Tag: pubmed

Dentomaxillofac Radiol. 2026 Jan 14:twag005. doi: 10.1093/dmfr/twag005. Online ahead of print.

ABSTRACT

OBJECTIVES: Upper airway assessment is crucial due to its impact on craniofacial growth and airway-related disorders. This retrospective observational cross-sectional study aimed to evaluate the upper pharyngeal airway space volume and minimum cross-sectional area in a normal sample from Upper Egypt population, analyzing age and gender-related variations using cone-beam computed tomography.

METHODS: Ninety cone beam computed tomography scans of patients aged 18 to 60 years were evaluated. The sample was divided into three groups (Group I: ≤20 years, Group II: 21-40 years, and Group III: >40 years). Each group was further divided into two subgroups according to gender. Nasopharyngeal, oropharyngeal, hypopharyngeal, and total airway volumes, as well as the minimum cross-sectional area, were calculated using Dolphin 3D® software. Two-way ANOVA with Bonferroni post hoc test was used for statistical analysis.

RESULTS: The findings revealed significant gender differences. Males exhibited larger airway dimensions across all age groups except for nasopharyngeal volumes in adults over 20 years. A decline in airway volumes and minimum cross-sectional area in individuals over 40 years. The most constricted airway area predominantly occurred in the oropharynx. A strong positive correlation exists between minimum cross-sectional area and airway volumes. Very good inter- and intra-observer agreement.

CONCLUSIONS: Upper pharyngeal airway dimensions in a sample of the Upper Egyptian population are influenced by age and gender, highlighting the need for age and gender specific considerations in the diagnosis and treatment.

ADVANCES IN KNOWLEDGE: This study is the first to evaluate age and gender-related variations in upper pharyngeal airway volume within the Upper Egypt population. Also, it introduces a discriminant model that provides a probabilistic classification of the site of minimum cross-sectional area with 62.2% accuracy.

PMID:41537243 | DOI:10.1093/dmfr/twag005

J Invest Surg. 2026 Dec;39(1):2611440. doi: 10.1080/08941939.2025.2611440. Epub 2026 Jan 15.

ABSTRACT

BACKGROUND: Chest wall invasion is a relatively kind of infrequent direct tumor extension in non-small cell lung cancer (NSCLC) with a poor survival outcome. Risk factors that impact overall survival (OS) and cancer-specific survival (CSS) remain unclear. We aimed to explore prognostic factors and construct predictive nomograms to predict both OS and CSS in NSCLC patients with chest wall invasion.

METHODS: We extracted a total of 2091 patients between 2010 and 2015 from the SEER database. The total patients were divided into the training cohort (1463 patients) and the validation cohort (628 patients). Univariate and multivariate Cox regression analyses were applied to distinguish the independent prognostic factors. Two prognostic nomograms for OS and CSS were established. The concordance index (C-index), receiver operating characteristic curves (ROC), calibration curves, and decision curve analysis (DCA) curves were applied to assess the performance of these two nomograms.

RESULTS: After analysis, age, sex, histology, grade, N stage, M stage, surgery, and chemotherapy were identified as independent prognostic factors for OS, meanwhile, age, histology, grade, N stage, M stage, surgery, and chemotherapy for CSS. The C-index for OS in the training and validation cohorts was 0.711 and 0.716, respectively. The C-index for CSS was 0.721 and 0.726, respectively. The ROC curves, calibration curves, DCA curves, and K-M survival curves also exhibited good predictive performance.

CONCLUSION: Two nomograms provide a useful tool to predict both OS and CSS in NSCLC patients with chest wall invasion.

PMID:41537240 | DOI:10.1080/08941939.2025.2611440

Oral Health Prev Dent. 2026 Jan 15;24:1-11. doi: 10.3290/j.ohpd.c_2446.

ABSTRACT

PURPOSE: This study investigated the association between periodontitis and oral HPV infection, while exploring the role of oral bacterial microbiota diversity.

