trauma-exposed adolescents; yet, access to evidence-based treatment remains limited in rural regions. Trauma-focused cognitive behavioral therapy (TF-CBT) is the first-line intervention, but structural barriers such as long travel distances and therapist shortages hinder implementation. Digital and blended formats may improve accessibility, but evidence for adolescents with PTSD is limited. Shame and self-criticism are common following interpersonal trauma and can reduce engagement; compassion-focused strategies target these mechanisms and aim to enhance emotional safety.

OBJECTIVE: This protocol outlines a pilot randomized controlled trial (RCT) evaluating the feasibility of delivering blended trauma-focused cognitive behavioral therapy with compassion (bTF-CBT-C) for adolescents with PTSD in routine clinical care. A secondary aim is to assess the acceptability of the intervention among adolescents and caregivers. In addition, the study explores patterns and variability in clinical outcomes to inform the design of a future noninferiority trial.

METHODS: A 2-arm parallel-group pilot RCT will randomize 40 adolescents (12-17 years) with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) PTSD to bTF-CBT-C or standard TF-CBT in routine child and adolescent psychiatric services. The intervention includes an approximately 5-week web-based stabilization phase, followed by 7-14 therapist-led sessions delivered primarily via videoconference, with some in-person sessions. Primary outcomes will assess feasibility (recruitment, retention, adherence, data completeness, and adverse events) and acceptability (satisfaction, alliance, and qualitative interviews). Exploratory outcomes include PTSD symptoms, self-compassion, emotion regulation, depression, anxiety, suicidality, and dissociation. Assessments will be conducted at baseline, poststabilization, posttreatment, and 6-month follow-up. Feasibility and acceptability will be summarized descriptively. Exploratory analyses using analysis of covariance and mixed effects models will estimate variance parameters, confidence intervals, and descriptive change trajectories without hypothesis testing. Qualitative data will be analyzed using reflexive thematic analysis.

RESULTS: Recruitment started in February 2026, and data collection is projected to be completed by December 2028. Feasibility and acceptability outcomes, along with exploratory clinical patterns, will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) extension for pilot and feasibility trials.

CONCLUSIONS: Findings will inform the refinement of the intervention, the assessment of trial feasibility, and the selection of outcomes for a fully powered noninferiority RCT. The study will also contribute to understanding how compassion-focused strategies may support emotional safety and engagement in trauma-focused treatment for adolescents.

PMID:42456165 | DOI:10.2196/92270

JMIR Form Res. 2026 Jul 15;10:e89719. doi: 10.2196/89719.

ABSTRACT

BACKGROUND: The postpartum period represents a critical window for maternal health, yet many individuals lack sustained support and timely identification of physical and mental health risks. Digital health interventions offer a scalable approach to extend care beyond clinical settings. Yet, key elements, including real-world challenges, usability, and effectiveness of such platforms, are insufficiently characterized in this literature.

OBJECTIVE: This study aimed to conduct a formative randomized evaluation to assess the feasibility, engagement, and preliminary signals of impact of the Joyuus platform and to examine the potential for early identification of postpartum health risks.

METHODS: We conducted a 12-week randomized evaluation with postpartum participants recruited through community-based organizations. Participants were randomized to either the Joyuus intervention or standard postpartum care. Primary and secondary outcomes included the Barkin Index of Maternal Functioning, the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory, and the Connor-Davidson Resilience Scale. Analyses were conducted using an intention-to-treat approach with linear regression models adjusting for baseline values. Engagement metrics (ie, sessions, time on site, and feature use) were captured through in-app analytics. An exploratory predictive model was developed using baseline clinical, behavioral, and demographic variables to identify individuals at risk for postpartum depression.

RESULTS: Baseline characteristics were generally balanced across arms, and no statistically significant differences were observed in education, income, or marital status. No statistically significant differences were found between treatment and control groups in the 12-week changes for the primary or secondary outcomes. Mean EPDS scores were 9.7 in the intervention group and 9.3 in the control group. In the sample, 60 (45.5%) of the 132 participants met the criteria for elevated depression (EPDS score ≥11 or a positive response to question 10 on self-harm), indicating a high burden of symptoms within the study population. Engagement with the platform was highest during the first 4 weeks. Among intervention participants, 80% created an account. Participants reported high levels of perceived usefulness, ease of use, and relevance of content. Qualitative analysis of open-ended survey responses highlighted limited awareness of postpartum-specific resources and a preference for simple, accessible information. An exploratory predictive model demonstrated a recall of 0.89 and a precision of 0.73 in identifying individuals at risk for postpartum depression, suggesting the feasibility of early risk identification using integrated data inputs.

