Tag: pubmed

Acta Radiol. 2026 Aug 18:2841851261477088. doi: 10.1177/02841851261477088. Online ahead of print.

ABSTRACT

BackgroundThe relationship between acute myocardial injury and prognosis in acute myocarditis (AM) is unclear.PurposeTo evaluate myocardial injury characteristics by cardiovascular magnetic resonance (CMR) tissue parameters and their impact on adverse outcomes of AM patients.Material and MethodsThis retrospective study enrolled 41 patients with fulminant myocarditis (FM, including 17 FM patients without mechanical circulatory support [MCS] and 24 FM patients with MCS) and 35 patients with non-fulminant myocarditis (non-FM). Cine, mapping (native T1, T2, and post-T1), and late gadolinium enhancement (LGE) of the left ventricle were performed during CMR. Adverse clinical outcomes consisted of a primary endpoint, major adverse cardiovascular events (MACEs), and a secondary endpoint, a decline in functional status (defined as New York Heart Association [NYHA] functional classes II-IV).ResultsCompared with patients with non-FM, those in FM with MCS exhibited increased native T1 (P = 0.001), extracellular volume (ECV) (P = 0.018), and LGE (P = 0.005) values. After adjusting for the clinical variables (CRP > 67.9 mg/dL), LGE > 8.4% remained independently associated with adverse clinical outcomes and improved the predicting ability of the model (C-statistic improved from 0.74 to 0.82).ConclusionThe burden of necrosis and fibrosis was greatest in FM with MCS, while edema was similar across groups. Higher LGE% adds incremental prognostic value. A new classification using CRP and LGE improved prediction of adverse outcomes. Thus, CMR evaluation of myocardial injury extent offers variable information to improve risk stratification in FM.

PMID:42611031 | DOI:10.1177/02841851261477088

J Back Musculoskelet Rehabil. 2026 Aug 18:10538127261477947. doi: 10.1177/10538127261477947. Online ahead of print.

ABSTRACT

BackgroundFrozen shoulder (FS), commonly known as adhesive capsulitis, is a disabling musculoskeletal condition frequently accompanied by psychological distress. This meta-analysis aimed to evaluate the association between FS and depression.MethodsFor this meta-analysis, a systematic literature search of EMBASE, PubMed, and the Cochrane Library was conducted through 2025 using the keywords “frozen shoulder”, “adhesive capsulitis” and “depression.” Data regarding study characteristics, participant information, and depression-related outcomes were extracted. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Pooled odds ratios (ORs), mean differences (MDs), and corresponding 95% confidence intervals (CIs) were calculated. Statistical heterogeneity and potential publication bias were also assessed.ResultsNine studies including 122,378 participants met the inclusion criteria. The pooled prevalence of depression among patients with FS was 25.5% (95% CI: 16.7-36.8%). Patients with FS showed significantly higher odds of depression compared with individuals without FS (OR = 2.15, 95% CI: 1.57-2.94). In addition, FS patients had significantly higher HADS-D scores (MD = 2.97, 95% CI: 0.66-5.28). Substantial heterogeneity was observed across studies, while no significant publication bias was detected.ConclusionFS is associated with an increased risk of depression. These findings emphasize the importance of incorporating psychological assessment and management into the clinical care of patients with FS to improve overall outcomes.

PMID:42611029 | DOI:10.1177/10538127261477947

Orthopedics. 2026 Jul-Aug;49(4):e275-e283. doi: 10.3928/01477447-20260625-01. Epub 2026 Aug 14.

ABSTRACT

BACKGROUND: This meta-analysis compared the clinical efficacy of unilateral biportal endoscopic diskectomy (UBE) and percutaneous endoscopic lumbar diskectomy (PELD) for lumbar disk herniation.

MATERIALS AND METHODS: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wanfang was conducted from inception to May 2025. Comparative studies in adults undergoing UBE or PELD were included. Outcomes included operative and recovery parameters, complications, reoperation, Macnab outcomes, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), fluoroscopy exposure, and total cost. Pooled effects were calculated as mean differences or odds ratios with 95% confidence intervals. Prespecified subgroup analyses (PELD approach and operative level) and sensitivity analyses (leave-one-out/model switching) were performed. Clinical relevance was interpreted using commonly cited minimal clinically important difference thresholds for VAS and ODI.