METHODS AND MATERIALS: Data from 4,685 adults in the NHANES 2009-2012 cycles were analysed. Periodontitis was defined based on clinical examination, and oral HPV infection was identified using PCR from oral rinse samples. Multivariable logistic regression models were employed to assess the relationship, adjusting for body mass index (BMI), age, sex, ethnicity, education, smoking, alcohol consumption, daily dental flossing, and history of systemic diseases. Subgroup analyses were stratified by age, sex, and education. Mediation analysis was performed to evaluate whether the oral microbiome acts as a mediator in the relationship between periodontitis and oral HPV infection.

RESULTS: No statistically significant overall association was found between periodontitis and oral HPV infection (P > 0.05). However, females with moderate to severe periodontitis exhibited increased odds of oral HPV infection (P 0.05). Oral HPV infection was associated with greater microbial diversity (higher operational taxonomic units [OTUs]). No significant mediating effect of the oral microbiome was observed.

CONCLUSION: Moderate to severe periodontitis appears to be associated with higher odds of oral HPV infection in females. These findings highlight the potential relationship between oral health, microbial diversity, and oral HPV infection.

CLINICAL IMPLICATION: In the general population, periodontitis does not appear to be a major risk factor for oral HPV; however, female with moderate to severe periodontitis and individuals with higher educati-on showed increased odds of oral HPV infection, suggesting that maintaining periodontal health may be particularly important for HPV related risk management in these subgroups.

PMID:41537224 | DOI:10.3290/j.ohpd.c_2446

Ann Ital Chir. 2025 Sep 16;97(1):119-125. doi: 10.62713/aic.3938.

ABSTRACT

AIM: This study aimed both to compare the efficacy of intravenous (IV) ibuprofen with periprostatic nerve block (PPNB) in pain control during prostate biopsy procedures and to investigate factors influencing pain scores.

METHODS: A total of 128 patients were prospectively enrolled between June and December 2023 and randomized into two groups: IV ibuprofen was Group 1 (n = 64) and PPNB was Group 2 (n = 64). Pain levels were assessed using a Visual Analog Scale (VAS) at various stages of the procedure. Demographic and clinical data, including age, prostate specific antigen (PSA) levels, prostate volume, body mass index (BMI), histopathology results, and Prostate Imaging-Reporting and Data System (PI-RADS) scores, were recorded and correlated among themselves.

RESULTS: The mean ages (64.68 ± 5.87 vs 63.33 ± 7.26 years), and median PSA level was [13.00 (8.04-41.68) ng/mL vs 10.00 (6.73-23.80) ng/mL] of Group 1 and 2 were as indicated, (p = 0.267 and p = 0.053, respectively). There were no statistically significant differences between the two groups in terms of prostate volume, BMI, PI-RADS score, and benign-malignant pathology on biopsy (p > 0.05). The median VAS scores estimated during insertion of rectal probe [4 (2-5) vs 2 (0-3)], prostate biopsy needle [3 (2-4) vs 0 (0-1)], and overall median VAS scores [4 (3-4) vs 1 (0-2)] were lower in Group 2 than Group 1 (p < 0.001 for all stages). Correlation analyses revealed that PSA levels, and malignant pathology influenced the pain scores in Group 1 (r = 0.230, p = 0.024; r = 0.268, p = 0.032, respectively). Regression analysis demonstrated that PSA levels and malignant pathology affected the overall VAS scores in Group 1 (p = 0.024 and p = 0.019, respectively).

CONCLUSIONS: IV ibuprofen demonstrates promise as an easily applicable analgesic method for prostate biopsy, particularly for patients who are unwilling or unable to undergo PPNB. This study underscores the need for large-scale investigations to validate these findings.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov with identifier (NCT06737939).

PMID:41537216 | DOI:10.62713/aic.3938

Ann Ital Chir. 2026 Jan 10;97(1):36-62. doi: 10.62713/aic.4228.

ABSTRACT

AIM: Lentigo maligna (LM) is the commonest melanoma in situ variant and frequently arises on chronically sun-exposed facial skin, where subclinical radial spread and background actinic melanocytic atypia complicate both surgical clearance and histological interpretation. The aim of this study is to appraise contemporary surgical options for LM and their oncological outcomes, focusing on conventional wide local excision (WLE), Mohs micrographic surgery (MMS), Paraffin embedded margin-controlled (“slow Mohs”) techniques and staged excision (SE).