CONCLUSIONS: Joyuus demonstrated feasibility and acceptability but did not produce statistically significant improvements in maternal functioning or maternal health outcomes over 12 weeks. Joyuus identified high rates of depressive symptoms and early engagement patterns, which suggest an opportunity for earlier identification of risk and intervention during the postpartum period. Exploratory modeling results indicate the potential for data-driven approaches to support earlier detection. Future work includes optimizing engagement strategies and expanding validation of predictive detection to improve postpartum surveillance and outcomes.

PMID:42456164 | DOI:10.2196/89719

JMIR Med Educ. 2026 Jul 15;12:e77034. doi: 10.2196/77034.

ABSTRACT

BACKGROUND: The use of remote teaching in medical education has increased since the COVID-19 pandemic. However, the effectiveness of synchronous remote teaching for specific psychomotor components of the neurological examination, such as tendon reflex assessment, remains underexplored.

OBJECTIVE: This study aimed to evaluate the short-term effectiveness of synchronous remote teaching compared with traditional in-person teaching for training medical students in tendon reflex examination skills and related neurological examination knowledge.

METHODS: This quasi-experimental study enrolled 110 fifth-year medical students between August 2022 and April 2024, who were assigned to either synchronous remote teaching (n=46) or in-person teaching (n=64). The participants completed pre- and postcourse knowledge tests and an objective structured clinical examination (OSCE) assessing tendon reflex examination skills. Motivational beliefs related to self-regulated learning and technology acceptance were measured at baseline. Group differences were analyzed using t tests, Mann-Whitney U tests, and correlational analyses.

RESULTS: Posttest knowledge scores were higher in the synchronous remote teaching group than in the in-person group (mean difference 0.86, 95% CI 0.21-1.51; Cohen d=0.50; P=.01), indicating a modest effect size. Both groups demonstrated substantial improvements in tendon reflex OSCE performance; however, the between-group difference in OSCE score improvement was not statistically significant (mean difference -3.64; 95% CI -9.36 to 2.08; Cohen d=-0.26; P=.21). Within the synchronous remote teaching group, higher motivational beliefs were positively correlated with OSCE score gains (Pearson r=0.34; P=.04; n=46), suggesting a potential role of self-regulated learning-related motivational processes. These exploratory findings should be interpreted with caution.

CONCLUSIONS: Under the conditions of this study, synchronous remote teaching was associated with modest improvements in knowledge outcomes and with OSCE-assessed tendon reflex examination skill gains that were comparable to those of traditional in-person teaching, without statistically significant between-group differences in psychomotor performance. These findings do not establish durable skill acquisition and should not be interpreted as evidence of equivalence or superiority of synchronous remote teaching over in-person instruction. Unlike many prior remote medical education studies that primarily focused on asynchronous learning or self-reported outcomes, this study incorporated synchronous interactive instruction with objective OSCE-based psychomotor assessment. These findings contribute to the emerging literature on synchronous remote clinical skills education, although future randomized and longitudinal studies are needed to evaluate long-term skill retention and broader applicability.

PMID:42456133 | DOI:10.2196/77034

J Med Internet Res. 2026 Jul 15;28:e86045. doi: 10.2196/86045.

ABSTRACT

BACKGROUND: of findings (SoF) tables are widely used in systematic reviews and clinical practice guidelines to present evidence about health care interventions in a concise and transparent format. Although developed to improve accessibility and interpretation of evidence, previous studies have shown that users often experience difficulties understanding statistical information, certainty ratings, and the relationships between outcomes and treatment effects. Limited research has explored how different groups of users cognitively interact with SoF tables while solving evidence interpretation tasks, particularly when table complexity increases.