RESULTS: A total of 25 studies involving 2,087 patients were included. Compared with PELD, UBE was associated with longer operative time, greater intraoperative blood loss, larger incisions, longer hospital stays, and higher hospitalization costs, but significantly fewer intraoperative fluoroscopy exposures. No significant differences were observed in complication or reoperation rates. Although some statistically significant differences were detected in early perioperative metrics, all between-group differences in VAS pain and ODI functional scores were far below the minimal clinically important difference thresholds, confirming clinically equivalent mid-term outcomes. Subgroup analyses identified that PELD approach and operative level were key contributors to between-study heterogeneity, and sensitivity analyses confirmed that our main conclusions remained stable.

CONCLUSION: Both UBE and PELD are safe and effective minimally invasive strategies for lumbar disk herniation, with comparable clinical efficacy. PELD offers advantages in lower surgical trauma and cost effectiveness, whereas UBE reduces intraoperative radiation exposure. Surgical selection should be individualized based on patient pathology and surgeon expertise.

PMID:42611015 | DOI:10.3928/01477447-20260625-01

Orthopedics. 2026 Jul-Aug;49(4):e368-e375. doi: 10.3928/01477447-20260722-01. Epub 2026 Aug 14.

ABSTRACT

BACKGROUND: Orthopedic surgery fellowships have evolved from optional to nearly mandatory since accreditation in 1981, yet factors influencing subspecialty selection remain incompletely defined. We evaluated orthopedic residency program director (PD) and department chair demographics and training backgrounds, resident fellowship match patterns, fellowship availability, and concordance between leadership training and resident subspecialty selection.

MATERIALS AND METHODS: Using programs accredited by the Accreditation Council for Graduate Medical Education, we analyzed available PD and department chair demographics and fellowship training. Five years of alumni fellowship data and fellowship availability at each institution were collected from program websites. Descriptive statistics, chi-squared tests, and crude odds ratios (ORs) were used, with P < .05 considered significant.

RESULTS: Among 109 residency programs and 5,443 recent graduates, residents most often matched into sports medicine (24.44%), arthroplasty (17.86%), and hand surgery (16.57%). PDs were most commonly trained in trauma, sports medicine, and hand surgery; chairs were most commonly trained in sports medicine, trauma, and spine surgery. Leadership was predominantly male and White (PDs: 87.16% male, 78.90% White; chairs: 93.58% male, 88.07% White). Programs offering spine, hand, or orthopedic oncology fellowships had higher match rates into those specialties than programs without them (OR: 1.20, 1.42, and 1.94; all P < .05). Residents were also more likely to enter arthroplasty when their PD was arthroplasty trained and to enter hand surgery or orthopedic oncology when their chair had concordant training.

CONCLUSION: Fellowship availability and leadership training background were each associated with resident subspecialty selection. Applicants with subspecialty interests should consider both factors when evaluating residency programs.

PMID:42611012 | DOI:10.3928/01477447-20260722-01

J Speech Lang Hear Res. 2026 Aug 18:1-13. doi: 10.1044/2026_JSLHR-25-00740. Online ahead of print.

ABSTRACT

PURPOSE: The minimally detectable change (MDC) provides a threshold for interpreting changes in outcome measures that are outside of measurement error. There is emerging evidence that dysarthria etiology and speech severity impact the MDC of speech intelligibility; however, an investigation of these factors is needed to determine the unique effects of dysarthria etiology and speech severity. The purpose of the current study was to calculate and compare MDCs of speech intelligibility across five dysarthria etiology groups and four severity levels.