METHODS: A comprehensive search of PubMed and Web of Science (January 2015-January 2025) retrieved retrospective cohorts, systematic reviews and meta-analyses that detailed technique, margin policy and outcomes for LM or lentigo maligna melanoma (LMM). Forty-six studies met prespecified criteria and were synthesised qualitatively.

RESULTS: WLE remains the most widely performed procedure but showed the greatest heterogeneity in practice. Initial clinical margins of 5 mm often required histological extensions to 7-12 mm to secure clearance; under WLE, residual disease rates reached 16.7% and recurrences ranged from 5.7% to 27.3%. In contrast, MMS, especially when using immunohistochemistry, achieved recurrence rates between 0-3% with ≥5 years of follow-up. Slow Mohs and staged excision provided intermediate recurrence control (0-5.7%) while preserving tissue but were limited by procedural variability and delayed reconstruction. Although one retrospective study reported improved disease-specific survival with MMS, most studies showed no significant differences in melanoma-specific or overall survival across surgical techniques. Limited long-term follow-up and inconsistent statistical reporting (e.g., confidence intervals) were common.

CONCLUSIONS: Margin-controlled approaches (MMS, slow Mohs, SE) afford superior local control to WLE and are preferable for lesions on cosmetically or functionally critical sites. Because survival appears equivalent, the choice of technique should be guided by anatomical location, lesion size, available expertise, patient characteristics and preferences as well as cost-effectiveness and available resources. Well-designed prospective trials with standardised protocols are essential to refine margin recommendations and compare long-term outcomes.

PMID:41537210 | DOI:10.62713/aic.4228

Ann Ital Chir. 2026 Jan 10;97(1):84-93. doi: 10.62713/aic.4374.

ABSTRACT

AIM: This study aimed to compare the efficacy and safety of ultrasound-guided percutaneous balloon dilatational tracheotomy (US-PDT) versus surgical tracheotomy (ST) in patients with acute respiratory failure (ARF).

METHODS: In this retrospective cohort study, 278 patients with ARF were enrolled from January 2022 to January 2025. These patients were divided into the US-PDT group (n = 135) and the ST group (n = 143) based on the surgical method used. Perioperative indicators, procedural success rates, inflammatory markers, hospitalization outcomes, and complications were systematically compared between the two groups.

RESULTS: The US-PDT group demonstrated superior outcomes across all measures. It was associated with a significantly shorter procedure time, smaller incision length, reduced intraoperative blood loss, and shorter duration of mechanical ventilation (all p < 0.001). The US-PDT group also showed a higher single-attempt procedural success rate, alongside a lower accidental extubation rate (all p < 0.001). Postoperative inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and procalcitonin [PCT]) were significantly lower in the US-PDT group (p < 0.001). Furthermore, the US-PDT group experienced reduced ventilator-associated pneumonia (VAP) incidence, higher weaning success, shorter intensive care unit (ICU) and hospital stays, and lower ICU and overall mortality (all p < 0.05). Complication rates were also significantly lower in the US-PDT group (p < 0.05).

CONCLUSIONS: US-PDT is a more efficient, safer, and less invasive alternative to ST for ARF patients, resulting in better clinical outcomes, reduced inflammation, fewer complications, and improved survival rates.

PMID:41537207 | DOI:10.62713/aic.4374

JAMA Netw Open. 2026 Jan 2;9(1):e2553803. doi: 10.1001/jamanetworkopen.2025.53803.

NO ABSTRACT

PMID:41533381 | DOI:10.1001/jamanetworkopen.2025.53803

JAMA Netw Open. 2026 Jan 2;9(1):e2551807. doi: 10.1001/jamanetworkopen.2025.51807.