OBJECTIVE: This study aimed to investigate how different types of users-Grading of Recommendations Assessment, Development, and Evaluation (GRADE) or Cochrane experts, practicing clinicians, and health care users-interact with SoF tables of varying complexity while answering intervention-related questions, and to examine differences in search behavior, navigation patterns, and task performance.

METHODS: We used the Read&Learn tool (ERI-Lectura and LAIA-UV) in an online, single-session study to evaluate participants’ interactions with SoF tables. Participants (n=120; 40 per group) accessed preselected SoF tables via a secure link and unique login. Participants completed tasks involving 4 SoF tables with increasing complexity. Specific table cells were blurred and had to be clicked to reveal information. Outcomes included the number of correct answers, total time spent on tasks, number of table cells visited, number of target and nontarget cells, and question-reading behavior.

RESULTS: Simpler SoF tables with a small number of outcomes and single target cells were correctly interpreted by most participants, regardless of their expertise. As table complexity and task demand increased, all participant groups demonstrated reduced performance and less efficient navigation patterns. Experts generally performed better than clinicians and health care users, particularly by spending less time reading nontarget cells and visiting fewer irrelevant table elements. Nevertheless, even experts experienced difficulties with tasks requiring synthesis and interpretation across multiple table cells. Questions requiring comparison and integration of information across outcomes resulted in the highest rates of incorrect responses in all groups. Heatmaps of the number of clicks and time spent on tables demonstrated that experts used more targeted search strategies, whereas clinicians and health care users explored a larger number of nontarget cells and spent more time navigating the tables. The most complex SoF tables produced the highest cognitive demands for all groups, suggesting that increasing element interactivity and information density substantially affect usability.

CONCLUSIONS: SoF tables remain cognitively demanding even for experienced users of evidence synthesis. Increasing table complexity appears to reduce users’ ability to identify, interpret, and synthesize relevant information. These findings suggest that current SoF formats may impose substantial intrinsic and extraneous cognitive load, particularly for nonexpert audiences. Future development of SoF tables should prioritize clearer presentation of clearer outcomes, inclusion of absolute alongside relative effects, and interactive or user-centered formats that support evidence navigation and interpretation.

PMID:42456099 | DOI:10.2196/86045

Crit Care Med. 2026 Jul 15. doi: 10.1097/CCM.0000000000007265. Online ahead of print.

ABSTRACT

OBJECTIVES: Amiodarone or lidocaine are recommended for the treatment of shockable out-of-hospital cardiac arrest (OHCA). Previous comparisons between the two antiarrhythmic drugs were inconclusive.

DESIGN: This analysis included data from the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry 3 (2011-2015). A target trial framework was used to overcome confounding inherent in observational comparisons.

SETTING: Data from patients with OHCA were prospectively collected by emergency medical services (EMS) at multiple North American sites.

PATIENTS: Adults with nontraumatic OHCA and an initial shockable rhythm who received at least three defibrillation attempts were included. Time zero was defined as first antiarrhythmic drug administration, at which eligibility criteria had to be met.

INTERVENTIONS: Two antiarrhythmic treatment strategies were compared: lidocaine vs. amiodarone.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was survival to hospital discharge. The key secondary outcome was favorable neurologic outcome at discharge (modified Rankin scale score of 3 or less). Group differences were adjusted using inverse probability weighting (key covariates: age, sex, location of OHCA, witness status, bystander resuscitation, automated external defibrillator shock, elapsed time from call to advanced life support arrival/first EMS shock/advanced airway, intraosseous access) and a multiple logistic regression model. Of 2451 patients included, 987 received lidocaine and 1464 received amiodarone. The adjusted percentage point difference in survival to hospital discharge was 2.8% favoring lidocaine (95% CI, -0.6 to 6.2); the estimated survival probabilities were 26.2% (275/987) with lidocaine and 23.5% (329/1464) with amiodarone. No difference was observed in the estimated probability of favorable neurologic outcome at discharge between the lidocaine group (17.7%) and the amiodarone group (16.2%) (adjusted difference, 1.5%; 95% CI, -1.5 to 4.5).

CONCLUSIONS: No statistically significant difference in survival or favorable neurologic outcome was observed between lidocaine and amiodarone; however, the wide CIs cannot exclude a clinically meaningful benefit for lidocaine. These findings are consistent with randomized controlled trials, but residual confounding cannot be excluded.