METHOD: Speech Intelligibility Test recordings from 200 speakers were used as stimuli, including recordings from healthy controls (n = 40) and individuals with neurodegenerative diseases such as amyotrophic lateral sclerosis (n = 16), Huntington’s disease (n = 44), multiple sclerosis (n = 60), and Parkinson’s disease (n = 40). Thirty inexperienced listeners provided orthographic transcriptions of 20 speakers each. MDCs were calculated, and speech severity levels were categorized based on empirically defined speech severity levels reported in Stipancic et al. (2021). Statistical analyses, including multiple linear regression, assessed the effects of etiology and severity on MDCs.

RESULTS: Speech severity was a significant predictor of MDCs, with greater impairments to speech intelligibility resulting in higher MDCs. Dysarthria etiology was not a significant predictor of MDCs.

CONCLUSION: The impact of speech severity on MDCs of intelligibility in dysarthria underscores the need to calculate and provide MDCs across severity ranges to enhance the interpretation of patient outcomes.

PMID:42611011 | DOI:10.1044/2026_JSLHR-25-00740

Biol Psychiatry. 2026 Aug 18:S0006-3223(26)01385-5. doi: 10.1016/j.biopsych.2026.06.025. Online ahead of print.

ABSTRACT

BACKGROUND: Increases in cannabis use, potency, and legal liberalization have raised concerns about psychiatric consequences. Previous studies suggest an association between cannabis use and earlier age at onset (AAO) of psychosis, but an updated meta-analysis is needed.

METHODS: MEDLINE, Embase, and PsycInfo were searched from inception to April 2025. Peer-reviewed cohort and case-control studies reporting mean and standard deviation of AAO of psychosis in cannabis users and nonusers or other effect size data were included. Pooled standardized mean difference was calculated using random-effects meta-analysis. Subgroup analyses used mixed effects models, and between-study heterogeneity was examined with random-effects meta-regression.

RESULTS: The main meta-analysis included 181 samples from 149 studies, comprising 18,272 cannabis users and 52,801 nonusers. Cannabis use was associated with a mean earlier AAO of 2.50 years. Subgroup analysis by sample mean onset age found no difference in AAO of psychosis between cannabis users and nonusers in the <20-year-old group, but there was a progressive age-related difference; cannabis users in the 20 to <25, 25 to <30, and ≥30 groups had an earlier AAO of 1.60, 4.43, and 6.30 years, respectively. Multiple meta-regression indicated that sample mean onset age was a strong and statistically independent moderator of earlier AAO effect size (z = -7.59, p < .0001).

CONCLUSIONS: The association between cannabis use and earlier psychosis onset is robust, with larger effect sizes in samples with later mean age of psychosis onset. These findings support consideration of public health warnings of the potential psychiatric risks associated with cannabis use across the lifespan.

PMID:42610992 | DOI:10.1016/j.biopsych.2026.06.025

BJS Open. 2026 Jul 3;10(4):zrag092. doi: 10.1093/bjsopen/zrag092.

ABSTRACT

BACKGROUND: Debate continues about the need for prophylactic concomitant cholecystectomy (CC) at the time of Roux-en-Y gastric bypass (RYGB). The concerns over higher complication rates should be balanced against the risk of future biliary events. This pilot trial compared RYGB with CC to RYGB alone in patients without preoperative gallstones to inform a future large randomized trial.

METHODS: Eligible patients without gallstones scheduled to undergo RYGB were randomized before surgery using a 1 : 1 allocation ratio. Surgeons and patients were not blinded. The primary outcome was a composite of intraoperative adverse events and 30-day postoperative complications. In addition, feasibility (time to enrolment, completion of follow-up) was added as a co-primary endpoint after the study started, driven by prolonged enrolment times and independent of trial results. Secondary outcomes included late complications, biliary events, length of operation, length of hospital stay, and quality of life.