ABSTRACT

IMPORTANCE: More than 30 million people in the US take prescribed benzodiazepines, which, when taken long-term, carry risks of falls, cognitive decline, and dependence. A previous trial showed that a patient-focused self-management intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) can reduce long-term benzodiazepine dependence use and the risks that accompany it.

OBJECTIVE: To replicate the finding of the EMPOWER trial after converting the intervention from printed materials to electronic format.

DESIGN, SETTING, AND PARTICIPANTS: This 2-arm, individually randomized clinical trial with a 6-month follow-up was conducted at US Veterans Health Administration primary care clinics in 2 Veterans Affairs health care systems. Participants included 161 primary care patients taking benzodiazepines for 3 or more months and having access to a smartphone, tablet, or desktop computer. Recruitment occurred from June 1, 2022, to January 31, 2024.

INTERVENTION: Participants were randomized to either the electronically delivered EMPOWER (EMPOWER-ED) protocol or asked to continue to follow clinician recommendations regarding their benzodiazepine use (treatment as usual).

MAIN OUTCOMES AND MEASURES: Preregistered primary outcomes were complete benzodiazepine cessation and at least 25% dose reduction at 6-month follow-up, assessed using pharmacy data. Secondary outcomes were self-reported anxiety symptoms, sleep quality, and overall health and quality of life. Analysis was performed on an intent-to-treat basis.

RESULTS: The 161 participants had a mean (SD) age of 61.9 (13.7) years and were mostly male (134 [83.2%]). Individuals assigned to the EMPOWER-ED group had a significantly greater likelihood of complete benzodiazepine cessation (odds ratio [OR], 5.31 [95% CI, 1.12-25.12]). There was no likelihood of at least a 25% dose reduction in the EMPOWER-ED group relative to the control group (OR, 2.51 [95% CI, 0.91-6.90]). No statistically significant difference was found between the 2 groups for the secondary outcomes.

CONCLUSIONS AND RELEVANCE: This randomized clinical trial found a large effect of a low-cost, self-administered electronic intervention for reducing benzodiazepine use among long-term users. Findings from this replicated clinical trial are encouraging given the prevalence of benzodiazepine dependence and the constraints on clinician time available to address it. Dissemination of this intervention-which is in the public domain-by health care and public health systems seems warranted.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04572750.

PMID:41533380 | DOI:10.1001/jamanetworkopen.2025.51807

JAMA Netw Open. 2026 Jan 2;9(1):e2552518. doi: 10.1001/jamanetworkopen.2025.52518.

ABSTRACT

IMPORTANCE: Lyme disease (LD) is the most common vector-borne illness in the US. Given the increasing prevalence and expanding geographic bounds of LD, in-depth, up-to-date understanding of costs associated with an LD diagnosis, including patient out-of-pocket (OOP) costs, is needed.

OBJECTIVE: To assess health care costs in a broad US population diagnosed with LD, overall and stratified by localized disease vs disseminated disease.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study identified patients from Optum’s deidentified Market Clarity Data (Optum Market Clarity) between December 2, 2014, and January 30, 2023 (study period), with an LD diagnosis between January 1, 2016, and December 31, 2022 (identification period), having at least 14 months of continuous health plan enrollment. Optum Market Clarity is an integrated, multisource medical claims, pharmacy claims, and electronic health records data set. Outpatients had a claim with an LD diagnosis plus relevant antibiotics within 30 days, and inpatients had a claim with LD as the primary diagnosis or as a secondary diagnosis with an LD-associated condition as the primary diagnosis. Data were analyzed from February 27, 2023, to October 20, 2025.

EXPOSURE: The main exposure was LD diagnosis. Case patients were classified as having disseminated, localized, or indeterminate LD based on diagnosis codes for LD and LD-associated conditions, inpatient vs outpatient services, or antibiotic treatment type.

MAIN OUTCOMES AND MEASURES: Health care costs (reported in US dollars) for LD cases overall and stratified by localized disease vs disseminated disease were assessed 4 ways: (1) LD-specific costs per episode, (2) all-cause 6-month baseline vs follow-up costs for case patients with LD, (3) all-cause 6-month follow-up costs for case patients with LD compared with the control group, and (4) multivariable case-control analysis. Costs are reported as estimated direct (standardized) costs and patient OOP costs. Wald 95% CIs were used for means of cost measures.