PMID:42456091 | DOI:10.1097/CCM.0000000000007265

J Clin Oncol. 2026 Jun 9:JCO2502520. doi: 10.1200/JCO-25-02520. Online ahead of print.

ABSTRACT

PURPOSE: To assess whether adding fluoropyrimidine sensitized radiotherapy (CXRT) to adjuvant chemotherapy improves overall survival (OS) after curative intent resection of the pancreatic head.

METHODS: This was a multicenter, randomized phase III, two step trial. Step 1: gemcitabine versus gemcitabine + erlotinib (previously reported). Step 2: random assignment to sixth chemotherapy cycle ± CXRT after five cycles of step 1 chemotherapy without progression. Outcomes of step 2 random assignment are reported here. Assuming 17 months median OS (chemotherapy alone), the sample size was 354 patients (hazard ratio [HR], 0.76, 80% power, one-sided α = .05, 316 OS events). OS/disease-free survival (DFS) were estimated by Kaplan-Meier and arms compared using the log-rank test.

RESULTS: A total of 354 patients (median age 63, 55% male, 56% performance status, 1) were randomly assigned to chemotherapy (174) or chemotherapy + CXRT (180). Univariable median and 5-year OS (90% CIs) were 2.6 years (2.1-3.1) and 23.1% (17.7-28.6) for chemotherapy alone, and 2.3 years (2.0-2.6) and 27.9% (22.2-33.6) for chemotherapy + CXRT. The OS primary end point was not met (HR, 0.96 [90% CI, 0.79 to 1.18]; one-sided P = .38, two-sided P = .77). Chemotherapy + CXRT was associated with a trend for improved DFS (univariably; HR, 0.82 [95% CI, 0.65 to 1.03]; P = .089), without increase in grade 4/5 toxicities. However, grade 3 toxicity increased (38% v 19%, P < .001). Significantly, treatment by nodal status interactions showed that CXRT improved OS (P = .0063) and DFS (P = .014) in node-negative patients.

CONCLUSION: Overall, the addition of adjuvant CXRT to adjuvant gemcitabine did not statistically significantly improve OS, DFS, or increase grade 4/5 toxicity. For node-negative patients, CXRT improved OS and DFS. These results, if confirmed in studies with current or future systemic therapies, would support the use of adjuvant/neoadjuvant CXRT for node-negative patients.

PMID:42456089 | DOI:10.1200/JCO-25-02520

Otol Neurotol. 2026 Jul 15. doi: 10.1097/MAO.0000000000005003. Online ahead of print.

ABSTRACT

OBJECTIVES: The advancement of high-resolution magnetic resonance imaging (MRI) has enabled clinicians to detect endolymphatic hydrops, thereby prompting interest in distinguishing between Ménière disease (MD) and vestibular migraine (VM) in patients presenting with vertigo, headache, hearing loss, ear fullness, and tinnitus. The aim of this study is to compare cochlear and vestibular endolymphatic hydrops in diagnosing VM, MD, and vestibular migraine with Ménière disease (VMMD).

METHOD: A prospective clinical study evaluating patients with episodic vertigo meeting criteria for either MD, VM, or both was conducted between July 2019 and December 2021. All patients underwent an MRI to assess hydrops in both ears. Treatment response was evaluated and considered the gold standard for diagnosis.

RESULTS: A total of 231 patients were included. The gold standard diagnosis was determined based on treatment response over at least 2 years. For MD, regardless of definite or probable diagnosis, grade I hydrops was most common for the cochlea (59.6%) and grade II for the vestibule (50.6%). No cochlear or vestibular hydrops were identified in 58.0% and 50.7% of VM cases, respectively. Grade I hydrops predominated in VM (cochlear: 39.1%; vestibular: 39.1%). Our study revealed statistically significant differences between the final diagnoses of MD, VM, and VMMD and the severity grading of vestibular and cochlear hydrops.

CONCLUSION: Endolymphatic hydrops and its severity grading are associated with MD. More than 50% of VM patients demonstrated no evidence of hydrops. However, it is important to recognize that when hydrops is present in VM patients, it is most often mild.

PMID:42456062 | DOI:10.1097/MAO.0000000000005003