RESULTS: In all, 96 patients were randomized between July 2018 and January 2023, and 95 were included in the full analysis due to one withdrawal. There were 49 and 46 patients in the RYGB with and without CC arms, respectively. The feasibility endpoint was met with regard to the completion of follow-up (95/95, 100% at 1 month; 88/95 93% at 18 months), but not the time to enrolment (21 patients randomized per year). The composite outcome of intraoperative and postoperative complications occurred in 44.9% and 26.1% of patients with and without CC, respectively (difference 18.8%; 95% confidence interval (c.i.) -0.6 to 36.8; P = 0.098). Patients with CC had a higher early comprehensive complication index score (mean 6.09 versus 2.06; difference 4.03; 95% c.i. 0.23 to 7.83; P = 0.047). Late (> 30 days) complications, length of hospital stay, and quality of life were similar between the two groups. During the 18-month follow-up, biliary events occurred in 3 patients without CC (6.5%), of whom 2 required biliary intervention (4.4%) compared with 1 patient with CC (2%), with no biliary interventions required.

CONCLUSION: The debate over performing CC during RYGB remains unresolved. The incidence of subsequent biliary interventions was low when CC was not performed. As a pilot study, this investigation sets the stage for a large randomized trial. Registration number: NCT04324515 (https://www.clinicaltrials.gov).

PMID:42610981 | DOI:10.1093/bjsopen/zrag092

J Antimicrob Chemother. 2026 Aug 4;81(9):dkag228. doi: 10.1093/jac/dkag228.

ABSTRACT

BACKGROUND: Antimicrobial resistance is driven by antibiotic exposure. People living with HIV (PLWH) and PrEP users face high STI rates, but the magnitude of cumulative antibiotic exposure in these populations compared with the general population has not been well characterized.

METHODS: This retrospective study (Madrid, 2024-2025) linked pharmacy and microbiology records of 562 325 adults. Participants were categorized into: (A) PLWH or PrEP users with documented rectal STI episodes in the context of active sexual health follow-up; (B) PrEP/PLWH without STIs; and (C) general population controls. Consumption was measured in Defined Daily Doses per 1000 persons-day (DHD) using propensity score overlap weights.

RESULTS: Antibiotic use was significantly higher in Group A (95.3%) compared to Group B (35.4%) and Group C (27.3%) (P < 0.001). After weighting, individuals with documented rectal STI episodes (Group A) exhibited a markedly higher overall antibiotic exposure compared with general population controls (Group C) (adjusted rate ratio [RR]-DHD 4.67, 95% CI 4.41-4.94), driven by tetracyclines (RR-DHD 23.7), corresponding to a population rate equivalent to ∼1.1 seven-day doxycycline courses per person-year (a population-level metric, not an individual estimate). Group B consumption was 33% higher than controls (P = 0.004). Direct comparison confirmed that Group A’s tetracycline use was 5.6-fold higher than Group B’s (P < 0.001).

CONCLUSIONS: PLWH and PrEP users with documented rectal STI episodes experience markedly higher antibiotic exposure than the general population, driven primarily by tetracycline use. This disproportionate exposure in a small, identifiable subgroup supports targeted antimicrobial stewardship strategies in sexual health and HIV care settings, including systematic consumption monitoring, individualized doxy-PEP counselling, and integration of STI-focused populations into national AMR surveillance frameworks.

PMID:42610960 | DOI:10.1093/jac/dkag228

J Int Med Res. 2026 Aug;54(8):3000605261476584. doi: 10.1177/03000605261476584. Epub 2026 Aug 18.