RESULTS: A total of 70 531 case patients with LD were included. Their mean (SD) age was 44.8 (21.3) years; 51.3% were female. Estimated direct costs of LD were substantial across assessment methods, including episode cost (mean, $2227 [95% CI, $2111-$2342]), case patients as self-controls analysis (difference, $3304 [95% CI, $3117-$3491] in mean 6-month costs between baseline and follow-up), case-control analysis (difference, $4098 [95% CI, $3888-$4307] in mean 6-month follow-up costs), and multivariable-adjusted analysis (case-control difference, $5571 in projected mean 6-month follow-up costs; cost ratio, 1.96 [95% CI, 1.90-2.02]). OOP costs were available for 10 962 patients (15.5%) with LD. Mean OOP costs attributed to LD ranged from $188 to $399. Extrapolating to the US population in high-incidence states, annual costs of LD could range between $591 million and $1.05 billion (2022 dollars), with $411 to $771 million attributable to disseminated disease.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, LD presented a large financial burden to the health care system and patients, especially for those with disseminated disease. These findings highlight the need for effective preventive measures to reduce costs for patients and the health care system.

PMID:41533379 | DOI:10.1001/jamanetworkopen.2025.52518

JAMA Netw Open. 2026 Jan 2;9(1):e2553965. doi: 10.1001/jamanetworkopen.2025.53965.

ABSTRACT

IMPORTANCE: Laboratory testing is necessary to distinguish blastomycosis, coccidioidomycosis, or histoplasmosis from other causes of community-acquired pneumonia (CAP). Robust data about testing for and diagnosis of these fungal diseases among patients with CAP throughout the US are lacking.

OBJECTIVE: To examine proportions and characteristics of (1) adult outpatients with CAP who underwent diagnostic testing for blastomycosis, coccidioidomycosis, or histoplasmosis; and (2) tested patients who received diagnoses of these diseases.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used 2017 to 2023 commercial health insurance claims data from the Merative MarketScan Commercial/Medicare Database. Adult outpatients with diagnosis codes for unspecified CAP were included.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients who underwent fungal diagnostic testing. The secondary outcomes were the proportions of tested patients who received diagnoses of blastomycosis, coccidioidomycosis, or histoplasmosis. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) for characteristics independently associated with receiving a diagnosis of coccidioidomycosis or histoplasmosis.

RESULTS: Among 573 994 patients (318 152 female [55%]; median [IQR] age, 54 [41-63] years) with unspecified CAP, 25 822 (5%) underwent fungal diagnostic testing, which occurred a median (IQR) of 3 (1-6) health care visits after the initial CAP diagnosis. Among tested patients, 755 (3%) received a blastomycosis, coccidioidomycosis, or histoplasmosis diagnosis code. Rash (aOR, 3.24; 95% CI, 2.27-4.63), lymphadenopathy (aOR, 1.74; 95% CI, 1.15-2.63), myalgia (aOR, 1.66; 95% CI, 1.11-2.49), chest pain (aOR, 1.65; 95% CI, 1.35-2.02), and receipt of antibiotics from multiple classes (aOR, 1.40; 95% CI, 1.17-1.67) were independently associated with increased odds of receiving a coccidioidomycosis diagnosis. Autoimmune inflammatory disease (aOR, 3.00; 95% CI, 1.72-5.21), chest pain (aOR, 1.84; 95% CI, 1.20-2.82), and abnormal weight loss (aOR, 5.15; 95% CI, 2.71-9.79) were associated with increased odds of receiving a histoplasmosis diagnosis.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with unspecified CAP, testing rates for blastomycosis, coccidioidomycosis, and histoplasmosis were low in many locations. Increased awareness of these fungal infections may help increase timely testing for fungal diseases among patients with CAP, decrease health care utilization and inappropriate antibiotic use, and improve patient outcomes.

PMID:41533376 | DOI:10.1001/jamanetworkopen.2025.53965