ABSTRACT

ObjectiveTo investigate short-term diffusion tensor imaging-derived changes in the knee physis after whole-body vibration and to assess postural stability in healthy adolescents.MethodsThis prospective, single-arm, within-subject exploratory study included 48 healthy adolescents (24 males and 24 females; mean age, 11.94 ± 2.31 years) who underwent a 1-week whole-body vibration protocol (15 Hz, 5 mm amplitude). Fractional anisotropy and apparent diffusion coefficient values of the distal femoral and proximal tibial physes were measured before and after whole-body vibration using knee diffusion tensor imaging. Postural stability was evaluated using force plate center-of-pressure parameters. Paired comparisons were performed for the overall cohort and sex-stratified subgroups, and age- and bone age-related trends were explored using quadratic regression models.ResultsIn the overall cohort, fractional anisotropy increased in both the distal femoral physis (0.472 ± 0.074 to 0.515 ± 0.070; mean change, 0.043; Cohen’s dz = 0.737; p < 0.001) and the proximal tibial physis (0.486 ± 0.063 to 0.527 ± 0.067; mean change, 0.041; Cohen’s dz = 0.897; p < 0.001). Apparent diffusion coefficient decreased in the distal femoral physis (1.171 ± 0.230 to 1.081 ± 0.160 × 10^-3 mm²/s; mean change, -0.090; Cohen’s dz = -0.483; p = 0.002) and the proximal tibial physis (1.171 ± 0.211 to 1.100 ± 0.168 × 10^-3 mm²/s; mean change, -0.071; Cohen’s dz = -0.584; p < 0.001). Sex-stratified analyses showed generally larger standardized changes in males, whereas apparent diffusion coefficient changes in females did not reach statistical significance. Exploratory scatter plots and quadratic regression models suggested that the magnitude of diffusion tensor imaging-derived changes varied with chronological age and bone age, with a trend toward larger changes within a bone age range of 12-14 years. Postural stability parameters increased transiently but remained within the “no-impact” safety threshold.ConclusionsA 1-week whole-body vibration protocol was associated with measurable diffusion tensor imaging-derived changes in the adolescent knee physis and transient changes in postural stability. These findings should be interpreted as preliminary, hypothesis-generating biophysical observations rather than direct evidence of improved physeal function, growth promotion, or beneficial structural effects. Larger sham-controlled longitudinal studies incorporating growth outcomes and complementary diffusion tensor imaging metrics are warranted.

PMID:42610955 | DOI:10.1177/03000605261476584

J Int Med Res. 2026 Aug;54(8):3000605261476138. doi: 10.1177/03000605261476138. Epub 2026 Aug 18.

ABSTRACT

ObjectiveGastroesophageal reflux disease comprises heterogeneous phenotypes, and symptom severity does not always correlate with endoscopic findings. This retrospective observational study aimed to characterize serum proteomic alterations in gastroesophageal reflux disease and to explore whether nonerosive reflux disease and reflux esophagitis exhibit distinct circulating protein signatures.MethodsSeventy individuals were included, comprising 26 controls, 14 patients with nonerosive reflux disease, and 30 with reflux esophagitis. For exploratory group-level proteomic discovery, pooled serum samples from each group were analyzed using liquid chromatography-tandem mass spectrometry. Clinical characteristics, upper gastrointestinal endoscopy, high-resolution manometry, and 24-h pH-impedance monitoring were assessed as appropriate. Differentially expressed proteins were identified using a fold change threshold of 1.3 together with nominal statistical significance, followed by functional annotation and enrichment analyses.ResultsAge and sex were comparable among the groups. Nonerosive reflux disease and reflux esophagitis showed no significant differences in gastroesophageal reflux disease questionnaire score, disease duration, body mass index, or most reflux-monitoring parameters. However, patients with reflux esophagitis had more gas reflux episodes, lower distal contractile integral values, and a higher frequency of esophageal motility disorders, suggesting impaired motor function. Proteomic profiling identified 872 proteins, including 666 quantified proteins. Differential expression analysis identified 48 proteins in nonerosive reflux disease versus controls, 43 in reflux esophagitis versus controls, and 7 in nonerosive reflux disease versus reflux esophagitis. The exploratory nonerosive reflux disease-associated protein profile was mainly characterized by cytoskeletal remodeling, adhesion-related regulation, redox adaptation, and selective immune rearrangement, whereas the exploratory reflux esophagitis-associated profile showed features related to actin remodeling, injury-defense responses, and alterations in lipid homeostasis.ConclusionsNonerosive reflux disease and reflux esophagitis exhibited distinct but partially overlapping serum proteomic profiles in this exploratory pooled serum analysis. These preliminary findings suggest phenotype-related biological differences beyond reflux burden alone; however, they should be interpreted as hypothesis-generating and require validation in independent, individual-level cohorts.

PMID:42610948 | DOI:10.1177/03000605261476138